RIO GRANDE CITY, Texas — Jake Margo Jr. stood within the triage room at Starr County Memorial Hospital explaining why an individual with persistent fever who might be handled with over-the-counter remedy didn’t have to be admitted to the emergency room.
“We’re going to handle the sickest sufferers first,” Margo, a household drugs doctor, stated.
It’s not like there was area on that June afternoon anyway. A small monitor on the wall pulsed with the vitals of present sufferers, who stuffed the ER. An ambulance idled exterior within the South Texas warmth with a affected person ready for a mattress to open up.
“All people exhibits up right here,” Margo stated. “Whenever you’re overwhelmed and also you’re overrun, there’s solely a lot you are able to do.”
Starr County, a largely rural, Hispanic neighborhood on the southern U.S. border, made headlines in 2024 when it voted Republican in a presidential election for the primary time in additional than a century. Immigration and the financial system drove the flip on this neighborhood, the place roughly a 3rd of the inhabitants falls beneath the poverty line.
Now, current actions by the Trump administration and the GOP-controlled Congress have triggered a brand new concern: the lack of medical doctors, hospitals, and different well being suppliers to proceed to take care of uninsured sufferers. It’s a worry not solely in Starr County, which has one of many highest uninsured charges within the nation. Communities throughout the U.S. with equally excessive proportions of uninsured folks might battle as further residents lose well being protection.
About 14 million fewer People are anticipated to have medical health insurance in a decade because of President Donald Trump’s new tax-and-spending regulation, which Republicans dubbed the One Massive Lovely Invoice Act, and the pending expiration of enhanced subsidies that slashed the worth of Inexpensive Care Act plans for tens of millions of individuals. The brand new regulation additionally limits applications that ship billions of {dollars} to assist those that take care of uninsured folks keep afloat.
“You possibly can’t disinsure this many individuals and never have, in lots of communities, only a collapse of the well being care system,” stated Sara Rosenbaum, founding chair of the Division of Well being Coverage and Administration at George Washington College’s Milken Institute Faculty of Public Well being.
“The longer term is South Texas,” she stated.
KFF Well being Information is inspecting the affect of nationwide well being care coverage adjustments on uninsured folks and their communities. Although the Trump administration advised KFF Well being Information it’s making “a historic funding in rural well being care,” individuals who deal with low-income sufferers, in addition to researchers and client advocates, say current coverage selections will make it tougher for folks to remain wholesome. Docs, hospitals, and clinics that make up the well being care security web might lose a lot cash they need to shut their doorways, a few of them warn.
“As a result of the affected person’s invoice just isn’t going to receives a commission,” stated Joseph Alpert, editor-in-chief of The American Journal of Medication and a professor of medication on the College of Arizona. “Uninsured sufferers stress the well being care system.”
Starr County exhibits how this dynamic unfolds.
Main care medical doctors within the county serve a median of slightly below 3,900 folks every, almost 3 times the U.S. common.
Margo, the household doctor, stated as a result of so many individuals lack insurance coverage and there are so few locations to hunt care, many residents deal with the ER as their first cease after they’re sick.
In lots of circumstances, they’ve uncared for their well being, making them sicker and costlier to deal with. And federal regulation requires ERs at hospitals within the Medicare program to stabilize or switch sufferers, no matter their capability to pay.
That leaves Margo and his workforce to observe what he described as “catastrophe drugs.”
“They arrive in with chest ache or they cease respiration. They collapse. They’ve by no means seen a health care provider,” Margo stated. “They’re actually dying.”
Well being Techniques in ‘Survival Mode’
When persons are uninsured or on Medicaid, they have a tendency to depend on a security web of medical doctors, hospitals, clinics, and neighborhood well being facilities, which supply providers freed from cost or soak up getting reimbursed at decrease charges than they do treating sufferers on business insurance coverage.
These suppliers’ monetary conditions can typically be precarious, main them to depend on myriad federal helps. The Trump administration’s cuts to well being care and Medicaid within the identify of eliminating “waste, fraud, and abuse” have many involved they gained’t climate the extra monetary pressure.
Trump’s new regulation funds his priorities, like extending tax cuts that primarily profit wealthier People and increasing immigration enforcement. These prices are coated partially by an almost $1 trillion discount in federal well being spending for Medicaid throughout the subsequent decade and adjustments to the ACA, similar to requiring further paperwork and shortening the time for folks to enroll.
Many Republicans have argued Medicaid has gotten too massive and strayed from the state-federal program’s core mission of masking these with low incomes and disabilities. And the GOP has fought to roll again the ACA since its passage.
Kush Desai, a spokesperson for the White Home, stated projections from the nonpartisan Congressional Finances Workplace about how many individuals might lose medical health insurance are an “overestimate.” He didn’t present an estimate the administration sees as extra correct.
Supporters of the “One Massive Lovely Invoice” say those that want well being protection can nonetheless get it in the event that they meet new necessities similar to working in alternate for Medicaid protection.
And Michael Cannon, director of well being coverage research on the Cato Institute, a libertarian assume tank, stated even with the laws, Medicaid spending will develop, simply not as shortly.
The funds regulation gained’t trigger “the sky to fall,” Cannon stated. “The inefficient suppliers ought to be shutting down.”
A current survey from AMGA, previously the American Medical Group Affiliation, which represents well being methods throughout the nation, discovered almost half of rural amenities might shut or restructure because of Medicaid cuts. Practically three-quarters of respondents stated they anticipated layoffs or furloughs, together with of front-line clinicians.
Public well being departments, which frequently fill gaps in care, additionally face federal funding cuts which have decreased their capability. In South Texas’ Cameron County, the well being division has eradicated almost a dozen positions, stated company head Esmer Guajardo. In neighboring Hidalgo County, the well being division has laid off greater than 30 folks, stated Ivan Melendez, who helps oversee its operations.
In July, the Texas Division of State Well being Companies canceled Operation Border Well being, a large annual occasion that final 12 months supplied free well being providers to just about 6,000 South Texas residents.
Gateway Group Well being Heart in Laredo, a border metropolis north of the Rio Grande Valley, is in “survival mode,” with a couple of third of sufferers already missing insurance coverage and much more who will battle to afford well being care if the ACA subsides aren’t renewed, stated David Vasquez, its director of communications and public affairs. The middle is on the lookout for different types of funding to keep away from layoffs or cuts to providers, and its growth and hiring plans are on maintain, Vasquez stated.
That downsizing is going on as extra folks lose medical health insurance and want free or reduced-cost care.
Esther Rodriguez, 39, of McAllen has been out of labor for 2 years and her husband makes $600 every week working in development. Neither of them has medical health insurance.
Medicaid coated the payments for the births of her 5 kids. Now, she is dependent upon a cell well being clinic run by a neighborhood medical faculty, the place she will be able to pay out-of-pocket for routine checkups and medicines to manage her Sort 2 diabetes. If she wanted extra care, Rodriguez stated, she would go to the ER.
“It’s important to adapt,” she stated in Spanish.
‘Loss of life by a Thousand Cuts’
Folks’s incapacity to pay leads to uncompensated care, or providers that hospitals, medical doctors, and clinics don’t receives a commission for, which, underneath an earlier model of the megabill, was projected to extend by $204 billion over the subsequent decade, in response to the City Institute, a nonprofit assume tank.
However the Trump administration can also be reducing different help that helped offset the price of take care of individuals who can’t pay. The brand new regulation caps federal applications that many well being suppliers for low-income folks have come to depend upon, particularly in rural areas, to shore up their budgets. These embrace taxes on hospitals, well being plans, and different suppliers that states use to assist fund their Medicaid applications. Such supplier taxes are a “monetary gimmick,” Desai stated.
Whereas the regulation creates a brief $50 billion fund to help rural medical doctors and hospitals, that’s a bit over a 3rd of estimated Medicaid funding losses in rural areas, in response to KFF, a well being data nonprofit that features KFF Well being Information. Desai referred to as the evaluation “flawed.”
Any loss in income might spell monetary break, particularly for small rural hospitals, stated Quang Ngo, president of the Texas Group of Rural & Group Hospitals Basis.
“It’s type of like demise by a thousand cuts,” he stated. “Some will in all probability not make it.”
And the hits might maintain coming. The Trump administration’s funds request for the approaching fiscal 12 months requires cuts to a number of rural well being applications operated by means of the Well being Sources and Companies Administration. Desai stated the spending regulation’s funding in rural well being “dwarfs” the cuts.
In February, the Trump administration introduced funding cuts of 90% to the ACA navigator program, which helps folks discover medical health insurance. That program has been “traditionally inefficient,” Desai stated.
In December 2023, almost 3 million of Texas’ uninsured had been eligible for ACA subsidies, Medicaid, or the Kids’s Well being Insurance coverage Program, in response to Texas 2036, a public coverage assume tank.
Maria Salgado spends her workdays tabling at neighborhood occasions, dropping off flyers at medical doctors’ workplaces, and holding one-on-one conferences with purchasers of MHP Salud, a nonprofit that connects residents to Medicaid and ACA protection.
She fearful funding cuts would actually set the group’s efforts again: “Numerous neighborhood members right here, they’re going to be left behind,” stated Salgado, a neighborhood well being employee, or promotora.
Chris Casso, a main care doctor who grew up in McAllen and now practices there, held again tears as she described treating sufferers who’ve delay seeing a health care provider due to an incapacity to pay, solely to have their preventable situations deteriorate.
She worries about the way forward for her neighborhood as doctor shortages worsen, probably leaving few suppliers to deal with uninsured folks.
“It’s heartbreaking,” she stated, sitting in a small again room in her workplace in a suburban strip mall, wedged between a Kohl’s and a Shoe Carnival. “These are hardworking folks,” she stated. “They struggle their finest to handle themselves.”
Casso stated her personal sister, who labored as a medical biller in a doctor’s workplace, couldn’t afford medical health insurance. She delayed care and died at age 45 of issues from diabetes and coronary heart illness. Casso worries the long run will discover extra folks in related conditions.
“Our inhabitants goes to endure,” she stated. “It’s going to be devastating.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working applications at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Be taught extra about KFF.
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