Published 02/01/04
The Galveston Daily News
By Sarah Viren

“They asked me for money, and I said ‘I am sorry I don’t have it,’” said the 45-year-old, who came to the clinic for stomach pains. “Usually when I get sick, I go to Mainland (Medical Center), and I owe them beau coups of money already.”

As an uninsured woman, one of the about 8,000 the clinic served last year, Morgan does not take her access to medical care lightly. Everything is a calculation, from the $4.50 cab ride to get to the doctor, to the collection of documents she must provide each year to continue receiving sliding-scale prices.

She’s not alone. Although it is often easier for women — especially women with children — to qualify for government coverage programs such as Medicaid, women are often the ones struggling to get health care, said Dr. Ben Raimer, of the Galveston County Health Access Program.

“The profile is an uninsured female with children who is working,” he said. “We have a large number of mothers, mostly single mothers, that are uninsured.”

At the County Coordinated Community Clinic, or 4Cs clinic, in Texas City, Susan Studebaker, deputy director of clinical services, said 4,000 more women than men came for health care services last year. About 90 percent of the patients at the 4Cs clinic, which is funded by the county and federal government, are uninsured.

Many of them are women like Morgan. She doesn’t work and her husband’s job as a cab driver barely pays the bills. They’ve been uninsured as long as she can remember.

Although she struggles financially, Morgan’s income is too high for her to qualify for Medicaid or the county’s indigent health care program. So the emergency room becomes her doctor, the 4Cs clinic her primary physician.

Galveston County has one of the highest rates of uninsured in Texas; the state ranks at the bottom in the nation for this same statistic.

Although there is no central registry of the uninsured, Raimer said about 55,000 to 85,000 people lack health insurance in the county.

Only 900 qualify for the county’s indigent care insurance program, which requires that patients make no more than 21 percent of the federal poverty threshold, or $1,900 a year. An estimated 20,000 visit a 4Cs clinic for primary care, Raimer said.

The rest either go without or depend on the emergency room for medical attention. And this isn’t cheap — for the taxpayers or the hospitals.

This year the county has budgeted $2.1 million to fund indigent secondary and tertiary care — things such as specialist care and extended hospital stays. Even with this assistance, local hospitals lose millions on unreimbursed health services each year.

“We still have a significant number of people that are accessing their health care through the emergency room and, for those people who are uninsured, our hospital ends up absorbing those costs,” said Harold Fattig, director of community relations for Mainland Medical Center.

Last year that hospital reported $28 million in unpaid bills. About 40 percent, or $11.2 million, is the actual value of that care, according to Scott Bentley, chief financial officer for the hospital.

Twice in the past three years, the county and a local health care task force have tried to get state legislative approval for a sales tax hike to help fund indigent health care services. The measure has failed both times.

Recent cutbacks in the Medicaid and Children’s Health Access Programs now make it harder for people to get coverage. This means even more uninsured — many of them women and children.

Bentley said the burgeoning number of uninsured, coupled with the rising costs of health care, is putting a bigger and bigger burden on health care providers.

“It’s gone up fivefold in the last seven years,” he said. “The more expensive health care gets, the more uninsured there are.”

Rosie Morales is 58, has diabetes and is part of this growing statistic. Morales lost health coverage in 1999 after osteoporosis, and several broken bones, forced her to leave her job at a Kroger grocery store. Although her husband could get insurance through his jobs as a concrete finisher, they can’t afford the premiums. Like Morgan and her husband, the Moraleses make too much money for government-subsidized insurance.

But they need health care. In 1998, Morales was diagnosed with diabetes; her husband has been living with the same disease since 1993.

After she lost her job, they went a full year before they heard about the 4Cs clinic. In that interim they had no health care at all. It was killing them.

“He and I both got so sick we were almost dead,” Morales said. “It took my doctor almost a year to get my diabetes under control.”

Through the Texas City clinic the Moraleses now pay $12 for each doctor’s visit and $10 for medicine. The reduced cost makes a big difference for the couple, who need about $2,000 in medicine each month.

But Morales said there are times she still can’t pay the bills. “It makes you feel really bad because a lot of times even as cheap as I get medicine, I don’t have the money to pay,” she said after a visit to the 4Cs clinic last month. “Today I needed five bottles and I didn’t have the money.”

Being uninsured is more than just a monetary problem. For those who lack coverage, it often feels like a social stigma as well.

“It’s very embarrassing having people help you, not being able to pay your doctor,” Morales said. “I get so embarrassed sometimes I don’t feel like going (to the clinic) anymore, but I know if I don’t I will get sicker.”

A lot of the uninsured women Studebaker sees each day at the clinic are employed, but either part-time or in the service industry. These jobs usually don’t provide coverage.

Through the health care access program he heads up, Raimer is working to get small businesses to offer health care coverage to their employees.

“We are going to look at everything we can to increase access to health insurance,” he said. “But we sure need a strong partner with the business and the community.”

Studebaker said coordinated efforts between government entities and nonprofits is also vital to alleviating current problems.

The D’Feet Breast Cancer organization, for instance, funds free mammograms for women. Last year, with their support, the clinic gave 750 women these exams.

Morales said a big help for her has been the diabetes support group at the clinic. It makes her feel less alone as an uninsured woman, she said.

“There is a lady there now who was in my same situation,” Morgan said last month after a visit to the Texas City clinic. “We were just talking about it. It helps to talk.”