Texas Politics

In the most uninsured state in the U.S., Texans of color hit hardest by medical debt

In the state with the highest uninsured healthcare rate nationwide, Texans of color are hit with medical debt the hardest, a report published Thursday found.

According to a report from the Center for Public Policy Priorities, a think tank in Austin, Texas consumers in neighborhoods of color are disproportionately affected by medical debt with 29% saddled by it compared with 23% of consumers in white neighborhoods.

The overall median medical debt in collections owed in Texas is $850, and Texans of color owe a slightly higher median of $875. According to the report, that’s 22% more than the national median share owed by Americans of color at $720.

The report pointed to a variety of factors that contribute to increased debt for Texans of color, noting the income gap between white and minority households and disparities in health insurance coverage.

White Texas households earn an average of $34,541 more per year than Texans of color, according to the report.

Arthur Mora, an associate professor and chair of the Health Behavior and Health Systems Department at the University of North Texas Health Science Center’s School of Public Health, said he’s not surprised to hear those numbers.

“This is just one manifestation of a larger income inequality issue,” Mora said.

“Without adequate health insurance they have to bear more of the cost of healthcare, and healthcare is really expensive,” Mora said. “They fall in what we call, the coverage gap, where they don’t qualify for Medicaid. But they’re also not receiving healthcare, nor are they receiving any sort of subsidies to purchase healthcare, and so it becomes a much more burdensome problem for them.”

And that problem can spiral, causing health issues to go undiagnosed or untreated. People may have to miss work because of health problems — therefore losing income to stay afloat of medical debts — or pay higher fees to get an issue addressed later when it may require more treatment.

The cost of healthcare has real effects, with about half of adults surveyed in a March 2019 poll by the non-partisan Kaiser Family Foundation, reporting that they or a family member put off care due to the costs, and about 13% of those saying their condition worsened as a result.

The report calls on states to expand federal healthcare coverage and institute guidelines to ensure financial assistance policies are in place for patients who need it the most.

For Texans struggling with affordable healthcare, Mora recommended seeking out community-based health centers that often offer services on a sliding scale based on a patient’s income.

U.S. Census Bureau figures released last week found that the number of people without health insurance at any point during the year increased to 27.5 million in 2018, or 8.5 percent of people, from 25.6 million, or 7.9 percent of people, in 2017.

And Texas topped the rest of the country, once again the state with the highest rate of uninsured residents at 17.7% — a little over 5 million people — and nearly double the national average of 8.9%. It was the second year in a row that Texas’ uninsured rate has risen, with about 4.8 million Texans without health insurance in 2017, according to the Census Bureau’s report.

And racial disparities persist in insurance rates too, according to CPPP’s report. In a state that is growing increasingly diverse, 13 percent of white Texans are uninsured, while nearly 18 percent of African-American Texans and 29 percent of Hispanic Texans do not have health insurance.

“Over half of all uninsured Hispanics in the United States live in Texas, which makes achieving racial equity in healthcare coverage and access all the more important if we aspire to be a prosperous state where people of all backgrounds reach their full potential,” the report read.

And on a county level, those disparities still exist. Based on 2017 data, 16% of residents were uninsured in Tarrant County with a 14 percentage point disparity in the non-white uninsured rate over white uninsured rate. While 9.3% of white residents were uninsured, Hispanic residents saw a rate three times as high, with 28.3% uninsured.

African-American residents were uninsured at a rate of 17.1%, American Indian/Alaska Native residents at a rate of 19.5% and people of two or more races at a rate of 12.2%.

Southlake church reaches out

Rev. Sam Robbins and the youth of White’s Chapel United Methodist Church in Southlake saw the burden medical debt can have, and have been raising funds to forgive $1.5 million of it in Tarrant and Dallas counties. Through everything from car washes to a chili cook-off, they’ve raised about $12,000 out of their $15,000 goal, Robbins said.

“Not only do people have their debt forgiven, but you hope that that helps them sleep better at night and it helps their mental health,” Robbins said. “And it helps them hopefully to be able to get out of the rent race.”

Partnering with RIP Medical Debt, a nonprofit that buys back medical debt across the country, on average every $1 will go toward erasing $100 in medical debt through the purchase of bundled portfolios.

And the organization specifically alleviates the debt of those who earn less than two times the federal poverty level, whose debts are 5% or more of their annual income, or whose debts are greater than their assets, according to the group’s website.

Costs of surgeries to ambulance rides are a need everyone can understand, Robbins said, and the fundraiser, which ends in October, is an immediate way to try and help the church’s neighbors.

“Division in our country is at an all time high,” Robbins said. “And people are drawing lines everywhere and putting labels on everything. This is one of those ways that we as a church in an affluent area, can reach out and say, ‘Hey, you’re one of us.’”

While state lawmakers passed laws this past legislative session that aim to create a temporary high-risk health insurance pool, provide relief from surprise medical bills, and more, they failed to expand Medicaid under the Affordable Care Act.

Texas is one of 14 states that have yet to do so, and the Census Bureau report found that in states that expanded Medicaid eligibility, the uninsured rate in 2018 was 6.6%, compared with 12.4% in states that did not.

And Texas is currently leading a lawsuit that has the potential to shake up the nation’s healthcare system by striking the ACA in its entirety.

Ending the act, often referred to as Obamacare, would eliminate protections for those with pre-existing conditions, such as pregnancy, arthritis and diabetes. A little over 1 million Texans signed up for insurance through the ACA last year. The case is likely headed to the U.S. Supreme Court.

“The more pieces and parts that get stripped away, the less likely it is that those that need health insurance the most are going to have access to healthcare,” Mora said of the act.

Related stories from Fort Worth Star Telegram

Tessa Weinberg is a state government for the Star-Telegram. Based in Austin, she covers all things policy and politics with a focus on Tarrant County. She previously covered the Missouri legislature where her reporting prompted an investigation by the Attorney General’s office. A California native and graduate of the University of Missouri, she’s made her way across the U.S. and landed in Texas in May 2019.