Access to health care improves, but unevenly, report says

While access to health care and insurance coverage has improved in the United States, troubling gaps persist in Texas and across the country that have been toughest on poor Americans, according to a major report on the nation's health care system.

Released Thursday, the Commonwealth Fund's 2016 Local Healthcare Scorecard reviewed 306 population centers, including 20 in Texas, to gauge the availability and quality of care, costs, obesity rates, repeat hospitalizations and insurance coverage.

Although most communities in the study showed some improvement, in many instances, researchers found progress was lackluster. In some places, health care declined. Wide disparities stretched between states and even within the same state, like Texas.

For example, the city of Bryan saw its overall ranking drop from 160 in 2012 to 233 this year. The study found higher instances of obesity, breast cancer and colorectal cancer as well as an increase in the unnecessary emergency room visits and hospital readmissions.

Despite drops of 3 to 5 percentage points in uninsured rates, about one in four residents in Houston, Dallas and San Antonio lack health coverage.

In parts of the Rio Grande Valley, one of every two people have no health insurance.

Sonia Shafer lives in the Rio Grande Valley town of Pharr, about 3 miles from McAllen, where 49  percent of the population is uninsured.

In February 2015, her 46-year-old sister, Irma Casarez, stumbled into the emergency room of the local hospital with unexplained bleeding and in terrible pain.

The doctor diagnosed cervical cancer, a type of cancer with one of the highest survival rates, Shafer said. But Casarez didn't have insurance or the $5,000 to pay for the treatment. So she was sent home.

A month later, she went to another hospital, where she was finally admitted as an emergency. Doctors found the fast-moving cancer had worsened. On May 7, she was dead.

"Not having insurance and not having money killed her," Shafer said.

'Long way to go'

The Commonwealth Fund's study is a follow-up to a report done in 2012, two years after the passage of the Affordable Care Act. The results, culled from data from 2014 and 2015 and compared to 2012, measure the state of the nation's health care system in the early days of the health reform law.

"There's still a long way to go," said David Radley, the study's co-author.

Texas is an example of progress, disappointments and challenges ahead for health care reform, Radley said.

A recent study by the Centers for Disease Control and Prevention found that the uninsured rate in Texas stood at 16.8 percent at the end of 2015, down from 26 percent in 2010, when the Affordable Care Act became law.

But Texas still has 5 million uninsured, the most in the nation.

Poverty remains a factor in the rates of uninsured. In Texas, half of the 20 places studied had 40 percent of the people living in poverty or near poverty.

In the Rio Grande Valley, more than 1 in 3 are poor, said Amber Arriaga-Salinas, director of public relations for Proyecto Azteca, a nonprofit that helps build housing for the poor in San Juan, not far from McAllen.

'We just stick it out'

"If we get sick, we just stick it out," she said.

She said her group did its own recent door-to-door survey of 500 people and found the vast majority did not have insurance.

In addition, the few who had tried to sign up for insurance through the Affordable Care Act's federal exchange for coverage usually abandoned the effort because they did not understand the process or know how to use insurance, she said.

It is not uncommon for people to hold fundraisers such as car washes and barbecue dinners at $6 per plate to pay for cancer care, Arriaga-Salinas said.

At local flea markets, some people buy blood pressure pills or antibiotics brought over the border from Mexico.

She said those who are eligible for insurance but do without are in the country legally.

Radley said such stories out of South Texas "paint a bleak picture."

He said the Texans of the Rio Grande Valley are among those who presumably could have been covered had Texas expanded its Medicaid program to cover more low-income people, as encouraged by the Affordable Care Act.

Texas is one of 19 states where leaders have refused to expand Medicaid, arguing that the federal safety-net system is broken and should not be widened. Former Gov. Rick Perry called it a states' rights issue that the federal government should not meddle in. Gov. Greg Abbott's office declined to comment on Wednesday.

Puzzling development

While the Commonwealth Fund report found progress, albeit uneven, in reducing the rate of uninsured, it came across one puzzling development. Even as more people have gained insurance, many went without a consistent provider, such as a primary care physician.

In Houston, for example, a city known for its state-of-the-art medical facilities, the number of people with a regular provider dropped from 70 percent to 67 percent.

"It seems to be a common occurrence. We don't know why," Radley said.

Radley speculated it might be that newly insured people never had a doctor before and did not know how to find one.