'Patients want equity': Hispanic uninsured rate among worst in U.S.

BySarah Rafique KTRK logo
Friday, October 1, 2021
Here's why Hispanic Houstonians go without insurance
When looking at the top 100 cities in the U.S., the Houston area has the 13th worst rate of uninsured Hispanics.

HOUSTON, Texas (KTRK) -- Whenever her blood pressure starts rising, Vivian Franco can feel her body shaking and sweating and her head starts to hurt.

She knows the symptoms well, but even when they keep lingering on, Franco said she doesn't call the hospital or go to her doctor. She just waits it out.

"I don't have the money to go to the doctor. I won't go. I won't even go to the emergency room because then you have that big bill from the emergency room where they just took your blood pressure and said, 'Oh, go take this' and they bill you like six, seven, $800," said Franco, an uninsured Hispanic who lives in southeast Houston. "I can't do it. So I just stay away."

In the Houston-The Woodlands-Sugar Land metro area, the uninsured rate among minorities is nearly three times the rate of uninsured white residents. It's even worse for Hispanics, whose uninsured rate is four times that of white residents.

The Equity Report, a project by our ABC data journalism team, found 30.6% of Hispanics in the Houston metro area are uninsured compared to just 8.3% of white residents who are uninsured. When looking at the top 100 cities in the U.S., the Houston metro area has the 13th worst rate of uninsured Hispanics.

INTERACTIVE: When looking at the top 100 largest cities in the U.S. the Durham-Chapel Hill metro area in North Carolina has the worst uninsured rate among Hispanics, with 34.9% that are uninsured. In the Houston metro area, twice as many Hispanics are uninsured than in the New York-Newark-Jersey City metro area and Los Angeles-Long Beach-Anaheim metro area. Explore the map below to see how Houston compares to others. On mobile device? Click here for a full screen experience.

Marcie Mir is CEO of El Centro de Corazón, a federally qualified health center that provides comprehensive primary care dental, behavioral and women's health services in the East End of Houston. She said 94% of their patients are Hispanic and 89% live at or below the federal poverty level.

"Insurance is so expensive and when you look at our particular patient population, there are so many other needs that they have, you know, rent, food, school supplies, that buying health insurance is just a luxury," Mir told 13 Investigates' Ted Oberg. "It is something that just goes by the wayside at times."

MORE: Our America Equity Report

Health experts we spoke with say residents without insurance, or a primary care physician, miss out on annual, preventative care, leaving them at risk of not finding high-risk illnesses until it's too late. They could also rely on emergency rooms, taking time and beds away from people experiencing true emergencies.

"When you look at a woman who doesn't have health insurance, doesn't know where she can go to get affordable health care, who knows how long it's going to take before she gets a mammogram, and by the time she gets a mammogram and then she's diagnosed with breast cancer, it could be stage three, stage four," Mir said. "If she would have had insurance, then she probably would have been able to have that mammogram on an annual basis."

'No help for us'

Franco said she would want health insurance if it was affordable. Although she works in retail, she said doesn't work the 40 hours a week needed to qualify for insurance through her employer.

Within the last few years, after getting laid off during the pandemic and then starting another job again, she's applied for Medicaid three times, but said she was denied every time for making slightly more than the poverty level and household size needed to qualify.

Franco said she's looked into getting private health insurance, but whenever she was quoted $200 a month by one possible carrier, it scared her away.

"It's hard after you've been denied," Franco said. "It's always like, 'Well, I know I'm not going to get it, but let me just try.'"

Franco said her children, who are in their 20s, also don't have insurance. When we asked her why she thinks the uninsured rate among Hispanics is worse than other demographics in the Houston area, she said she sees that her Hispanic family and friends also don't have insurance but doesn't know why it's harder for them.

"I wish I had an answer for it. I wish I did, but I sit here and think, I don't know. I really don't, but I see it a lot," she said. "It's like there's no help for us, nowhere through the system, through Medicaid, Medicare."

INTERACTIVE: Want to know how many residents are uninsured in your county? Explore the map below. The darker counties have a larger inequity gap, where more Hispanics are uninsured compared to white residents. On mobile device? Click here for a full screen experience.

Mir said more than half of their patients, like Franco, are uninsured. About 90 to 95% of their uninsured patients are adults.

One reason could be because undocumented adults whose children were born in the U.S. qualify for Medicaid or CHIP, the Children's Health Insurance Program, while the parents would not qualify themselves due to their status.

Still, Mir said adults who are undocumented or are in the middle of their immigration process could be fearful of providing the information needed to get their U.S-born children health insurance through federal programs for low income residents. She doesn't think it's just status that has driven the Hispanic population to have higher uninsured rates.

For many low-income residents, health insurance is too costly and they take on the mindset that "I'll just go to the doctor when I get sick. I don't need to get health insurance," Mir said.

"We still have so many communities, especially communities of color, that are just underserved and in need of resources to just provide for healthier lifestyles and just healthier community," she said.

'Patients want equity'

The El Centro de Corazón Magnolia Center is surrounded by parks, elementary schools and houses in the Greater East End.

Just a few miles east is the city's renowned medical center, yet the services can be out of reach for Houston's uninsured.

"Coming over here and being able to see the world's largest medical center and not be able to access it, it became very real," said Dr. Kavon Young, a Houston native and medical director at El Centro de Corazón. "To think that you're miles away, but you can't go there for so many reasons. It's sad. It might as well be on the other side of the world."

Young said one way Texas could make sure more residents have health insurance is by expanding Medicaid.

Texas is one of 12 states without expanded Medicaid coverage, according to the National Conference of State Legislatures, a bipartisan organization. In Texas, Medicaid currently provides coverage to residents who qualify based on their income and household size.

Expanded Medicaid coverage would allow residents to qualify solely based on if their income is below the federal poverty level.

"Our patients want equity," Young said. "A lot of our patients work in industries where employment-based insurance is not available to them. Private insurance is too expensive. Patients are unaware at times of things that are available to them."

Expanding Medicaid in Texas would have allowed more than 1.4 million uninsured adults to qualify for coverage, most of them minorities, according to the Kaiser Family Foundation, a nonprofit that provides information on health issues across the nation.

Of those 1.4 million uninsured residents, 80% are in families where at least one person is employed and 70% live below the poverty level. The foundation's data shows that 75% of Texans who would become eligible under expanded health insurance are minorities - 830,000 of them are Hispanic.

Franco, who said she makes $100 too much every paycheck to qualify for Medicaid, hopes lawmakers can find a way to provide reliable health care to anyone who needs it.

"We're human, just like they are. We struggle, I'm sure, just like they do. We just need that little extra. Even if it was a hundred dollars, it's still a help," she said. "If you can't help me, then help somebody else."

'Bring people to tears'

Mir said education and outreach within the community is an important part of what they do, so residents who need health care know they can visit their facility or others like it instead of going to an emergency room.

"The problem with our patients utilizing the emergency room is, a majority of the time, what they're going to the emergency room (for) can be seen in by the primary care physician, so we're driving up costs, we're taking up room for those true emergencies and it just isn't the place for our patients to be seen," Mir said.

But, without insurance and yearly visits, Young said by the time patients come to them, sometimes their illness is already in an advanced stage.

Young is also an advocate for her uninsured patients because without insurance, she said it could take anywhere from three to nine months to get into a specialist for the necessary evaluation or testing their facility doesn't provide.

Young works nearly 12-hour days, spending her lunch hour eating a quick bite at her desk while making calls to providers or catching up on paperwork.

"It's never a slow day. It's patient after patient and one of the challenges with being a provider now is that you are more than the provider. We are talking on the phone to the pharmacist to try to see which medication is going to be cheaper. ... It's trying to figure out transportation. If I need to get that patient to specialty care, it's working with the referral specialists trying to figure out where there's a place for them to go and how much is the private cost of that," Young said. "It's more than just writing a prescription. It's listening first and foremost."

Even if she had insurance, Franco said she would continue going to El Centro because she's been seeing doctors there ever since she was 14 years old.

But, without insurance, she might not seek emergency care the next time she feels her blood pressure rise and her body start to shake. Instead, she's hoping it doesn't turn into something more serious.

"It's very frustrating," she said. "It just brings people to tears."

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