Continued from October 27
Within days, the application was pulled down from the health department’s website. When it went back up about a week later, clinics that were working toward FQHC status could apply for as much as $1 million. The state health department told Public Health Watch that the change was made after the agency got “feedback from stakeholders.”
Robison quickly submitted the clinic’s application, and in early August he received an email granting the $1 million request. By the middle of the month, ETCC signed its contract with the state and began waiting for the first $50,000 to arrive.
Curran and Robison shared ETCC’s story at the annual Texas Primary Care Consortium summit in Austin. The idea was to inspire others to use their model — combining an FQHC with a medical residency program — to help close health care gaps in other parts of Texas.
But even Curran, a determined optimist, says Texas’ health care problems won’t be solved until the state’s political leaders prioritize health care for the poor. What ETCC is doing is important, but as far as statewide impact is concerned, Curran says “it’s like peeing in the ocean.”
“They’ve set up things that are hurtful to patients and that harm our state’s ability to really care for our people,” he said. “I think they’ve messed up.”
Expanding Medicaid would be a big step toward helping those people.
More than 1.4 million uninsured Texans would become newly eligible for coverage if Medicaid were expanded, according to data from the Kaiser Family Foundation. In Henderson County alone, about 4,700 residents would become eligible, according to the Houston-based Episcopal Health Foundation.
Hospitals and criticalneed clinics like ETCC would also benefit, because they would be reimbursed for more of the uncompensated care costs they now have to absorb. More rural hospitals have closed in Texas — 26 since 2010 — than in any other state, and expansion dollars could have saved at least some of them, said John Henderson, CEO of the Texas Organization of Rural and Community Hospitals. “We say we’re not going to expand Medicaid, but 38 states have and [Texans] help pay for it,” Henderson said. “We’re just exporting our health care dollars to expansion states.”
Texas’ resistance to broader coverage has left billions of federal dollars on the table.
The Perryman Group, a Waco-based firm that provides economic analysis, estimates that after a decade of Medicaid expansion Texas would reap net economic benefits of more than $319 billion.
“There’s a huge body of evidence out there that the state actually would make money off of it,” said Ray Perryman, the group’s founder, “so it’s a fiscally responsible thing to do.”
Perryman described the high number of uninsured Texans as “a human tragedy with profound consequences.”
Last year, state Rep. Lyle Larson, a Republican from the San Antonio area, authored a bill that would have put Medicaid expansion on the ballot, so voters could decide the issue. But it never got out of committee. When Democrats later proposed a state budget amendment to expand Medicaid, Larson was the lone Republican to vote with them.
“We’ve limited our access to health care because of political decisions,” Larson told Public Health Watch. “I think it’s the most fiscally irresponsible thing that you can do for the people that you represent.”
Beto O’Rourke, the Democrat who’s running for governor in November, has made Medicaid expansion a campaign promise. He calls it a “commonsense, fiscally responsible thing” to do and the “best shot” at turning around Texas’ health care access problems.
Abbott, who is running for a third term as governor, doesn’t mention Medicaid expansion on his campaign site, except to tout his record of opposing “ObamaCare.” In 2018, Abbott led an unsuccessful lawsuit to overturn the Affordable Care Act and in the past has described Medicaid expansion as “coercive” and “wrong for Texas.” Two emails to his campaign, asking for Abbott’s current position on Medicaid expansion, haven’t been answered.
While lawmakers argue, Curran, Mettetal and Robison are pushing ahead with their plans to make sure people in their patch of northeast Texas have access to health care.
Over the summer, they moved the Gun Barrel City clinic into a bigger building about a mile down the road. It has 12 exam rooms and can accommodate as many as 120 patients a day. An expensive-looking, stoneand- wood bench dominates the waiting room, the latest proof of Robison’s knack for finding a bargain. He got it for $300 from someone in Dallas and drove it home in a U-Haul along with other good finds.
By the end of 2023, they hope to open a third clinic in an empty church in Athens. Another group of local doctors — a different one this time — plans to buy the 7,900-square foot building and lease it to ETCC. The added space will allow them to serve more patients and meet the needs of their growing residency program, which now has eight doctors in training.
Curran and Mettetal still see patients two or three days a week, clocking ninehour shifts. They recently started taking small salaries, to help prove to the Health Resources and Services Administration that ETCC can sustain itself in the real world, where doctors get paid.
When they aren’t in the clinic, they’re often out with Robison, trying to persuade people to support their effort in any way they can. They’ve raised about $1.8 million in donations since 2019. As of last week, none of the state incubator or FQHC money had arrived.
On Friday, Robison got an email from the Health Resources and Services Administration, saying it was ready to schedule the FQHC site visit they’d been waiting for. But, like everything else in the application process, it wouldn’t happen fast. The dates the agency suggested aren’t until March 2023, six months away.
To keep things running smoothly through the winter, Robison is getting ready to ask ETCC’s three primary funders for another $500,000. The clinics are on track for about 25,000 patient visits this year, 10,000 more than they saw in 2021.
Disclosure: Episcopal Health Foundation, the Texas Association of Community Health Centers and the Texas Medical Association have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
This story is part of The Holdouts, a reporting collaborative focused on the 12 states that have yet to expand Medicaid, which the Affordable Care Act authorized in 2010. The collaborative is a project of Public Health Watch.
Kim Krisberg and David Leffler are contributing writers for Public Health Watch, a nonprofit investigative news organization based in Austin.
- Log in or Subscribe to post comments.