An expected increase in non -insured will be local health systems

Sam Whitehid and Renoka Rayasam

Rio Grande City, Texas-Jake Margo Junior stood in the sorting room at Star Memorial County Hospital explains why a person with a persistent fever that can be treated with the drug without a prescription to the emergency room.

“We will take care of most patients first,” said Margo, a family medicine doctor.

It is not as if there was an area in the afternoon of June anyway. A small screen on the wall vibrant for current patients, who filled ER. An ambulance outside in southern Texas with a heat with a patient waiting for the bed to open.

“Everyone appears here,” Margo said. “When you are drowned and overcome, there is a lot you can do.”

Star Province, a large -scale Spanish community on the southern American border, The headlines are issued in 2024 When I voted a Republic in presidential elections for the first time in more than a century. Immigration and economics Face In this society, nearly a third of the population is located below the poverty line.

Now, the recent measures conducted by the Trump administration and the Congress -controlled by the Republican Party have sparked a new source of concern: the inability of doctors, hospitals and other health services providers to continue caring for unlikely insured patients. It is a fear not only in Star Province, which has one of the highest unbelievable prices in the country. Societies throughout the United States with high levels can be similar to unconfirmed persons, as the additional population loses health coverage.

It is expected that about 14 million Americans will have health insurance for a decade due to President Donald Trump’s new law, which Republicans called the one beautiful bill, and ending the end of the outstanding subsidies that reduced the price of the patronage law at reasonable prices for millions of people. The new law also Dimens programs That sends billions of dollars to help those who are interested in unlikely insured people standing on his feet.

“You cannot destroy this many people and they have no, in many societies, just a collapse of the health care system,” said Sara Rosnabjam, head of an institution of the Ministry of Health and Administration at the Milkin College of Public Health at George Washington University.

“The future is southern Texas,” she said.

KFF Health News is studying the impact of national health care policy changes on non -insured persons and societies. Although the Trump administration told the KFF Health News it is “a historical investment in rural health care”, people who treat low -income patients, as well as researchers and consumer advocates, say that recent political decisions will make it difficult for people to remain in good health. Some warn of the money that their doors should disappear, and some warn that doctors, hospitals and clinics that make up a health care safety network may lose a lot of money that they must close their doors.

“Because the patient’s bill will not receive salaries,” said Joseph Albert, editor -in -chief of the American Medicine and Professor of Medicine at Arizona University. “The unbelievable patients confirm the health care system.”

Star Province shows how this dynamic is revealed.

The province’s primary care doctors serve a medium Shortly less than 3900 people Each, approximately three times the average United States.

Margo, the family doctor, said that many people lack insurance, and there are few places to seek care, and many residents deal with their first station when they are sick.

In many cases, they neglected their health, making them more ill and more expensive for treatment. and Federal Law Eers requires hospital in Medicare to achieve stability or transfer patients, regardless of their ability to pay.

This leaves Marjo and his team to practice what he described as “disaster medicine”.

“They come with chest pain or stop breathing. They are collapsing. They have never seen a doctor.” “They are literally dying.”

Health systems in “Survival”

When people are not insured or medicaid, they tend to rely on a safety network of doctors, hospitals, clinics and community health centers, which provide free services or absorb compensation at lower rates of patient treatment for commercial insurance.

The financial positions of these service providers are often unstable, which leads to relying on countless federal support. The Trump administration’s discounts for health care and a doctor in the name of eliminating “waste, fraud and abuse” have a lot of anxiety because it will not overcome additional financial pressure.

Trump’s new law finances its priorities, such as extending tax cuts that mainly benefit the wealthy Americans and expand the enforcement of immigration. These costs are partially covered by reducing nearly a trillion dollars in federal health spending on Medicaid over the next decade and ACA changes, such as ordering additional papers and shortening time for people to register.

Many Republicans have argued that Medicaid has become very large and has been struck by the main task of the government program of covering those with low incomes and disability. The Republican Party has fought the ACA retreat since its passage.

The White House spokesperson, Kush Disai, said that the expectations of the non -party Congress budget office about the number of people who could lose health insurance are “exaggerated”. He did not provide an estimate, as the administration sees more accurate.

“Those who need health coverage can still get it if they meet new requirements such as work in exchange for medicaid coverage.

Michael Canon, director of health policy studies at the Kato Institute, a Libertari research tank, even with legislation, said the spending on the one will grow, not quickly.

Canon said that the budget law would not cause the “sky”. “Inentity service providers must be closed.”

A recent survey study From AMGA, the American Medical Group Association previously found health systems across the country, that nearly half of the rural facilities can be closed or restructured due to medicaid discounts. Nearly three quarters of the respondents said that they expected to lay off workers or leave, including the front lines doctors.

Public health departments, which fill gaps in care, face federal financing discounts that have reduced their ability. The head of the agency, Azram Ghatwado, said that the Ministry of Health had canceled nearly ten positions. “The Ministry of Health has registered more than 30 people.

In July The boundary health process has been canceledA huge annual event that provided free health services last year to nearly 6000 of the population of South Texas.

David Vaskuiz, Director of Communications and Public Affairs, said that the Gateway Community Center in Lardo, a border city north of the Rio Grande Valley, in “Survival Status”, with about a third of patients who already lack insurance, and even more than they will fight to afford health care costs if ACA is not renewed. Vasquiz said that the center is looking for other forms of financing to avoid the demobilization of workers or discounts in services, and that expansion and employment plans are suspended.

Reducing its size occurs as more people lose health insurance and need free or low -cost care.

Esther Rodriguez, 39, of McACALEN, was unemployed for two years and her husband achieved $ 600 a week in construction. None of them has health insurance.

Medicaid covered bills to give birth to her five children. Now, it depends on a mobile health clinic run by a local medical college, where it can pay outside the pocket to perform routine tests and medicines to control type 2 diabetes. Rodriguez said, if she needs more care, then she will go to ER.

“You have to adapt,” she said in Spanish.

“Death with a thousand pieces”

People’s inability to pay the results in non -rewarding care, or services that hospitals, doctors and clinics do not receive, which are expected to increase under a previous version of the huge by 204 billion dollars over the next decade, According to the urban instituteNon -profit research tank.

But the Trump administration also reduces the other support that helped compensate for the cost of care for people who cannot pay. New law Federal program capsules Many health service providers for low -income persons, especially in rural areas, are adopted to support their budgets. These taxes include In hospitals, health plans and other service providers that the states use to help financing their Medicaid programs. Desai said that these saving taxes are a “financial fraud.”

While the law creates a temporary fund worth $ 50 billion to support doctors and rural hospitals, this is slightly more than a third of Medicaid financing losses in rural areas, According to KFFIt is a non -profit health information that includes KFF Health News. Desai called the analysis “defective”.

Queen, head of the Texas Foundation for the Rawiya and Community Hospitals, said that any revenue loss can spoil the financial ruin, especially for small rural hospitals.

“It is like death with a thousand pieces,” he said. “Maybe some will not make it.”

The strikes can continue to come. The Trump administration’s budget request for the next fiscal year calls for discounts to multiple rural health programs that work through health resource and services management. Desai said that the investment of the “Dwarves” spending law in rural health.

In February, the Trump administration announced 90 % financing discounts for ACA Navigator, helping people find health insurance. Desai said this program is “historically ineffective.”

In December 2023, approximately 3 million unbelievers were insured from Texas qualified to obtain ACA or Medicaid benefits or children’s health insurance program, According to Texas 2036Thought reservoir in public policy.

Maria Socado spends working days to present them in the community’s events, flyers fall into doctors ’offices, and hold individual meetings with MHP salud agents, a non -profit organization linking residents to cover Medicaid and ACA.

“I was concerned that the financing discounts would restore the organization’s efforts:” Many members of society here will leave behind, “said Salvo, a health worker. Public Prosecutor.

Chris Caso, the primary care doctor who originated in McClic and March now there, retreated to tears when she prescribed the treatment of patients who were late in seeing the doctor due to the inability to pay, only for the deterioration of their preventive conditions.

She worries about the future of her community Doctor shortage gets worseIt is possible that a few service providers will be left to treat non -insured persons.

“It is a sad thing,” she said in a small background in her office in a commercial center in a suburb, installed between Colls and the shoe carnival. “They are doing their best to care for themselves.”

Caso said her sister, who worked as a medical hall in the doctor’s office, could not afford health insurance costs. The care was delayed and died at the age of 45 of the complications of diabetes and heart disease. Caso fears that the future will find more people in similar situations.

She said, “Our residents will suffer.” “It will be destroyed.”

KFF Health News It is a national news room that produces in-depth press on health issues and is one of the basic operating programs in KFF-independent source of health policy research, polling, and journalism. Learn more about KFF.