Many In Rural Communities Aren't Insured and Live Far From Health Providers

With all the week's ranting in town halls about what health reform will or won't do for Americans, I kept thinking about what the U.S. Census revealed last week about some parts of rural America.

The bureau's simple Excel chart showed for each county across the country just how many people under age 65 have no health insurance. No Medicare, no Medicaid, no Veteran's Administration benefits. And of course no private commercial coverage either.

So there they are. Of the 10 counties with the highest rates of no insurance, eight are in Texas, and the worst is Terrell County, just above the Mexican border. There, 46.9% of all adults not old enough for Medicare coverage have no health coverage of any kind. Terrell was followed by Edwards County, two counties to the east, where 45.9% had no insurance of any kind.

I wasn't able to reach anyone in Edwards or Terrell Counties but I had more luck with the third highest county, Hudspeth on the westernmost edge of Texas just east of El Paso. Hudspeth has 3,137 people. My call took me to the Hudspeth County Courthouse and to Alma Bustamante, assistant to County Judge Becky Dean-Walker in Sierra Blanca.

Turns out, Bustamante also serves as the county's indigent health coordinator and was the right person to find to learn about Hudspeth County healthcare.

"We had a (county-funded) clinic, but three months ago it was shut down," she says, apparently because there wasn't enough money to keep it going.

"Just as we speak," she continues, "county commissioners are convening to decide whether to keep it open. But it doesn't look very promising."

So that means that for those who qualify for the county's indigent program, she must help them get that care somewhere else, usually in El Paso or Culberson County, 30 miles away.

"Healthcare in the U.S. is more of a privilege than an essential thing in our country. That's my opinion," she says. "If you don't have the right job with insurance, you're not going to have insurance. It's a luxury."

In Hudspeth County, particularly Sierra Blanca, jobs with insurance are those like hers, with the county, or with the school system or prison. Getting a job with the U.S. Border Patrol will get you health covered too. But some programs won't cover spouses, and some require copayments or have high deductibles. It's not easy, she says.

Farmers and ranchers in the area, generally speaking, don't have coverage, she says.

Now, the pervasive problem in Hudspeth County, like many other counties in Texas and throughout the U.S., is diabetes. And there aren't many doctors who will treat patients with no health insurance these days, she says. There were one or two from El Paso, but, she says, "they come and go."

Most often, she says, patients "just end up in the emergency room" of a hospital in another county. "They're routed to a doctor that way. And I know that's not the best way to provide healthcare. It's more expensive."

Bustamante then tells me about her mom, who lived with Bustamante's older sister, who had an income and insurance.

One year, her mother needed surgery for a hernia that was causing her pain, and so she applied for Medicaid. "But my sister had a new van, and that disqualified my mom from getting Medicaid. If she would have sold the van, my mom would have qualified. Isn't that the craziest thing you ever heard?"

Her mother refused to go to the doctor because she didn't want to burden her sister.

She died in 2002 at age 65.

And her sister now has diabetes that has progressed to the point that she is on the liver transplant list. Soon, Bustamante says, her sister will move to El Paso to be close to the hospital when an organ becomes available.

By the end of August, however, she's being forced to retire from her job, and there's a question about whether she will still have health coverage, or whether she and Anna Bustamante will be able afford its copayments and premiums.

I asked Alma Bustamante what she thought about the progress made toward health reform in Congress and the President's speeches pushing for a public plan.

She said she really hadn't kept up with the details. "I really don't know much about it. I've heard something about it, but I can't really tell you much."

For Bustamante, I suppose, this is the way it is. Like she said, healthcare in the U.S. is more of a privilege than it is essential, at least for people in her part of west Texas. "Healthcare is a luxury," she tells me.

I wondered what the people railing against health reform in the town hall meetings might think if they just made a call to a little town like Sierra Blanca in Hudspeth County.