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

Cheryl Clark, for HealthLeaders Media, August 12, 2009

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."

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