In my last blog post, I discussed what factors influence the health of Houstonians. This time, I will present some factors that determine who has access to certain healthcare-related resources and who does not.

Before I dive in, I would like to mention a few statistics that will help you get a better sense of the overall access to health in Houston. In 2017, Harris County indicated that 24.3% of adults were unable to afford to see a doctor sometime in the past 12 months. Unfortunately, it seems like this percentage has only continued to increase since 2014. When people do not have the financial means to see a doctor, there is a high chance they are not receiving proper medical services allowing a greater opportunity for adverse health outcomes, conditions to go untreated or undetected, and missed diagnoses. Without the proper financial means, one is less likely to get routine checkups and screenings and end up seeking treatment for illnesses once it’s a bit too advanced which, unfortunately, causes it to be more costly and difficult to treat. Low-income people are less likely to have insurance as well which often results in more ER visits rather than seeks a primary care physician.

For the same year, 67.9% of adults had a routine check-up in the past year. Routine check-ups are essential to maintaining good health but, although the percentage is 0.2% higher than the 2016 percentage indicating an increase, Houston’s percentage remains lower than the country’s value (70.6%).

The state of Texas is also one of only 14 states that chose not to expand Medicaid even under the Affordable Care Act (ACA) despite strong support from Texans. Because of this, many uninsured people have had to remain uninsured due to the high cost of insurance. According to understandinghouston.org, in 2017, 20.4% of the population in Harris County had no health insurance. When compared to the percentage for the entire state of Texas (17.3%) and the country’s percentage (8.7%), Houston has a significantly higher percentage of its population that is uninsured. An even more shocking fact is that the uninsured rate amongst children is more than double the national average. A total of 184,301 children in Houston didn’t have any type of health insurance coverage in the year 2017 meaning that the rate of uninsured children (those under 19) was about 11% while the US average was only at about 5%. According to understandinghouston.org, Texas has the highest number of uninsured children in the country with Hispanic children having the highest uninsured percentage (15.9%). Almost three times the rate of White children!

The fact that the percentages vary depending on one’s racial/ethnic group speaks a lot for Houston. Recall that in my previous blog post, I mentioned how diverse Houston is. Well, regardless of Houston’s diversity, Blacks and Hispanics still have lower health insurance coverage and access to primary care. For those who are uninsured, the uninsured rate amongst all Hispanics is 42.8%, nearly four times that of Whites (11%), while Blacks have an uninsured rate of 21.5%. Because it is estimated that there are about 400,000 undocumented people living in Houston, this, in part, explains why there is a high uninsured rate in the area as undocumented immigrants are ineligible for either Medicaid or Marketplace coverage.

This leads to the next determining factor that I would like to discuss.

In general, people who are in the country illegally are barred from enrolling in Medicaid or Medicare and cannot buy insurance through the Affordable Care Act marketplace since it is publicly subsidized. Though it is still possible to be insured if you are undocumented (assuming you can afford unsubsidized insurance), it doesn’t come easy as undocumented people oftentimes work jobs that don’t pay well enough to cover such high costs. Because of a lack of health insurance, most end up using emergency rooms for non-emergency care. When you break this down, one quickly realizes that many rather avoid going to the doctor than receiving a big hospital bill. But why is this? Well, undocumented people live with the constant fear that they will be asked for citizenship documentation, making them less willing to access services and programs for which they might be eligible for. But don’t worry, it isn’t the end of the world! Those who have access to health care tend to do so at federally funded health care centers which are required to treat anyone, can adjust costs, and doesn’t ask for citizenship documentation. If you or someone you know can’t afford or doesn’t qualify for health insurance, use this site as it provides you with services without the need for insurance. They can provide COVID-19 testing, STD testings, physical exams, urgent care, preventative care, discounted laboratory testing, and much more at a location near you! There are also free and income based clinics in the Houston area, so click here to learn more. For immigrant families specifically, AccessHOU is a database of resources working with immigrants in the greater Houston area. It helps you search through hundreds of agencies and programs that can provide help for legal reasons, health, education, food, housing, employment, and more.

When it comes to children, there are a bit more opportunities.

A larger percentage of children in Houston have health insurance compared to adults. In 2018, it was concluded that 86.0% of children compared to 68.9% of adults had insurance. Health insurance is especially important for children since, in order to stay healthy, children need to have regular checkups, dental and vision care, and medical attention for illness and/or injuries to prevent serious illness development. 

Children from low-income families may be eligible for Medicaid and the Children’s Health Insurance Program (CHIP). CHIP is primarily designed for families that earn “too much” money to qualify for Medicaid but not enough to afford private health coverage. For Texas residents specifically, the Texas Children’s Health Plan, which offers low-cost health coverage for children from birth through the age of 18, is also an option. According to texaschildrenshealthplan.org, the most a family will pay is $50 per year for all children that qualify but they claim that most families pay $35 or less per year. Aside from this, one must also pay additional co-payments on some of the services offered. Some benefits include doctor visits, dental care and teeth cleaning, prescriptions, eye care and glasses, hospital care, hearing testing, x-rays, etc. What determines whether a family qualifies depends on the number of children you have and the amount the family earns. To check if you qualify you can check this income chart. Some other determining factors for the Texas Children’s Health Plan include being a Texas resident and a US citizen or a legal permanent resident. Because it does look into legal status, this, unfortunately, leaves out a large portion of Houston’s population. Also, because Texas did not expand Medicaid regardless of the Affordable Care Act as previously mentioned, the state has seen virtually no change in Medicaid and CHIP enrollment since 2013. 

The factors that determine someone’s access that I mentioned in this post are very interconnected. A Houstonian can have multiple factors that prevent them from being able to have certain access such as being low-income, being undocumented, and a victim to health disparities while another can only have limited access for one reason. Regardless of the individual circumstances, the main components are whether the person has insurance or not, their legal status, race/ethnicity, age, and income. This is in no way claiming that these are the only factors that determine who has access or not. But there is always a silver lining.

Houston has been attempting to address the high percentage of uninsured people which has led to The Harris Health System which provides access to quality health care for Harris County residents, regardless of their ability to pay. The system includes three hospitals, twelve community health centers, a dental center, and an AIDS clinic, as well as several school-based clinics. It is nice to see there is a variety of resources made available in this system alone and hopefully more people become more aware of such opportunities. There is also the Harris County Public Health and Environmental Services (HCPH), a county health department that also provides public health care services ranging from nursing, dental health, health education, nutrition, and more! It even has a jurisdiction that provides services to about 4.7 million people! There are also programs like Doctors for Change that serve as an educational resource and forum where healthcare providers, students, and community members can advocate for improvements to the health care system in Texas. Check them out here. Lastly, I would also like to shine attention to HCA- Houston Healthcare as they provide over 2 billion dollars in charity care annually! Hopefully, there’s at least one resource here that can help!

 

Sources:

“About Us.” HCA Houston Healthcare, hcahoustonhealthcare.com/about/index.dot.

“Access to Care.” Doctors for Change, 4 Aug. 2020, doctorsforchange.org/access-to-care/.

“Access to Health Care in Houston.” Understanding Houston, 2020, www.understandinghouston.org/topic/health/access-to-healthcare/.

“Adults Unable to Afford to See a Doctor.” Houston State of Health, Mar. 2019, www.houstonstateofhealth.com/indicators/index/view?indicatorId=53.

“Adults Who Have Had a Routine Checkup.” Houston State of Health, Jan. 2020, www.houstonstateofhealth.com/indicators/index/view?indicatorId=3645.

“Adults with Health Insurance.” Houston State of Health, Jan. 2020, www.houstonstateofhealth.com/indicators/index/view?indicatorId=8287.

“Children with Health Insurance.” Houston State of Health, Jan. 2020, www.houstonstateofhealth.com/indicators/index/view?indicatorId=2732.

“CHIP.” CHIP | Texas Children’s Health Plan, 2020, www.texaschildrenshealthplan.org/what-we-offer/chip.

“Health.” Back to Www.houstontx.gov, 2020, www.houstontx.gov/abouthouston/health.html.

“Houston TX Free & Income Based Clinics.” Clinico, 2020, www.freeclinics.com/cit/tx-houston.

“Our Services- We Care for Your Entire Family.” Access Health Clinic, 2020, www.accesshealthclinictexas.com/services.html.

Uhler, Andy. “Here’s How It Works If You’re Undocumented and Need Health Care.” Marketplace, 9 July 2019, www.marketplace.org/2019/07/09/heres-how-it-works-if-youre-undocumented-and-need-healthcare/.