A MARTÍNEZ, HOST:
The Rio Grande Valley in southern Texas has some of the highest uninsured rates in the country. In some counties, one in three people do not have health insurance, and that is expected to get much worse as President Trump's spending cuts hit. Millions of Americans are set to lose their coverage over the next decade because of the federal policy changes. Sam Whitehead from our partner KFF Health News has more.
SAM WHITEHEAD, BYLINE: It's early June and flirting with 100 degrees when Maria Salgado rolls her wheeled backpack into the air-conditioned refuge of the Roma Public Library. In a small back room, she flicks on a tower fan...
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WHITEHEAD: ...And pulls out the tools of her trade - laptop, scanner, printer.
MARIA SALGADO: Also, we have, you know, the documents that they need to complete their application, so I have everything in here.
WHITEHEAD: Salgado is a community health worker, a promotora. She traverses the largely Hispanic counties that hug the Southern U.S. border and helps people sign up for - and keep - Affordable Care Act and Medicaid health coverage. Today, she's meeting with a man and his wife who are afraid they've missed his Medicaid renewal deadline.
SALGADO: And we reviewed his account, but it's not time to renew. He's good until November of this year.
WHITEHEAD: Salgado says lots of people in this largely low-income community need this kind of help, and more could soon. President Trump's budget law will dramatically reduce spending on Medicaid and the ACA, programs Republicans say have gotten too large. The nonpartisan Congressional Budget Office says it will cause 10 million fewer Americans to have health coverage within the next decade.
SARA ROSENBAUM: You can't disinsure this many people and not have, in many communities, just a collapse of the health care system.
WHITEHEAD: Sara Rosenbaum is a retired health policy expert from George Washington University. A growing body of research shows having health insurance makes you healthier. Rosenbaum says even more people could lose coverage if stepped up federal help to pay for ACA plans expires at the end of the year.
ROSENBAUM: Are going to start losing their coverage very quickly.
WHITEHEAD: Growing up in the Rio Grande Valley, sometimes Chris Casso's family could afford insurance. Sometimes they couldn't. Now she's a doctor there. Casso says it's common for her patients with preventable conditions like diabetes to delay treatment until they develop complications like kidney disease.
CHRIS CASSO: Sometimes it's heartbreaking, you know, personally. I mean - sorry. Getting a little emotional?
WHITEHEAD: Her sister died at age 45. Casso says she couldn't afford insurance and was unable to manage her diabetes and heart disease. Casso worries more could face that fate.
CASSO: Our economy is going to suffer. Our population is going to suffer. It's going to be devastating.
WHITEHEAD: Eating more costs for people who can't pay will strain many hospital budgets. At the same time, the budget law reduces federal financial programs that many rural hospitals have come to rely on.
QUANG NGO: We often say it's kind of like death by a thousand cuts, you know?
WHITEHEAD: Quang Ngo works with Texas' Rural Hospital Association. Some facilities, he says, might not make it.
UNIDENTIFIED PERSON: He's already been seen.
WHITEHEAD: Star County Memorial Hospital is just down the street from a brand-new McDonald's. The border wall hulks beyond the drive through. It's late afternoon, and every bed in this emergency room is full. Dr. Jake Margo Jr. says traffic picks up here when nearby health clinics close for the day.
JAKE MARGO JR: So they all come here, and we're the only ER.
WHITEHEAD: They take all comers. Federal law says if hospitals want to participate in Medicare, their emergency rooms have to stabilize everyone seeking care - insured or not.
MARGO: You know, we're very efficient, and yet, when you're overwhelmed, when you're overrun, there's only so much you can do.
WHITEHEAD: Margo says resources like bed space and his staff's attention can only stretch so far before patients begin to notice. In the Rio Grande Valley, I'm Sam Whitehead.
MARTÍNEZ: Sam is with our partner KFF Health News.
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