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Now, recent actions by the Trump administration and the GOP-controlled Congress have triggered a new concern: the inability of doctors, hospitals, and other health providers to continue to care for uninsured patients. It\u2019s a fear not only in Starr County, which has one of the highest uninsured rates in the nation. Communities across the U.S. with similarly high proportions of uninsured people could struggle as additional residents lose health coverage.<\/p>\n
About 14 million fewer Americans are expected to have health insurance in a decade due to President Donald Trump\u2019s new tax-and-spending law, which Republicans dubbed the One Big Beautiful Bill Act, and the pending expiration of enhanced subsidies that slashed the price of Affordable Care Act plans for millions of people. The new law also limits programs<\/a> that send billions of dollars to help those who care for uninsured people stay afloat.<\/p>\n \u201cYou can\u2019t disinsure this many people and not have, in many communities, just a collapse of the health care system,\u201d said Sara Rosenbaum, founding chair of the Department of Health Policy and Management at George Washington University\u2019s Milken Institute School of Public Health.<\/p>\n \u201cThe future is South Texas,\u201d she said.<\/p>\n KFF Health News is examining the impact of national health care policy changes on uninsured people and their communities. Though the Trump administration told KFF Health News it is making \u201ca historic investment in rural health care,\u201d people who treat low-income patients, as well as researchers and consumer advocates, say recent policy decisions will make it harder for people to stay healthy. Doctors, hospitals, and clinics that make up the health care safety net could lose so much money they must close their doors, some of them warn.<\/p>\n \u201cBecause the patient\u2019s bill is not going to get paid,\u201d said Joseph Alpert, editor-in-chief of The American Journal of Medicine and a professor of medicine at the University of Arizona. \u201cUninsured patients stress the health care system.\u201d<\/p>\n Starr County shows how this dynamic unfolds.<\/p>\n Primary care doctors in the county serve an average of just under 3,900 people<\/a> each, nearly three times the U.S. average.<\/p>\n Margo, the family physician, said because so many people lack insurance and there are so few places to seek care, many residents treat the ER as their first stop when they\u2019re sick.<\/p>\n In many cases, they have neglected their health, making them sicker and more expensive to treat. And federal law<\/a> requires ERs at hospitals in the Medicare program to stabilize or transfer patients, regardless of their ability to pay.<\/p>\n That leaves Margo and his team to practice what he described as \u201cdisaster medicine.\u201d<\/p>\n \u201cThey come in with chest pain or they stop breathing. They collapse. They\u2019ve never seen a doctor,\u201d Margo said. \u201cThey\u2019re literally dying.\u201d<\/p>\n Health Systems in \u2018Survival Mode\u2019<\/strong><\/p>\n When people are uninsured or on Medicaid, they tend to rely on a safety net of doctors, hospitals, clinics, and community health centers, which offer services free of charge or absorb getting reimbursed at lower rates than they do treating patients on commercial insurance.<\/p>\n Those providers\u2019 financial situations can often be precarious, leading them to rely on myriad federal supports. The Trump administration\u2019s cuts to health care and Medicaid in the name of eliminating \u201cwaste, fraud, and abuse\u201d have many concerned they won\u2019t weather the additional financial strain.<\/p>\n Trump\u2019s new law funds his priorities, like extending tax cuts that mainly benefit wealthier Americans and expanding immigration enforcement. Those costs are covered in part by a nearly $1 trillion reduction in federal health spending for Medicaid within the next decade and changes to the ACA, such as requiring additional paperwork and shortening the time for people to sign up.<\/p>\n Many Republicans have argued Medicaid has gotten too large and strayed from the state-federal program\u2019s core mission of covering those with low incomes and disabilities. And the GOP has fought to roll back the ACA since its passage.<\/p>\n Kush Desai, a spokesperson for the White House, said projections from the nonpartisan Congressional Budget Office about how many people could lose health insurance are an \u201coverestimate.\u201d He did not provide an estimate the administration sees as more accurate.<\/p>\n Supporters of the \u201cOne Big Beautiful Bill\u201d say those who need health coverage can still get it if they meet new requirements such as working in exchange for Medicaid coverage.<\/p>\n And Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank, said even with the legislation, Medicaid spending will grow, just not as quickly.<\/p>\n The budget law won\u2019t cause \u201cthe sky to fall,\u201d Cannon said. \u201cThe inefficient providers should be shutting down.\u201d<\/p>\n A recent survey<\/a> from AMGA, formerly the American Medical Group Association, which represents health systems across the country, found nearly half of rural facilities could close or restructure due to Medicaid cuts. Nearly three-quarters of respondents said they anticipated layoffs or furloughs, including of front-line clinicians.<\/p>\n Public health departments, which often fill gaps in care, also face federal funding cuts that have reduced their capacity. In South Texas\u2019 Cameron County, the health department has eliminated nearly a dozen positions, said agency head Esmer Guajardo. In neighboring Hidalgo County, the health department has laid off more than 30 people, said Ivan Melendez, who helps oversee its operations.<\/p>\n In July, the Texas Department of State Health Services canceled Operation Border Health<\/a>, a massive annual event that last year provided free health services to nearly 6,000 South Texas residents.<\/p>\n Gateway Community Health Center in Laredo, a border city north of the Rio Grande Valley, is in \u201csurvival mode,\u201d with about a third of patients already lacking insurance and even more who will struggle to afford health care if the ACA subsides aren\u2019t renewed, said David Vasquez, its director of communications and public affairs. The center is looking for other forms of funding to avoid layoffs or cuts to services, and its expansion and hiring plans are on hold, Vasquez said.<\/p>\n That downsizing is happening as more people lose health insurance and need free or reduced-cost care.<\/p>\n Esther Rodriguez, 39, of McAllen has been out of work for two years and her husband makes $600 a week working in construction. Neither of them has health insurance.<\/p>\n Medicaid covered the bills for the births of her five children. Now, she depends on a mobile health clinic run by a local medical school, where she can pay out-of-pocket for routine checkups and drugs to control her Type 2 diabetes. If she needed more care, Rodriguez said, she would go to the ER.<\/p>\n \u201cYou have to adapt,\u201d she said in Spanish.<\/p>\n \u2018Death by a Thousand Cuts\u2019<\/strong><\/p>\n People\u2019s inability to pay results in uncompensated care, or services that hospitals, doctors, and clinics don\u2019t get paid for, which, under an earlier version of the megabill, was projected to increase by $204 billion over the next decade, according to the Urban Institute<\/a>, a nonprofit think tank.<\/p>\n But the Trump administration is also cutting other support that helped offset the cost of care for people who can\u2019t pay. The new law caps federal programs<\/a> that many health providers for low-income people have come to depend on, especially in rural areas, to shore up their budgets. These include taxes<\/a> on hospitals, health plans, and other providers that states use to help fund their Medicaid programs. Such provider taxes are a \u201cfinancial gimmick,\u201d Desai said.<\/p>\n While the law creates a temporary $50 billion fund to support rural doctors and hospitals, that\u2019s a little over a third of estimated Medicaid funding losses in rural areas, according to KFF<\/a>, a health information nonprofit that includes KFF Health News. Desai called the analysis \u201cflawed.\u201d<\/p>\n Any loss in revenue could spell financial ruin, especially for small rural hospitals, said Quang Ngo, president of the Texas Organization of Rural & Community Hospitals Foundation.<\/p>\n \u201cIt\u2019s kind of like death by a thousand cuts,\u201d he said. \u201cSome will probably not make it.\u201d<\/p>\n And the hits could keep coming. The Trump administration\u2019s budget request for the coming fiscal year calls for cuts to multiple rural health programs operated through the Health Resources and Services Administration. Desai said the spending law\u2019s investment in rural health \u201cdwarfs\u201d the cuts.<\/p>\n In February, the Trump administration announced funding cuts of 90% to the ACA navigator program, which helps people find health insurance. That program has been \u201chistorically inefficient,\u201d Desai said.<\/p>\n In December 2023, nearly 3 million of Texas\u2019 uninsured were eligible for ACA subsidies, Medicaid, or the Children\u2019s Health Insurance Program, according to Texas 2036<\/a>, a public policy think tank.<\/p>\n Maria Salgado spends her workdays tabling at community events, dropping off flyers at doctors\u2019 offices, and holding one-on-one meetings with clients of MHP Salud, a nonprofit that connects residents to Medicaid and ACA coverage.<\/p>\n She worried funding cuts would really set the organization\u2019s efforts back: \u201cA lot of community members here, they\u2019re going to be left behind,\u201d said Salgado, a community health worker, or promotora<\/em>.<\/p>\n Chris Casso, a primary care physician who grew up in McAllen and now practices there, held back tears as she described treating patients who have put off seeing a doctor because of an inability to pay, only to have their preventable conditions deteriorate.<\/p>\n She worries about the future of her community as physician shortages worsen<\/a>, potentially leaving few providers to treat uninsured people.<\/p>\n \u201cIt\u2019s heartbreaking,\u201d she said, sitting in a small back room in her office in a suburban strip mall, wedged between a Kohl\u2019s and a Shoe Carnival. \u201cThese are hardworking people,\u201d she said. \u201cThey try their best to take care of themselves.\u201d<\/p>\n Casso said her own sister, who worked as a medical biller in a physician\u2019s office, couldn\u2019t afford health insurance. She delayed care and died at age 45 of complications from diabetes and heart disease. Casso worries the future will find more people in similar situations.<\/p>\n \u201cOur population is going to suffer,\u201d she said. \u201cIt\u2019s going to be devastating.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"http:\/\/www.dangeladvertising.com\/wp-content\/uploads\/2025\/09\/Salgado_021.png\")
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