Houston Chronicle

Uninsured often delay getting treated

- By Jenny Deam

When a car slammed into Rosa Ortez’s SUV on June 20, flipping and totaling it, she crawled out the sunroof amazed but thankful she was OK. Then a few days later the headaches and memory blackouts started.

A doctor at a walk-in clinic told the 28-year-old she needed an MRI to determine the extent of what was probably a head injury. But the $500 price sent her right back out the door. With no insurance and a budget stretched to the breaking point, she skipped it.

Hers is one of the stories behind the numbers, and the often overlooked consequenc­es, of the Texas uninsured.

A report released Thursday reveals that nearly one in three Texans without insurance skipped primary care visits and more than 20 percent did not get needed tests or treatment last year because they could not afford it without insurance.

The findings, from the ongoing re-

search by the Episcopal Health Foundation and Rice University’s Baker Institute, also found another 20 percent said they did not fill prescripti­ons. Still others delayed or skipped mental health counseling, specialist treatments or dental care, the report found.

“The uninsured fare worse in many, many ways,” said study co-author Vivian Ho, a health economist at Rice’s Baker Institute.

Top bankruptcy cause

Unpaid medical bills, for example, remain the No. 1 cause of personal bankruptcy in this country.

“Delaying treatment for a primary health care issue such as diabetes or hypertensi­on can quickly and tragically move from a relatively low-cost treatment through medication and lifestyle change to a life-threatenin­g health crisis that can bankrupt an entire family,” said Jose E. Camacho, executive director and general counsel for the Texas Associatio­n of Community Health Centers.

Missing doctor visits or forgoing treatments have far-reaching effects beyond medical care, Ho said. A lingering or worsening condition can reduce workplace productivi­ty and potentiall­y damage personal relationsh­ips.

Carl Anderson lost his insurance when he lost his job. The 25-year-old needs a daily regimen of drugs to control a chronic immune system disorder, but he could not begin to pay for the expensive collection of medicine. That’s when he began taking a pill or two every other day to make his supply last.

“I really, really got sick,” he said.

Anderson said curtailing his medication began to affect his mental health. He became despondent and no longer wanted to see people. Eventually he was able to restart his treatment and medication when he got insurance through the Affordable Care Act’s federal marketplac­e.

Top state for uninsured

Texas continues to lead the nation in the number of uninsured. A recent Gallup poll showed it was the only state remaining with an uninsured rate of more than 20 percent.

The state also has one of the highest rates in the nation of people skipping treatment.

In a separate national study, four of 10 Texans age 19 to 64 — both insured and uninsured — acknowledg­ed they did not see a doctor when sick, declined to fill a prescripti­on, missed follow-up appointmen­ts or needed specialist care or skipped a needed test or treatment because of cost, according to the Commonweal­th Fund 2014 Biennial Health Insurance Survey released in April.

The study looked at the four most populous states and found Texas and Florida tied with the highest rate of 43 percent.

While it might seem obvious why someone without insurance skips doctor visits, the more surprising number was how many who had insurance still delayed or declined treatment, Sara Collins, co-author of the Commonweal­th Fund study, said in an interview.

Again, it comes down to cost.

In 2013 the average deductible for a person with employer health coverage paid $1,543 in Texas. A decade before, in 2003, the average deductible for a single employer plan in Texas was $624, Collins said.

Making hard choices

When money is tight, hard choices have to be made.

Ortez is a student at Houston Community College hoping to enter the public relations or marketing field. She also works full-time as data-entry clerk for an oil company. As a contract worker, she is not eligible for group insurance. Her $2,500 monthly take-home pay covers tuition, rent, car insurance and other bills.

She had to decide between paying out of pocket for school or for health insurance.

She chose her education because she didn’t want student-loan debt. She knows she will have to pay the federal tax penalty for not having insurance but felt she had run out of options.

Eventually she was able to get an MRI through medical coverage attached to her car insurance. The results are pending. She sees a neurologis­t next week. It is unclear how much damage was done and if the delay made it worse.

Ho finds such stories both heartbreak­ing and terrifying.

“Especially when you are 28,” she said, “and have so much to lose.”

 ?? John Shapley / Houston Chronicle ?? Rosa Ortez, a 28-year-old who was injured in a car accident this summer, says she chose to pay her tuition rather than health insurance.
John Shapley / Houston Chronicle Rosa Ortez, a 28-year-old who was injured in a car accident this summer, says she chose to pay her tuition rather than health insurance.

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