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Houston Chronicle: Texas ranks among worst in the nation for racial health disparities

November 18, 2021

Racial and ethnic disparities in medical treatment are among the worst in the nation in Texas, where Black and Latino populations are less likely to receive preventative care and more likely to have treatment delayed, according to a new study.

Texas ranked in the bottom quarter of the states when it comes to both access to and quality of care for Blacks and Latinos, hinting at deep-seated racial and ethnic health inequities, according to the Commonwealth Fund, a health policy foundation in New York. Blacks and Latinos are also more likely to have worse outcomes from treatment than whites, according to the study.

The study examined access, quality and hospital services used as well as health outcomes for racial and ethnic groups, producing a scorecard that ranked each state. Texas ranked in the 22nd percentile for the health system’s treatment of Blacks and Latinos, putting it in the bottom fourth. It ranked in the 63rd percentile for treatment of whites, putting it in the top 40 percent.

“The scorecard explores the vital question: are people of color having different experiences than white people in the same health system?” said Dr. David Blumenthal, president of The Commonwealth Fund. “The answer is almost always yes.”

People of color were less likely to receive preventative health care because of long-standing historic and systemic barriers, Commonwealth researchers said They are more likely to have lower incomes and inadequate health insurance, reducing their access to health care. They also are more likely to live in neighborhoods that are far from doctors, hospitals and clinics without transportation to get to medical providers, the study found.

Many of the disparities come from factors that don’t even involve the health care system, said Andrea Caracostis, CEO of Hope Clinic, which serves the working poor in southwest Houston. Although access to preventative care is important, she said, so is having safe places to live, enough to eat, and access to healthy food.

“If you have a child with asthma, we can treat them,” Caracostis said, “But if they go back to an apartment with mold, they are going sick again.”

About 90 percent of the clinic’s patients are people of color, Caracostis said, and nearly all struggle to make ends meet, stretching low incomes to pay rent, utilities and grocery bills. In many cases, serious illnesses could have been prevented with regular checkups, she said, but working class families often had more immediate needs that force them to put off medical care.

“Our population has different priorities,” Caracostis said. “Checkups and screenings are not a priority if you’re trying to pay bills and keep food on your table.”

Even if they do make it to a doctor’s office, they still might not receive the care needed, some research shows. More than a third of Black and Latino adults nationally report that they or household members who have seen a health care professional or been hospitalized overnight, experienced one or more forms of discrimination, including not being offered the best available treatment and being denied or delayed access to services because of their race, ethnicity, or the language that they speak, according to the report.

Uninsured in Texas

About one in five people in Texas have no health insurance, the highest rate of uninsured in the nation. Among Hispanics in Texas, the uninsured rate is 38 percent, nearly double the state average. About 20 percent of Blacks in Texas are uninsured, compared to 15 percent for whites.

These disparities come as no surprise to Cathy Moore, the executive director of Epiphany Community Health Outreach Services, (ECHOS), a nonprofit that helps families who don’t have health insurance and can’t afford care. The nonprofit helps people signing up for programs such as Medicaid, the government health insurance program for the poor, or the Gold Card, which provides reduced rates for health services in Harris County.

Moore estimates at least 90 percent of Epiphany’s clients are people of color, many of them immigrants. Before the pandemic, Epiphany each day would serve 60 to 90 people, who would start lining up outside the office at 5 a.m.

Moore said several factors have kept Epiphany’s clients from gaining health insurance and access to care, including language barriers, lack of knowledge of programs, such as Medicaid, that might be available to them, and fear that signing up for the benefits will interfere with efforts to gain citizenship.

Maricela Delcid, a community health worker who helps people sign up for programs, said these trends have persisted throughout her seven years working at Epiphany. Even immigrants who have legal status face challenges gathering documents, such as birth certificates, that are required to enroll in benefits programs. In many cases, obtaining the documents entail paying fees, putting more pressure on tight budgets.

In addition, they often must wait for documents to arrive, forcing them to delay care.

“Sometimes people need to see a doctor right away,” Delcid said. “But it’s taking longer than it should for them to get documents they need.”

Gray area

Many people are also left in a gray area of the health care system. They earn too much to qualify for Medicaid but can’t afford polices sold through the Affordable Care Act markets.

Texas has had the opportunity to close that gap, but lawmakers have repeatedly rejected efforts to expand eligibility for Medicaid to cover a larger segment of the working poor. Under the Affordable Care Act, the federal government would pay 90 percent of the cost of the expansion. Texas is one of 12 states that hasn’t expanded Medicaid coverage.

“There's no question that failure to cover health care services decreases access to those services,” said Blumenthal of the Commonwealth Fund. “So, Texas does relatively poorly on uninsurance generally, and failure to expand Medicaid is one factor.”

Issues:Healthcare