By Chris Lane
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Saldierna was doing filing and accounts for a small business that didn't offer insurance to its few employees. Her husband never had insurance and with him out of work there didn't seem to be any way to pay for the expensive doctor visits and medication he needed.
The couple found their way to the San José Clinic in Midtown, making the 27-mile drive from Cypress. Cost of treatment became manageable; doctor visits were assessed on a sliding scale of $15 to $35. Two years later, his illness is stable and she says she and her husband are happy with the care they receive.
All of which is good, because when Alma, 52, came in for a check-up for herself last week, she was told she had a thyroid tumor and would have to undergo a biopsy to see if it was cancerous. A pink rose in hand, the mother of four children ranging in age from 21 to 29 seemed to be taking her latest news and what would happen next philosophically.
"You either live to survive or you have insurance. And I don't have the money to be able to afford insurance," she said in Spanish through a translator. "The service here is excellent. I don't know what I would do without it."
The Affordable Care Act, vilified by detractors as Big Brother/Big Government Obamacare and held up by supporters as a shining promise of health care for all, turns out, in reality, to be neither. Both caution and hope crash and burn when confronted with coverage gaps and people who make too much for Medicaid but still too desperately little to afford any kind of insurance.
In Texas, this is exacerbated by Governor Rick Perry's decision not to expand Medicaid coverage in the state. During a September trip to the state, Health and Human Services Secretary Kathleen Sebelius said Texas is leaving $79 billion of federal money on the table by refusing to expand its Medicaid program, adding that this would affect 2.5 million Texans, who would otherwise be covered.
These are people who don't make enough money to file tax returns to either receive a subsidy or be penalized on those returns for failing to secure insurance under provisions of the Affordable Care Act. Some are undocumented workers, immigrants without papers who don't qualify for anything. All of them sometimes turn into patients in need of care, who opt for emergency rooms where they can't pay the bills there either, ratcheting up the cost of health care for everyone.
What San José Clinic Executive Director Paule Anne Lewis is most concerned about, most recently, is that people of means will assume that their donations, which have played such a vital role in this nonprofit clinic's funding, are no longer needed.
"The biggest issue is the state's decision to not expand Medicaid. I think that's going to hurt a lot of people in our community that the Affordable Care Act was meant to help," Lewis says. "The bottom line is there's still going to be tens of thousands of people who are uninsured."
"Texas has more uninsured people than any other state in the country," she adds.
Ninety-one years ago, San José Clinic started out in a small wood-frame house on Canal Street, moved to another house ("held together by duct tape and ticky-tack," Lewis says) on Hamilton across from Minute Maid Park, and since 2010 has been quartered in a sparkling building in a transitional part of Midtown, one block off the McGowen light-rail stop on Main.
Part of the ministry of the Archdiocese of Galveston-Houston and operating under Roman Catholic rules (no birth control, no pregnancy-termination referrals), San José Clinic is an entity owned by Cardinal Daniel DiNardo. It pays rent of $1 a year to the CHRISTUS Health system — which owns the building — but it is not part of it. What it represents, Lewis says, is the Catholic Church's determined presence in inner Houston, after its sale of St. Joseph Medical Center in 2011 to a Tennessee health-care company.
Since the clinic's start, it has grown to include radiology and expanded its pharmacy. Besides the standard examining rooms, there's an eye clinic. The third floor is taken up by dental offices — of particular importance to its diabetic patients, Lewis says, because of the pressing danger infection of any type poses to them. Most charity clinics don't offer dental coverage. And dental is not covered in the Affordable Care Act, Maureen I. Sanders, San José's development officer, points out.
It can't perform surgeries or colonoscopies, and sometimes that's where the process grinds to a halt. Some patients can get their operations through the Harris Health System; Lewis says she makes appeals to area hospitals. Or the patients just take themselves to an emergency room.
"[Our patients] are really hardworking individuals that earn low wages and either have no access to health-care coverage or can't afford [it]. Or they're not eligible because of their residency or the citizenship aspect.