Two years ago, Alma Saldierna's husband was diagnosed with Parkinson's disease. As his central nervous system broke down, he was hit hardest on his left side, leaving him deaf in that ear. He was trapped in his own body with an incurable verdict, his life as a construction worker over.
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.
"These are working people who mow your lawn, cut your hair. They want to keep healthy and get back to work," Lewis says. "We only take care of the uninsured, the people who absolutely have nothing."
Patients come to the clinic from 20 counties and more than 200 ZIP codes, and most are female ("Men don't go to doctors" is a common refrain at San José). The majority suffer from the chronic trinity of hypertension, diabetes and obesity, with more than 80 percent diagnosed as diabetic, Lewis says.
The average patient is a female head of household and has four children, says Maureen I. Sanders, San José's development officer. About 10 percent of the clinic's patients are children, but children are omnipresent, brought along when one member of these blended, multigenerational families goes to the doctor.
While its director and many of its volunteers are Roman Catholic and Jesus on the cross hangs in rooms throughout the complex, the clinic is open to anyone who meets its guidelines. To receive services, patients cannot be covered by Medicaid, a third-party insurer or CHIP (the federal Children's Health Insurance Program), and they must prove they are living at or below 250 percent of the federal poverty level ($11,490 for a single person this year) and that they are who they say they are, make what they say they make and live where they say they live.
There is a full-time physician, but most clinic services are rendered by the 600 to 800 professionals each year who donate their time to the clinic at no cost. (Lewis estimates the worth of their contributions at three-quarters of a million dollars a year.) Mammograms are free. There's also a vast support network from places like Baylor, St. Joseph, Methodist, Memorial Hermann, Houston Community College and Texas Southern University. All of which enables the clinic to operate on an $8 million annual budget.
Students from nearby medical schools do their rotations throughout the clinic. In addition, a nutritionist works with many of the patients, and the Houston Food Bank brings fresh fruits and vegetables in for patients to take home at their 90-day recheck visits.
There's no charge for lab services, but a routine dental visit runs about $100. Prescription costs usually range from $4 to $40, and X-rays are $15. Last year the clinic saw 4,358 patients who accounted for 31,153 visits, and the pace hasn't slowed this year, they say.
Virgina Casas, 61, was another patient being seen last week on the clinic's busiest day, Wednesday. Casas goes by her middle name, Helen — "that's what everyone calls me" — bestowed on her by the Irish nuns in Houston at St. Joseph who saved her life and that of her mother, who had almost miscarried several times while pregnant with her. "My dad let them name me because he was so grateful."
She had fond memories of the earlier incarnations of San José, beginning with when she was a child and when she returned to the clinic in the periods between insurance coverage. "I have been coming to the clinic in and out through my whole life." When her two daughters were younger, she took them to the old clinic on Hamilton.
Casas, who has high blood pressure and a heart condition, says her job of 18 years at a uniform supply store ended three years ago when the recession hit and she lost her health insurance. Since then she's done occasional caregiver work, none of which offers her medical coverage.
Sitting with a boot on one foot thanks to a broken toe, Casas says she appreciates the treatment she gets when she comes to the clinic from her home in Denver Harbor near the Houston Ship Channel. "They're very respectful and they're kind to you. The doctors explain a lot of things."
Casas says she's worked all of her life and "if I had the opportunity to take insurance wherever I worked, I would always take it. I would sign up for it. I've always had insurance. And when I didn't, I went to Ben Taub. "
Even if Governor Perry had said yes to an expansion of Medicaid in Texas, it would not have helped the majority of San José Clinic clients, Sanders says. "We did look at our patient bases. Maybe 25 percent might have been helped," she said.
All patients are expected to pay something, but Sanders notes, "We don't turn patients away if they don't have the ability to pay."
You might ask why St. Joseph, which is no longer affiliated with the Catholic Church, funds a Baylor College of Medicine doctor's full-time work at San José.
The main reason, an argument successfully made by Lewis to St. Joseph executives, is that it significantly cuts down on the number of trips these people make to the hospital's emergency room. A physician's annual salary has to vastly pale in comparison to multiple ER visits by patients whose once manageable illness has now reached crisis and more costly proportions and who will be unlikely to settle their bill in full.
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Alma Saldierna says she's treated better at San José Clinic than at private doctors' offices, and adds that if it weren't here, she doesn't know what she would do. "Everything is too expensive. I wouldn't be able to afford the medicine."
Part of San José Clinic's mission is "to provide quality health care and education to those with limited access to such services." Lewis says "We serve everyone. Everyone's a human being to us. That's why we're taking care of them."
It's a good thing it's there. But it also stands as witness to the fact that with all our dabbling, we haven't fixed our healthcare system yet. It remains broken.