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North Texas Counties Contend With Issue of Out-of-County Health Care

By Sujata Dand, KERA reporter

Dallas, TX – Sujata Dand, KERA 13 reporter: The Collin County Adult Clinic opens at 6:30 on Thursday evenings. Patients begin lining up outside at noon.

Linda West, Patient: I haven't been on my medicine. I'm out of it. This heat is not going to go well with me.

Dand: Linda West got here a little after 2, but she gets an emergency spot. She was in the emergency room last week; the hospital bill for three days at Plano Medical Center - $6500 - her prescriptions for diabetes and high blood pressure - total more than $100 a month, because she couldn't pay. The hospital told her to come to the clinic for her medicines.

West: People are blind. The real issues of healthcare - yeah this is a rich county but brother, we've got some problems.

Dand: Retired nurse Julia Grenier runs this one-night-a-week clinic. She, like the doctors, nurses, lab technicians and translators, works for free. Collin County does have a clinic funded by the county. The budget is more than $2 million a year. But the county restricts care to individuals who make less than $2500 a year, assets included. Less than 400 patients qualified last year, yet Collin County has more than 23-thousand who fall below the federal poverty level and around 20 percent who don't have insurance. That's why people turn to the Adult Services Clinic, where more than a thousand Collin County residents have been treated since it first opened 14 months ago.

Julia Grenier, Retired Nurse: What we're doing is we're covering the gap; those who are just above the indigent qualifications for those and those who are uninsured.

Dand: The adult clinic is like a doctor's office, but for patients who need serious treatment, beyond prescriptions. There is no place to refer them so patients often turn to their religious communities for help. Pam Kaus is the health coordinator for Collin County Area Interfaith. She's negotiated payment plans with hospitals, and even taken up alms for treatment for patients.

Pam Kaus, Health Coordinator, Collin County Area Interfaith: They are telling us that they have to go to Parkland and lie and they don't want to do that. They have to stay sick and they don't want to be sick.

Dand: Parkland has to take out-of-county residents when they come through the emergency room. It's a federal law. The Dallas County hospital admitted more than 200 Collin County residents without insurance or Medicaid. The cost to Parkland: nearly $2 million. Collin County did pay for one of the admitted patients, who made less than $2500 a year. Even then, the county paid less than half of the $38,000 bill.

Kaus: It is the responsibility of our elected officials to take the lead in solving our health care issues. And they are not doing that in Collin County.

Dand: Phyllis Cole is a Collin County commissioner. She's proud to say she helpted to keep the tax rate steady for the last decade. An average homeowner in Collin County pays around $500 a year in county taxes. A Dallas County resident pays $900 for a home appraised at the same value.

Phyllis Cole, Collin County Commissioner: If we try to provide health care for everyone in Collin County who did not have insurance, our tax rate would be so high that then we would have a whole other group of people who were in need because we would be taking their income because we would be raising taxes so much.

Dand: Unlike Dallas County residents, who pay 40 percent of Parkland's budget, the Collin County indigent clinic is paid for through a trust created when the county sold its public hospital twenty years ago. The trust is expected to run out in the next five to six years. At that point, county commissioners say they'll now have to double the tax rate just to maintain what they're doing now.

Cole: If Parkland chooses to treat them and if the citizens of Dallas County want to include that in their tax rate, then that's a wonderful thing they are doing. In Collin County, we are not going to pick up the difference between indigent and insured.

Dand: But in Denton County, the People's Clinic is picking up the difference between the indigent and uninsured, and it's not costing local taxpayers a dime.

Jane Nelson, Texas Senator, Chairman of the Senate Health and Human Services Committee: By investing in programs like the People's Clinic, we could provide more care than just simply waiting for the hospital bill. It reduces the burden on our emergency rooms.

Dand: State Senator Jane Nelson chairs the Health and Human Services Committee. She suthored legislation to give counties seed money to start non-emergency clinics where anyone without insurance can get treatment. Patients pay on a sliding scale; no bill exceeds $40. Besides state dollars, the CEO's of both hospitals in Denton County chipped in $100,000 each.

Nelson: The federal government offered a really nice matching grant; almost a three-to-one match for local programs like this that formed a coalition of support in that county.

Dand: Senator Nelson knows there are more uninsured Texans than ever before, and that's put a burden on county hospitals like Parkland, which can't force other counties to share in the increased costs.

Nelson: I believe they are contributing somewhat right now. Is it enough? Probably not.

Dand: For years, Parkland has proposed surrounding counties contribute for the services only Parkland can provide, like the level one trauma and burn units. Nelson says her committee is examining that proposal, but she's focused on encouraging counties to invest in preventive clinics with the help of state dollars.

Nelson: It may be that we will come into some counties; that we will have to say there are some counties you will have to treat and its up to you to figure out how you will go about doing that.

Dand: Meanwhile, the volunteer Adult Clinic in Collin County continues to see patients. Retired nurse Julia Grenier:

Grenier: These people are here. We're passing them in the grocery stores on the side walks and they are like ghosts. They are being totally invisible to a lot of people who feel that we are in a wealthy town.

Dand: For KERA 90.1, I'm Sujata Dand.

Sujata Dand will have more on this story on KERA 13's "On The Record," tonight at 8:30 p.m.

For more KERA coverage of public health issues, visit KERA's Life in the Balance page

Email Sujata Dand about this story.