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Efforts to Enroll Colonia Residents in Health Care Continue Despite GOP Medicaid Expansion Refusal


by: Shelby Alexander

Tue Feb 25, 2014 at 11:00 AM CST



The coverage gap in Texas, otherwise known as the Republican refusal to expand Medicaid, hits areas like colonias in the borderland the hardest. With almost 400,000 people living in the 2,300 colonias along the borderland, these people experience some of the most massive health disparities in comparison to other areas around Texas due to lack access to adequate water, sewer, and solid waste disposal services.

However, as reported in the Texas Tribune, efforts to support healthcare enrollment in have continued despite GOP push-back. With assistance from community organizations in and around colonias, residents are receiving help through the application process to obtain a "hardship waiver" to be exempted from having to buy health insurance.

This exempts people living in the coverage gap who make less than $11,490 a year or a family of four making less than $23,550 from paying a penalty when they file their taxes for 2014. The Tribune reports somewhere between 50 and 80 percent of colonia residents are currently uninsured.

Read more about local efforts to bring health care to colonias below the jump.

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"We help people go through the application process, even if we can figure out pretty quickly that they're in the gap," Rachel Udow told the Tribune. She is the program director for Migrant Health Promotion, a Weslaco-based group with six full-time navigators charged who helps individuals sign up for health insurance through the federal marketplace. "Because at the end, they'll receive the determination that essentially says they're in the gap, which they'll then be able to use to access the waiver."

Other organizations such as La UniĆ³n del Pueblo Entero, a nonprofit community union, hold public seminars and enrollment events, where staff members provide colonia residents information about the federal health reform law and navigator referrals.

The article cites navigators finding more residents than expected to enroll in the marketplace. Unfortunately, the gap still keeps many colonia residents from continuing the process after they realize they cannot afford full-price premiums.

In an August presentation by Enroll America at the Texas Medical Association's 8th Annual Border Health Conference, it was reported that most uninsured Hispanics are at income levels that qualify for Medicaid expansion or subsidies. Unfortunately, without Medicaid expansion, it's obvious many colonia residents are still left behind.

Texas' own resources, such as the State Comptroller note the insufficient gap between private insurance and public dollars available to improve healthcare in the borderland, and have for a while. One webpage sites older reports noting how cases of hepatitis A, a gastrointestinal virus borne by contaminated food and water, are four times as common in the Rio Grande Valley as in the rest of Texas, as well as how the diabetes death rate is 25 percent greater than the state rate.

These types of alarming statistics are not new, and are cited from almost 20-year-old resources. With the population only increasing and top policy makers only continuing to refuse adequate expansion of services, it's no wonder no one is rushing to update what new information reveals. However, we understand the health care challenges in colonias, and that current services, even with expanded enrollment, will not assess the needs of Texans like Medicaid expansion would. Outreach is cited as a persistent challenge, with many colonia residents still not familiar with the Affordable Care Act and what it provides.

Regardless, the work being done by community organizations and navigators is paving the way by providing access to care that otherwise would not exist. With hardworking advocates doing necessary on-the-ground work, colonia residents and Texans are receiving some of the attention that is desperately needed in our region.



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With 6 million cancellations and a high estimate of 3.2 million policy's under the ACA hopefully all 400,000 colonias residents can be enrolled to get closer to a zero sum gain. Probably will not reduce the estimates of rising costs either.  

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