Without health insurance, women in North Texas must make tough choices

by Jake Kemp

DALLAS — The waiting room for prenatal care at Los Barrios Unidos is packed. Kids scurry around while their pregnant mothers wait to be seen. If it weren't for this clinic, these women would receive no care during pregnancy, making the chances for complications much higher.

Inside Los Barrios are low-income, uninsured women which some doctors call society’s most vulnerable. They have been neglected – not just by the system, but by themselves. They are the caretakers who time and time again put their children and families first.

And they wouldn’t have it any other way.

For thousands of women in the Dallas-Fort Worth area, this is what being a mother means – slighting their own well-being. Lack of easy access to basic health care for some exacerbates this situation, and many times women’s health needs are put on the back burner.

It's easy to see how beneficial simple medical care can be for the well-being of female patients, says Paul Hoffman, executive director of Community Dental Care. “We'll see women who will come in, she'll be covering her mouth with her hand when she talks to us, and then after they're treated, you see this big bright smile and they're encouraged to actually go look for a job because they are finally feeling good about themselves,” he said.

Jennifer Kampan, a doctor who volunteers at Hope Clinic in Garland, says the impact of treating women can be huge, not just for them personally but for the community. “One of the reasons we started our women's clinic is because we see women in that role, as caretakers. If we can take care of them, we are making it easier for them to take care of those around them,” said Kampan.

Removing barriers

The Dallas-Fort Worth area is home to a vibrant network of non-profit community health clinics. Leonor Marquez, CEO of Los Barrios, one of region's largest community clinics, knows they exist just outside the mainstream. “We're still a well-kept secret,” she says.

For many women, clinics like Los Barrios are literally life-savers because of the preventative care they provide at little to no cost. If they can get care at one of these clinics, they no longer have to choose between their own needs and those of their children. “We really feel like we are in the business of removing barriers,” said Marquez.

Each individual clinic has its own approach to billing, as well as differing standards for the types of patients they see. For example, Hope Clinic in Garland will only see patients if they do not qualify for any form of insurance (Medicaid, Medicare, etc.). They do not charge patients but will allow them to donate whatever they would like. Los Barrios, on the other hand, will take government insurance and charges patients based on a sliding scale, a sort of “pay what you can” approach. However, the goal of all the clinics is the same: to provide easy access to basic health to anyone that needs it, no matter their circumstances.

Every doctor and administrator interviewed for this story acknowledged that they probably see a fair amount of patients who are in this country illegally. But they don't ask questions, and they don't care. “That's not what we're here for. We're here to provide health care. If you're here, I take care of you. That's it,” said Dr. Rochelle McKown, who volunteers at Los Barrios.

There was another common opinion expressed by virtually every doctor and administrator interviewed expressed – that basic health care should be provided universally to U.S. citizens by the government. However, Marquez believes there would still be a need for places like Los Barrios. “People without insurance (for whatever reason) are always going to be here,” she said.

Numbers of uninsured persist

A recent study by the Dallas Women’s Foundation found that one out of five women (419,500 total) in this area live without health insurance. That's 50,000 more people than the entire population of Arlington. It’s not that the percentage of uninsured women is substantially higher than men – in fact, it is slightly lower. However, the challenges women face without health insurance are very different than those that men face.

One in four households in the Dallas-Fort Worth area is headed by a single mother. Those 600,000 moms have emotionally wrenching decisions to make every month about what’s most important, prioritizing the needs of themselves and their children. Without insurance, the cost of things like routine checkups, clinical breast exams, and gynecological exams are far too high to make it into the family’s monthly budget.

“They have to ask – am I going to buy groceries or go to the doctor? Groceries and taking care of their kids, every time. And they’re going to pay rent before health care. That’s just the kind of decisions our patients have to make,” said Marquez.

Making the situation even more complicated is the fact that women require more medical care throughout their lives than men do. “It’s primarily because of reproduction. Pure and simple, biology. There are theories out there about them being more willing [to receive care] and all that, but it’s just bottom line reproduction,” said Lyssa Jenkens of the Dallas Women’s Foundation.

Jenkens, a former economist with the Dallas Chamber of Commerce, says insurance companies know this fact and use it is a “pricing mechanism.” “There is a lot discrimination in the insurance industry. Issues like having a C-section, you now have a preexisting condition, and that seems, to me personally, unfair,” she said.

Substantial discrepancies in pay also exist for men and women in many jobs, Jenkens said. So, even though it costs more for women to buy their own insurance, and they are much more likely to be in the position of caring for a family on their own, they are in a less economically advantageous position than men to be able to do so.

Obviously, this issue affects women on the lowest level of the socioeconomic strata the most, with more than one-third of poor women nationally going without health insurance. (In the Kaiser Foundation study, “poor” is defined as family income below the federal poverty threshold.) Minorities are also disproportionately uninsured: Thirty-eight percent of Latinas don't have coverage, compared with 13% of white women who don't.

Frustration of a 'silent epidemic'

Hoffman can feel the frustration of his patients when they come to his clinic. “We say that it is a silent epidemic, because most of the people that come to us are not part of the mainstream, and they for the most part do not participate in the political process,” he said. When he tries to advocate on behalf of uninsured women, Hoffman says he is met with deaf ears.

Dental care is in more problematic for the poor because it is paid for out-of-pocket more often than other types of health care.

“If you’ve never had a toothache, you don’t really understand why dental care is important,” he said. Hoffman says that the majority of Americans with health insurance don't understand the impact that not being covered can have on someone's daily life. “Most of the population who are affluent go to the dentist twice a year; they catch issues early on before it becomes a problem,” he said. “Most of the patients we see have pain and infection because it's been put off.”

Going without preventative care: Costly, even deadly

Preventable or easily treatable health issues will often spiral into serious, debilitating health problems, Hoffman said.

A 2007 study by the Kaiser Family Foundation found that women without health insurance experience “higher use of emergency services, higher rates of bankruptcy, and even higher rates of mortality" – all of which could be reduced by providing all women with basic preventative care. Jenkens says this is why the Dallas Women's Foundation puts their money into clinics like Los Barrios. “We're trying to keep it from getting downstream to where it's a really, really costly issue,” she said.

The Kaiser foundation study highlighted how dangerous living without health care can be for women. About 40% of women without health insurance reported going without a pap smear when it was needed, as opposed to 20% of those with insurance. Similarly, 42% of uninsured women reported neglecting to fill a needed prescription, as opposed to 18% of those who were covered. Perhaps most telling, 67% said that at one point in the last year they “needed care but didn't get it due to cost,” as opposed to only 19% for those with insurance.

Marquez says she believes these sorts of tough choices that women have to make about their own health shouldn't be choices at all. “Just my opinion, as a human being you should not have to worry about where you're going to get health care or if you're going to get health care.”

The number of women without health care seems to be too large for even this impressive network of community clinics to handle on its own. The demand for care far outpaces the supply. “The need is so great, and the resources so few, that wherever we put our money it has big impact. But right now it's just a matter of doing the best with what's there,” Jenkens said.

Barbara Burton at the Hope Clinic in Garland sees this rampant demand first-hand. “Anytime we get a doctor to do a half day at the clinic, it fills up within 24 hours,” she said.

So while the nation's decision-makers continue to debate the latest reform legislation – while enjoying the best medical care the world has to offer -- hundreds of thousands of women in the Dallas-Fort Worth area will have to decide if they are going to buy their child new shoes or get a breast exam. Or whether they will have enough money to get a dental infection treated after buying groceries. Several doctors and administrators interviewed spoke of a “disconnect” between politicians and those “most vulnerable” in society – low income women raising families on their own.

Hoffman believes the negative implications affect more than just the women and children directly involved.

“It's a really sad situation," he said. "Ultimately, it's sad in terms of the overall impact on our society.”

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