‘‘In a sense we've been in the worst-case scenario in Texas for a long time,’’ said Lewis Foxhall, MD Anderson’s vice president of health policy in Houston. ‘‘The large number of uninsured and the large low-income population creates a very difficult problem for us.’’
Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors’ offices. But in the first year, $600 million was cut from the centers’ usual allocation, leaving many to use the money to fill gaps rather than expand.
There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.
Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.
For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.
‘‘They always attended to me,’’ she said, ‘‘even though it’s slow.’’
Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .
Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .