Program cuts leave patients in lurch

MARFA — One local woman was preparing for gallstone surgery when she got the news: Her health insurance didn’t work anywhere in the Big Bend region.

For decades the 51-year-old local, who spoke on condition of anonymity because she did not want friends and neighbors to know her health concerns, has relied on Primary Health Care, a state-run program that subsidizes health care for people who make less than 200 percent of the federal poverty line. In other words: People who aren’t living in poverty but might still struggle with medical bills.

In August, though, the Texas Health and Human Services Commission abruptly cut ties with clinics throughout the region. And with talk of further cuts, even programs at those out-of-reach clinics could soon be on the chopping block.

For the woman, the news came as a shock.

I’m not even sure what to do,” she said. “I’m just feeling a little devastated.”

In a letter in August, HHSC told several Big Bend clinics that Primary Health Care contracts would expire on August 31 and that “a new contract will not be extended.”

It also gave doctors a form letter to give patients, which explains that “certain primary health care providers in your area will no longer be offering services” and that “this change may affect your current provider.”

It referred some people to an online coverage map showing the nearest remaining Primary Health Care providers in Texas. From Marfa, the nearest clinics are in Odessa, almost three hours away.

Marfa Country Clinic received notice by email on August 19. The email began, “As you are aware” — but Valerie Breuvart, a staff member at the clinic, said the clinic “hadn’t heard anything” prior to the email.

For patients who weren’t poor enough to qualify for Indigent Health Care or Medicaid, the Primary Health Care program was the “only program that would pick them up,” Breuvart said.

Those patients, she said, are “getting the short end of the stick.”

Stacy Ruckman, chief financial officer for Preventive Care Health Services, says she was told in a conference call with HHSC that the Primary Health Care program was being ended entirely — to be replaced by something new as late as 2021.

They basically just told us that as everyone’s contract expires, they’re not renewing because that program itself is over,” she said.

What exactly that means — especially for patients — is still unclear. HHSC did not respond to multiple requests for comment.

In 2015, Texas lawmakers transferred control of Primary Health Care and other programs from the Department of State Health Services to HHSC, a newly created entity. Since then, HHSC has been undergoing a process it calls “transformation” to make state health-care services “more efficient, effective, and responsive,” according to its website.

The woman with gallstones said it would be a “hassle” to find a new health program that covered her — much less to travel over five hours round trip for surgery. But with her condition, she doesn’t see any other choice but to make the trek.

On Wednesday, she says she spoke with a nurse who stressed the gravity of her medical situation. “I need to take care of [the surgery] as soon as possible, before anything else happens,” the local woman said.