County Judge Clay Jenkins and Dr. Philip Huang, the head of Dallas County Health and Human Services. (Photo courtesy NBC 5's Live Feed)

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The Reason Why Fighting Coronavirus Will Be So Difficult In North Texas

We have more uninsured than basically anywhere in the country. That throws a wrench into public health models.

On Wednesday, after the county banned social gatherings of 10 or more, County Judge Clay Jenkins made the ominous prediction that he believes controlling the coronavirus will be more difficult here than any other city in the nation. We are in the largest city with the worst uninsured rate, where nearly a quarter of our residents do not have insurance. Of 548 American cities regardless of population, Dallas ranks 539th.  About 24.42 percent of our city’s residents lack health coverage. That is more than 317,000 people out of 1.3 million.

The reason is the Texas Legislature, which has stubbornly refused to expand Medicaid ever since President Barack Obama signed the Affordable Care Act in March of 2010. The U.S. Supreme Court ruled that states could decide whether to do this, a move that would allow millions of Americans the ability to buy health insurance. Texas, repeatedly, has said no. This means more than a million Texans fall into what’s known as a coverage gap or donut hole: they make too much to go on Medicaid but too little to qualify for the federal subsidies that make Obamacare’s exchanges affordable.

So they go without. This is a massive group of working poor, men and women who stock grocery store shelves and cook cheeseburgers and do any number of service jobs that you come into contact with every day. (Or used to, at least.)

Here is Jenkins speaking on Wednesday:

My fear is that COVID-19 will be worse in Dallas County and North Texas than most other places in the United States for two underlying factors. … One is we have community spread and it’s beginning to be massively expanding. But two is, every other place in America that has faced this so far has what’s called Medicaid expansion, so that there’s healthcare coverage and people are going to the doctor who make $14, $15 an hour.

We don’t have that in Texas. (Dallas County has) a quarter million people in our workforce who don’t have health coverage because we don’t have that. And because of that, you’ve got people leaving their house everyday going to their workplace. If they just have a runny nose and a cough, they can’t afford a doctor visit. And those folks, it’s not their fault, but they will be a vector. It’s not their fault that they don’t have health coverage. It is, frankly, the state’s fault. But it’s not their fault.

And because we have so many of those people, more people don’t have coverage because of that Medicaid expansion decision in North Texas than in any other metro area in the united states. Because of that, we are in a uniquely bad situation and we’ve got to act aggressively – all of us, everyone personally responsible for everyone, if we’re going to come out of this with as few casualties as possible.

A key part of preventing a run on hospitals is the system’s funnel. Say your symptoms are all there: you’ve got a fever, a cough, and you’re having trouble breathing. You’re asked to call your doctor. Your doctor decides whether you come into the office; the CDC advises that they allow mild cases to quarantine at home. So should you even be tested for COVID-19? Or are your symptoms severe enough that you need to be hospitalized? The physician makes those calls.

Take out that doctor and you destroy the pipeline. The uninsured get sick and go to the emergency room, where there are only so many available beds. Last week, when we could see this coming, I posited this question to Dr. Mark Casanova, the head of the Dallas County Medical Society. What do we do with the population that lacks a gatekeeper?

For one, he said the media helps. Two, he said the county needs to get that information out via its website. There’s now a hotline.

How do we relay information to those individuals? Is it contacting social services through the city of Dallas? Is it contacting the County Health Department? And then being able to go to a website and having that resource. Saying, ‘Hey, listen, if you’re symptomatic and you feel ‘I need to get tested, but I want to do it the right way. I don’t want to put myself at risk and catch COVID-19 in a crowded ER when all I really had was a regular coronavirus.’ Vice versa, if I have (novel) coronavirus, I’m going to make sure I know, and I get the appropriate care I need, but again, keep others safe.”

So here you go: if you’re uninsured, call the hotline. That number is 972.692.2780. Hours are 9 a.m. to 8 p.m. Outside of those, dial 211. Drive-thru testing is available at Parkland for patients there. Read more here. Two more drive-thru facilities will open this weekend, but you’ll need a referral to be tested. If you’re insured, your first call should be to the hotline or to your doctor’s office.

For the rest of us, stay home and stay away from others. The uninsured population is counting on it. We all are.

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