Deep in the troubled heart of Texas, health care suffers

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By Sharon Jayson, Kaiser Health News

AUSTIN, Texas — The booming $1.8 trillion Texas economy rivals that of many countries and puts the state at the top of a host of rankings for its fast-growing cities, low unemployment and job growth.

But the familiar Texas braggadocio disappears when it comes to health care.

Texas has both the largest number (4.7 million) and highest percentage (19 percent) of uninsured residents under age 65 in the country, according to a new Urban Institute analysis. Two-thirds of the uninsured are in families with at least one full- or part-time worker. The state ranks 34th in the 2017 issue of America’s Health Rankings, an annual state-by-state assessment of the nation’s health. Thirty-three percent of adult Texans are obese. The state’s maternal mortality rate is 34.2 per 100,000 live births, a rate that has increased 10 percent since 2016 and is one of the worst in the country. It ranks 47th in the number of primary care doctors per capita.

The state’s “Don’t Mess With Texas” mantra drives much of its politics and policies, as limited government, low taxes and individual rights have prevailed at the statehouse for almost a quarter-century. That freewheeling formula has worked gangbusters for the economy, including the business of medicine, giving rise to some of the nation’s wealthiest hospital systems, as well as hundreds of freestanding emergency rooms and surgery centers.

But it has also left citizens struggling to get care and pay bills in health care’s wild west. It has allowed and supported entrepreneurial health care practices that are illegal in many states, including freestanding emergency rooms, doctor-owned hospitals and balance billing. Texas has more uninsured residents than any other state, in part because its largely Republican state politicians elected not to expand Medicaid.