How refusing to expand Medicaid has hurt folks in east Texas, and the quest of three men to meet the need

Kim Krisberg and David Leffler reported last month from Gun Barrel City, Texas, population 6,190, in Henderson County, on the years-long effort to establish a Federally Qualified Healthcare Center (FQHC) to meet the needs of low-income folks in the region.  The clinic, known as the East Texas Community Clinci (ETCC), is now up and running, serving some of the nearly 30% of Gun Barrel City's residents who don't have health insurance.  That's considerably higher than the 18% of Texans without health insurance, which is the highest state average in the nation.  Yet the clinic, which now has two locations, still does not have its FQHC status.  

Here's more on the two physicians and one administrator behind the ETCC, detailing their efforts:

Doug Curran and Ted Mettetal have practiced medicine for 80-plus years combined, most of it in a thriving private practice in the town of Athens, about 20 miles east of Gun Barrel City. In 2019, at an age when most physicians are ready to retire, the longtime friends set out on a new venture: opening a safety-net clinic that would treat anyone, regardless of their ability to pay.

* * * 

The Gun Barrel City clinic opened at 8 a.m. on May 20, 2020. As Curran waited for the first patients to arrive, he wondered — for a moment — what he had gotten himself into.

“Here I am, 70 years old, starting a new adventure,” he said. “You kind of ask yourself, what in God’s name am I doing?”

His friend Mettetal was 69. And Robison, then 45, had left a steady job and taken a pay cut to join them. The plan may have seemed crazily ambitious to an outsider, but the three men had seen firsthand the consequences of people having to forgo care because they couldn’t afford it. They felt compelled to help.

Retirement didn’t suit the doctors, anyway. They relished the joys and pace of small-town medicine: delivering a baby in the morning, stitching up a wound in the afternoon, making a house call after work.

“When you’re used to going 90 miles an hour, you kind of go stir crazy,” Mettetal said.

* * * 

Curran has tried for years to persuade the Republican-dominated state Legislature to address these problems. When he served as president of the Texas Medical Association from 2018 to 2019, he made it his mission to get Gov. Greg Abbott’s signature on a bill to expand Medicaid coverage, a position 69% of Texans now support, according to a 2020 poll by the Episcopal Health Foundation. But Texas remains among 12 states that have refused expansion, even though the federal government would pay at least 90% of the cost.

“I basically spent a year of my life trying to convince Texas legislators that they really ought to value our people more, they ought to provide better access for all our people, especially our working poor,” said Curran, who leans conservative but has grown increasingly progressive. “But our state has not had the wisdom of engaging that.” 

* * * 

The idea was to build a network of safety-net clinics to serve a mostly rural area east of Dallas, beginning with the clinic in Gun Barrel City. They’d combine the clinics with a medical residency program to bring desperately needed new doctors into the region.

To launch the East Texas Community Clinic, or ETCC, they persuaded two local organizations to put up $200,000 in seed money. For long-term funding they set out to apply to a federal agency, the U.S. Health Resources and Services Administration, which offers millions of dollars in grants and enhanced Medicaid and Medicare reimbursements to qualified clinics in poorly served areas.

The doctors have repeatedly gone back to these two organizations, along with a third funder more recently, for more money as they await approval of their FQHC status.  It's a story chock full of details and personality and well worth a read.  

And here's an October 6, 2022 follow-up story in Public Health Watch with some good news in the aftermath of the late September story--and attributable to that reporting. 

In the two weeks since its publication, the story has caught the attention of policymakers and audiences around the country. It has been shared on social media by Texas lawmakers of both parties, including U.S. Sen. John Cornyn, a Republican, and U.S. Rep. Lloyd Doggett, a Democrat. It has been published by The Texas Tribune, The Daily Yonder and the Forney (Texas) Messenger. It has also inspired follow-up stories, including this broadcast from an ABC affiliate in Tyler, Texas. People from around the country sent words of support and small donations.

The story’s impacts went beyond shares, likes and page views.

One of the problems Curran and Mettetal face is getting the U.S. Health Resources and Services Administration to approve East Texas Community Clinic as a [FQHC]. That designation allows safety-net clinics to receive enhanced Medicaid and Medicare reimbursements and gives them access to millions of dollars in federal grants. The doctors had expected to receive the designation by the end of 2021. But when our story was published, the crucial last step in that process — a site visit by federal inspectors — wasn’t scheduled until March 2023. That meant the clinic would have to continue relying on donations to stay afloat.

After reading the story, staff from Cornyn’s office contacted Curran, who had been trying to secure the senator’s help in moving up the visit. Just days after publication, Glen Robison, the clinic’s operations manager, got an email from the Health Resources and Services Administration saying it would reschedule the visit for mid-December.

That means Robison should be able to meet the end-of-year deadline to apply for $3 million in federal funds to support the clinic’s medical residency program.

Both stories are part of the Public Health Watch series, "The Holdouts" on what has happened in the dozen states that refused federal funding available under Obamacare to expand Medicaid.