Tiffany Conner, 43, has spent a large chunk of her life without health insurance. There was a brief period, she said, when she made so little money she was eligible for Texas' Medicaid program.
But a few years ago, she got a part-time job. It offered zero benefits, but the pay was enough to disqualify her from the program.
Conner found herself uninsured, again.
“At one point, you almost kind of get used to it,” she said.
Conner, who lives in South Austin, is a single mom. Her mother helps with her 5-year-old son, but for the most part, she’s on her own if something happens.
She said getting sick is a fear that looms over her all the time.
“It’s terrible,” Conner said. “If I get sick it becomes a bit of a challenge.”
The fear has escalated in the past few weeks, as news reports trickle in about the spread of the coronavirus in the U.S. Conner said it’s “pretty scary” to think of what would happen if she got sick.
“When you have something like this – this pandemic – it definitely heightens your awareness of being uninsured,” she said.
So far, her plan has been to focus on not getting sick in the first place. Conner, who has a master’s degree in information science, said she is making an effort to get information about how to prevent coming into contact with the virus from as many proper sources as possible.
She's also worried about her mother, who is in her 60s. Public health officials say people over 60 are one of the most vulnerable populations.
As a result, Conner said, she’s paying a lot of attention to what folks in the public health community are advising.
“We are washing our hands,” she said. “We are avoiding people who are sick – not putting ourselves in context where we can potentially be exposed. But there is only so much you can do.”
Conner said she wishes she had access to a doctor or another medical professional she could go to with concerns.
“This is the time when it would be wonderful … to be able to call my [primary care provider] and say, ‘Hey, what do I need to be doing here?’” she said. "'How scared should be I? Or what should I be worried about? What precautions should I take?’ All I can do is go on the basis of what I am reading online.”
Calling a doctor with questions is not something a lot of uninsured people can do, Dr. Jewel Mullen, associate dean for health equity at Dell Medical School, said.
And that's one of the main pieces of advice public health officials are giving people right now, she said.
“We are telling people, ‘Don’t just go to an emergency department or show up the doctor’s office – call your doctor,’” she said. “Fifty percent of people who lack health insurance report that they don’t have a usual source of care. There’s no logical place for them to automatically call.”
Mullen, who is also a primary care physician, said a big part of her job is doing what she calls “right-sizing concern.” Basically, she helps patients run through a checklist to figure out how at risk they are of getting sicker or getting someone else sick.
“Think about how often people just want to call and say, ‘Do I need to come get a test for that?’” she said. “People who lack insurance don’t as much ease at just talking to someone to get peace of mind and reassurance about following good public health advice.”
More than 5 million Texans don’t have health insurance. The state has the highest uninsured rate and number in the country – and it’s been getting worse recently.
Anne Dunkelberg, an associate director with the Center for Public Policy Priorities in Austin, said she's concerned about this population as the coronavirus spreads.
“They are not quite as vulnerable as seniors,” she said, “but they do face a special round of challenges.”
Most of these people are among the state’s working poor. Dunkelberg said these people work mostly in the service industry and – on average – make less than $32,000 a year.
“Our folks who are out there in the retail and service trades – practically and economically – have a hard time trying to comply with the ideal behaviors that we are putting out there as what we want people to do during a disease outbreak,” Dunkelberg said.
Another piece of advice people in the service industry often can’t follow: staying home if they feel sick.
Jonathan Lewis, a policy analyst at the Center for Public Policy Priorities, said about 78% the state’s service industry doesn't have sick time.
“This is especially concerning because this is the industry that is working in restaurants, handling food, cooking food,” he said. “These are folks who are working in nursing homes, that are taking care of the elderly – that are particularly more at risk.”
Lewis said a lot of these workers are financially incapable of taking time off and that will only make it harder to contain the virus.
“That’s a pretty big part of our population that does not have the ability to stay home without losing wages,” Lewis said. “And so they are more likely to end up continuing to go to work even if they do feel under the weather.”
Another piece of advice that’s harder for uninsured folks to follow: making sure they have an extra month's supply of medications. Without insurance, Mullen said, getting medication can be prohibitively expensive, particularly for the working poor.
There also aren't a lot of places the uninsured can turn to for care. Mullen said the spread of the virus could end up putting significant strains on safety net providers in Texas, like federally qualified health centers.
Mullen said she hopes all this forces state leaders to take a look at the cost of the state’s high uninsured rate.
“What stays at the front of my mind is how we keep that conversation going when the emergency ends,” she said. “Because for 20% of adults and more than 10% of children in Texas that’s a daily, daily problem – only made worse at times like this.”
Conner said she hopes people do what they can to avoid spreading the virus.
“If you care about the people in your life – especially people who don’t have health insurance or access to medical care – take those tiny precautions,” she said. “Remember it’s not just about you.”
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