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In Texas, COVID-19 cases have been skyrocketing. And there's another thing that has been surging as well. That's Texans without health insurance. A lot of people lost jobs that had health plans attached to them. Ashley Lopez of member station KUT reports the Texas hasn't set up any health care coverage options for many of them.
ASHLEY LOPEZ, BYLINE: Steve Alvarez is a Tejano musician who lives in the San Antonio area. In late June, he started feeling sick. It started out mild, but then he had fever, chills, shortness of breath. Alvarez thought it was a cold he just couldn't shake off.
STEVE ALVAREZ: I'd have a couple of good days. I felt like I'd backtrack, and I was just really run down. This thing lingered and lingered.
LOPEZ: Alvarez eventually got a free coronavirus test from the city. It was positive. Alvarez and his wife, who also got infected, never ended up in the hospital. But he says there were some scary days there.
ALVAREZ: We thought if this starts getting much worse, we need to start thinking about how we're going to deal with it, how we're going to pay for it. It was just abject terror as to what was going to happen.
LOPEZ: He lost his health insurance a year ago when he was laid off from his day job in construction safety. So while he was sick, he paid for everything - remote doctor visits, some prescriptions and over-the-counter medication all out-of-pocket.
ALVAREZ: If there's something that's not generic, that's just absolutely too expensive. I have to consider doing without it.
LOPEZ: The pandemic has driven the uninsured rate even higher in Texas. Now, among Texas adults under 65, 29% don't have health insurance.
Elena Marks is with the Episcopal Health Foundation in Houston.
ELENA MARKS: Texans who lose their health insurance that is tied to jobs simply have fewer options for new insurance because we do not have Medicaid expansion.
LOPEZ: Texas officials have refused to expand Medicaid despite having the highest uninsured rate in the country for years. Marks says the pandemic has raised the stakes.
MARKS: Everything that's happening now was happening before. It's just on a path of acceleration because there are so many more people who are sick and who are getting very sick. And the costs are really expensive.
LOPEZ: And this hurts patients.
Stacey Pogue is with Every Texan, a policy think tank in Austin. She says some uninsured people have found free testing, but others have had to pay hundreds of dollars they can't afford.
STACEY POGUE: We need to do everything we can to make sure people in our community aren't afraid to get tested because of cost or aren't afraid to get treatment because of cost.
LOPEZ: And when uninsured Texans do need care, it's the hospitals that often have to pick up the cost.
John Hawkins is with the Texas Hospital Association. He says even before the pandemic, the price for Texas hospitals to treat the uninsured was more than $7 billion a year.
JOHN HAWKINS: We've been able to make it work, frankly because of the growth in the state. But as we look at COVID going forward, it really does make the case that we have to look at addressing the coverage piece.
LOPEZ: Hawkins says there's some federal relief money coming in soon. But he says in the long term, this could lead to service cuts and hospital closures. And in the short term, uninsured Texans like Steve Alvarez are feeling squeezed. Alvarez says they're doing everything they can to not lose their house.
ALVAREZ: But that bottom's going to fall out soon enough, and that's what I'm really dreading right now.
LOPEZ: Advocates say Texas lawmakers will have to start seriously considering expanding health care coverage to more Texans - maybe even Medicaid. And they plan to make it a political issue for Texas Republicans in November.
For NPR News, I'm Ashley Lopez in Austin.
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