On a sweltering September afternoon in Starr County, Texas, the triage room at the local Memorial Hospital is packed to the gills. Dr. Jake Margo Jr., a family medicine physician, stands amid the controlled chaos, calmly explaining to anxious staff why a patient with a low-grade fever—something that could be treated with over-the-counter medicine—doesn’t need an emergency room bed. “We’re going to take care of the sickest patients first,” Margo says, his voice steady despite the relentless tide of need. The ER is already overflowing, with a monitor on the wall blinking the vitals of every bed and an ambulance idling outside, waiting for space to open up.
This is the new normal in the Rio Grande Valley, a region in South Texas with some of the highest uninsured rates in the United States. And, according to KFF Health News, the situation is only set to worsen. The number of uninsured residents is expected to swell over the next decade, driven by recent changes in national health policy and the expiration of enhanced Affordable Care Act (ACA) subsidies. Starr County, a mostly rural, Hispanic community where about a third of the population lives below the poverty line, finds itself at the epicenter of this looming crisis.
In 2024, Starr County made headlines for flipping Republican in the presidential election for the first time in over a century—a change driven by concerns over immigration and the economy. But now, new actions by the Trump administration and a GOP-controlled Congress are triggering a different kind of alarm: the growing inability of doctors, hospitals, and clinics to care for uninsured patients. The passage of the One Big, Beautiful Bill Act (OBBBA), a sweeping tax-and-spending law, and the pending expiration of ACA subsidies are projected to leave about 14 million fewer Americans with health insurance over the next decade, as reported by KFF Health News.
“You can’t disinsure this many people and not have, in many communities, just a collapse of the health care system,” warns Sara Rosenbaum, founding chair of the Department of Health Policy and Management at George Washington University’s Milken Institute School of Public Health. “The future is South Texas.”
Primary care doctors in Starr County now serve an average of just under 3,900 people each—nearly three times the U.S. average. With so few options, many uninsured residents use the ER as their first stop when illness strikes, often waiting until conditions become severe. Federal law requires hospitals participating in Medicare to stabilize or transfer patients regardless of their ability to pay, which means Dr. Margo and his team are left practicing what he calls “disaster medicine.” He describes patients arriving with chest pain or struggling to breathe—some collapsing, others having never seen a doctor before. “They’re literally dying,” Margo says.
The strain extends far beyond the hospital walls. When people are uninsured or on Medicaid, they rely on a patchwork safety net of clinics, community health centers, and public health departments, which often provide services at little or no cost. But these providers are now facing their own financial cliff. The Trump administration’s cuts to Medicaid and other federal health care funding, justified as efforts to eliminate “waste, fraud and abuse,” have left many rural health systems teetering. “Because the patient’s bill is not going to get paid,” says Dr. Joseph Alpert, editor-in-chief of The American Journal of Medicine and a professor at the University of Arizona, “uninsured patients stress the health care system.”
Trump’s new law prioritizes extending tax cuts that mainly benefit wealthier Americans and expanding immigration enforcement, covering the costs in part by slashing nearly $1 trillion from federal health spending for Medicaid and tightening ACA requirements. While administration officials argue that projections of mass coverage loss are “overestimates,” they have not provided alternative figures. Supporters of OBBBA claim those who need coverage can still get it if they meet new requirements, such as working in exchange for Medicaid. But critics argue that these changes, along with increased paperwork and reduced sign-up periods, will leave millions without a safety net.
The impact is already being felt. According to a recent AMGA survey cited by KFF Health News, nearly half of rural health systems could close or restructure due to Medicaid cuts, with almost three-quarters anticipating layoffs or furloughs—including frontline clinicians. In Cameron County, the public health department has eliminated about a dozen positions. In neighboring Hidalgo County, more than 30 jobs have been cut. In July 2025, the Texas Department of State Health Services canceled Operation Border Health, a massive annual event that had provided free health services to about 6,000 residents.
Gateway Community Health Center in Laredo, where about a third of patients are uninsured, is now in “survival mode.” With the future of ACA subsidies uncertain, the center is scrambling to find alternative funding to avoid layoffs and service cuts, putting expansion and hiring plans on indefinite hold. “That downsizing is happening as more people lose health insurance and need free or reduced-cost care,” says David Vasquez, the center’s director of communications and public affairs.
The financial toll is staggering. The Urban Institute estimates uncompensated care costs—services for which hospitals, doctors, and clinics never get paid—will increase by $204 billion over the next decade. Meanwhile, the Trump administration’s new rules cap federal programs that help providers cover these costs, reducing support especially in rural areas. While a temporary $50 billion fund has been created to support rural doctors and hospitals, it’s only a fraction of what’s needed to offset projected Medicaid funding losses. Additional cuts to rural health programs are on the table for the coming fiscal year.
In February 2025, the Trump administration slashed funding for the ACA navigator program by 90%. This program helps people find health insurance, and the cuts have left community health workers like Maria Salgado deeply worried. Salgado, who works for the nonprofit MHP Salud, spends her days tabling at community events, distributing flyers, and meeting one-on-one with clients to connect them to Medicaid and ACA coverage. “A lot of community members here, they’re going to be left behind,” she says.
The human cost of these policy changes is heartbreakingly clear to Dr. Chris Casso, a family medicine physician in McAllen, Texas. She’s seen patients delay care because they can’t afford insurance, only to watch their preventable conditions spiral into life-threatening illness. The pain is personal—her own sister, who worked as a medical biller, delayed treatment for heart disease and diabetes because she couldn’t afford coverage. She died at just 45. “It’s heartbreaking,” Casso says, tears welling in her eyes. “These are hardworking people. They try their best to take care of themselves.”
The future for South Texas—and communities like it—looks increasingly uncertain. As the safety net frays and the number of uninsured climbs, doctors, patients, and advocates alike are bracing for what comes next. For many, the stakes couldn’t be higher.
