Longtime friends and physicians Ted Mettetal, left, and Doug Curran stand outside the East Texas Community Clinic's second location in the town of Athens. Photo credit: Blaine Young

In 2021 and 2022, Public Health Watch reporters Kim Krisberg and David Leffler made six trips to rural Henderson County, Texas, to interview two physicians who had opened a clinic for low-income, uninsured residents. The initiative underscored a larger issue: Because state leaders had refused to expand Medicaid, more than a million Texans, many of whom lived in rural communities, were struggling to get health care.

What follows is an update on the doctors’ efforts to make the East Texas Community Clinic a federally qualified health center, or FQHC — an official designation that is key to the clinic’s long-term survival. Read the original story here

Almost three years after the East Texas Community Clinic took in its first patient, it’s finally getting the federal support it needs to keep the doors open indefinitely. 

On April 27, the U.S. Health Resources and Services Administration approved the clinic’s application to become an FQHC “look-alike.” The special designation, given to clinics caring for medically underserved populations, comes with enhanced Medicaid and Medicare payment rates, as well as new grant opportunities, that will be central to the clinic’s long-term financial stability. 

An ongoing series on the states that refuse to expand Medicaid.
An ongoing series on the states that refuse to expand Medicaid. Credit: Rob Dobi

Glen Robison, ETCC’s chief executive officer, had been working on the FQHC application since before the clinic opened. It took him two attempts, thousands of hours and as many pages of paperwork. “But it’s all been worth it,” he said.

The safety-net clinic — the idea of longtime friends and physicians Doug Curran and Ted Mettetal — opened its first location in May 2020 in a renovated accounting office in the town of Gun Barrel City, 57 miles southeast of Dallas in Henderson County. The goal was to serve anyone, regardless of their insurance status or ability to pay. Word quickly spread, and people poured in for help, many having delayed needed care for years because they couldn’t afford it.  

Glen Robison, the clinic’s CEO. Photo credit: Blaine Young

Nearly one-third of Gun Barrel City residents younger than 65 have no health insurance, according to the latest census data, which is more than three times the national rate. They live in one of 10 states where lawmakers refuse to expand Medicaid under the Affordable Care Act — a decision Curran, an ardent expansion advocate, calls “stupid” because it leaves billions of federal dollars on the table that could be helping the state’s working poor. 

About 4,700 people in Henderson County would be eligible for coverage if Texas adopted expansion, according to the Houston-based Episcopal Health Foundation. Many of those people rely on ETCC — which opened a second location in 2021 in Athens, 21 miles from Gun Barrel City — as their primary source of medical care. The number of patients on the clinic’s rolls has grown from 1,870 in 2020 to almost 8,700 today. By the end of this year, Robison expects it to top 12,000. 

About 30 percent of the clinic’s patients are uninsured and 40 percent have Texas Medicaid coverage, which pays far lower reimbursement rates than private insurance and Medicare, Robison said. 

“That’s a prescription for disaster if you’re not an FQHC,” Curran said about the clinic’s payer mix. 

Committed donors helped ETCC fend off financial ruin while Robison led the years-long effort to turn the clinic into an FQHC. The newly secured federal designation, and the extra funds that go with it, “will be a godsend to stabilize our operation,” Curran said.   

But caring for so many uninsured and underinsured patients will never be easy. “We’re still hemorrhaging money,” Robison said. It costs about $140,000 a month to run ETCC, which has a staff of 29, including six doctors. 

Robison said word is still spreading that ETCC takes people without health insurance and accepts Texas Medicaid — something many doctors don’t because it pays so poorly — and patient loads are growing. 

He expects the number of uninsured patients to go even higher as Texas redetermines Medicaid eligibility for those who qualified during the national COVID-19 emergency. The unwinding process, which began in April, could result in loss of coverage for as many as 2.7 million Texans.

Having FQHC status will make it much easier for ETCC to accommodate the crush of patients, but it will still need donations to keep up with demand. Expansion plans include a third clinic, also in Athens, and a fourth in nearby Van Zandt County, where about one-fifth of residents younger than 65 are uninsured.

When ETCC opened, Curran and Mettetal, both in their 70s, were the only doctors on staff, sometimes seeing dozens of patients in a shift. Now that the free clinic they dreamed up during early-morning walks near Curran’s cattle ranch is on the cusp of financial stability, they say they might slow down but don’t intend to step away.

“I don’t want to be an old man sitting on a porch doing nothing,” Curran said. “I want to be a pain in the ass for somebody until I’m gone.” 

This story is part of “The Holdouts,” a reporting collaborative focused on the 10 states that have yet to expand Medicaid, which the Affordable Care Act authorized in 2010. The collaborative is a project of Public Health Watch and is supported by grants from The Commonwealth Fund and the T.L.L. Temple Foundation. The contents of this article do not necessarily reflect the views of T.L.L. Temple Foundation or any director, officer or employee thereof. 

Kim Krisberg covers health care access and the impacts of being uninsured. Reach her at kkrisberg@publichealthwatch.org. Follow her on Twitter at @KKrisberg.