Dade Phelan’s Efforts to Expand Healthcare Still Leave Many Struggling in His District

The measures, authored by Republicans and Democrats, were applauded by health advocates such as the Texas Medical Association. This month, an updated version of one of the most noteworthy bills took effect, extending postpartum Medicaid coverage for new mothers from two months after giving birth to a year.

Phelan toes a conservative line, including supporting one of the country’s most restrictive abortion bans. But some advocates were hopeful that Phelan’s “Healthy Families, Healthy Texas” plan, which included bills from Republicans and Democrats, might signal openness to Medicaid expansion approval to cover more low-income adults. Texas is one of 10 states that haven’t expanded the program and has the nation’s highest rate of residents without health insurance, at nearly 19 percent for those under age 65.

Phelan is fighting to keep his House seat in a primary runoff on May 28 in his far southeast Texas district. In the March primary results, Phelan trailed his Trump-endorsed challenger David Covey by three points. Another candidate, Alicia Davis, came in third and has since endorsed Covey. It was the first time Phelan had faced an opponent since he was elected to the House in 2014.

District 21 represents all of Jasper and Orange counties and about a quarter of Jefferson County’s population, including part of Beaumont, Phelan’s hometown. Nearly 19 percent of District 21 residents younger than 65—or about 28,500 people—are uninsured, according to the Census Bureau’s 2022 five-year estimates.

Like much of Texas, the district has a shortage of primary care providers. Hospital services are tenuous. In rural Jasper County, there’s only one hospital—Jasper Memorial, part of Christus Southeast Texas—and it no longer has a labor-and-delivery unit. The next closest is an hour northwest to Lufkin or an hour south to Beaumont.

The health district started offering free and low-cost primary care about 30 years ago to help address the region’s access gap. Its clinic, located inside the agency’s century-old building near Jasper’s town square, sees hundreds of primary care patients a year, all of them uninsured and living on low incomes.

In 2016, Jessica Hill, then executive director of the Orange County Economic Development Corporation, was attending a Commissioners Court meeting when she got a text message: Baptist Hospital in Orange, which had been cutting its services for years, was closing its ER, citing financial strains that included the state’s failure to expand Medicaid. That left the county without a single hospital.

Phelan’s House district cuts across a range of county-level uninsured rates. In Jefferson County, where Beaumont sits, the uninsured rate is almost 23 percent; in Orange County, it’s 16 percent, and in Jasper County nearly 19 percent. The district’s uninsured rate for children alone—those 18 and under—is in double digits, at 10.4 percent, despite Medicaid’s Children’s Health Insurance Program. One of Phelan’s “Healthy Families” priority bills, House Bill 290—which ultimately was folded into another bill signed into law in 2021—was aimed at streamlining CHIP enrollment so kids don’t churn in and out of coverage.

Phelan hasn’t endorsed expansion, despite evidence of its positive health and financial benefits. But his healthcare work in the House—such as shepherding the Medicaid postpartum extension through two legislative sessions, benefitting 137,000 Texans—has signaled his interest in addressing systemic health issues.

TAN Healthcare, a federally qualified health center in District 21, takes Medicaid, but its providers regularly have trouble finding nearby specialists willing to take Medicaid referrals, said Dena Hughes, TAN’s chief executive officer. Sometimes the closest available specialist is more than an hour away in Houston, which is especially difficult for people with limited incomes and transportation.

MyEisha Clifton, lead nurse practitioner and director of medical services at TAN, said the center can help people access low-cost primary care and discounted prescriptions. But if uninsured patients need higher-level care—for example, TAN has recently seen a lot of cancer cases, Clifton said—the costs can be devastating.