ROBERT SIEGEL, HOST:
Last year, we spent around $2,700,000,000,000 on health care. That is more than the entire economy of France or Britain. Our national health care tab is huge. We pay for it through a variety of schemes, public and private. In a few minutes, our health policy correspondent, Julie Rovner, will give us the big national picture. But given the size and diversity of the country, the economics of health care vary from state to state. We've going to hear stories now from two states that differ dramatically. Texas has the highest percentage of uninsured people in the nation - 25 percent. And reporter Carrie Feibel, of member station KUHF, tells us about one uninsured woman from Houston.
CARRIE FEIBEL, BYLINE: More than six million Texans have no health coverage - government or private. That often means an anxious scramble for care at overcrowded charity clinics or the emergency room.
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FEIBEL: One of those six million works here, at the Faith Christian Academy. It's a private school located just a few miles south of Houston's refinery row. You can't see the petrochemical plants, but you can sometimes smell them. Melinda Maarouf is a teacher's aide.
MELINDA MAAROUF: Unfortunately, we're a small school, and the budget doesn't allow for insurance for the employees.
FEIBEL: Maarouf is 55, divorced, with one daughter in college. The school can't afford to bring her on full time right now, so she makes just over $11,000 a year. That's right around the federal poverty line, and that means hard choices when it comes to her health. Maarouf has hypertension, and she says there have been times when she skipped pills to make them last longer.
MAAROUF: I can always tell when my blood pressure is elevated. I feel uncomfortable. I feel edgy and kind of shaky, and my ears ring.
FEIBEL: Maarouf knows that if she doesn't control her pressure, she could have a stroke, a heart attack or kidney damage. Recently, she found help at a charity clinic called Ibn Sina. She pays only $25 per visit. But Maarouf says the blood pressure is all she can afford to treat right now.
MAAROUF: I haven't had a Pap smear - goodness - I can't even tell you - probably since my daughter was born, and she's 26. And I haven't had a well woman exam, and I'm sure it's time for some routine blood work. But, you know, it's just not in the budget.
FEIBEL: Maarouf has never had a mammogram, and she's continued to push off some needed dental work. Medical bills scare her. In 2010, she went to the emergency room with chest pain. Doctors didn't find anything wrong, but she ended up with $3,000 in bills she couldn't pay.
MAAROUF: I think that the E.R. physician he was there for maybe a total of 20 minutes. His bill was around 1,200. And then there was the bill for the EKG. There was the bill for the chest X-ray. There was the bill for the blood workâ¦
FEIBEL: Maarouf couldn't keep up with the payment plan, so she sent simply shoved the bills into the bottom of her drawer and swallowed her anxiety.
MAAROUF: Oh, my credit is pretty much, you know, shot, as far as that goes. But, you know, there's not much I can do about it. You know, you just have to move on. Do what you have to do to survive.
FEIBEL: Melinda Maarouf is like millions of other working Texans. As long as she's not disabled, she can't get Medicaid, and she's years away from Medicare. Hospitals in Texas spend over $4 billion a year treating uninsured patients like Maarouf. County taxpayers absorb some of the cost, and some get shifted onto insured Texans who end up paying higher premiums for their own coverage. Melinda Maarouf says she feels stuck and exposed.
MAAROUF: It's like you're sort of walking a tightrope or sometimes feel like I'm on the edge of a cliff. As long as everything is status quo and there's no glitches or bumps in the road, I feel OK. But I sometimes feel like I'm one emergency room visit away from a catastrophe.
FEIBEL: And Maarouf knows that the stress and anxiety probably aren't helping her blood pressure, either. For NPR News I'm Carrie Feibel in Houston. Transcript provided by NPR, Copyright NPR.
