Updated at 7:24 p.m., Oct. 3, 2019: After this story was published, Baylor Scott & White Health helped Oscar Torres clear his $20,000 medical bill. The story was also updated with information about the company's financial assistance program.

AUSTIN — Oscar Torres was struck in the face by a metal sheet while repairing a garage door at work and rushed to Baylor University Medical Center in October 2017.

Doctors spent 12 hours treating the gashes across his nose and right eye. Two weeks later, Torres was shocked to receive a $20,000 bill in the mail. After The Dallas Morning News wrote about his story, Baylor Scott & White Health, which oversees the hospital, helped him apply for financial assistance to forgive his debt.

But the bills didn’t stop there. After having an appendectomy at Parkland Memorial Hospital last year and complications following the surgery, his debt soared to $250,000.

“If it happened to me, it can happen to anyone,” said Torres, a 44-year-old who migrated to Dallas from Veracruz, Mexico, for work in 2016.

People of color, like Torres, are more likely to face medical debt because they lack health insurance coverage, have lower incomes, according to a report that the left-leaning Center for Public Policy Priorities published last month.

Nearly 4.3 million Texans living in ZIP codes where more than 60% of the residents were not white had unpaid medical debt sent to a collections agency, according to an analysis of credit reports and 2017 U.S. Census data.

In Dallas County, 32% of residents in neighborhoods of color had medical debt sent to a collections agency, compared with 13% of residents in the county’s majority white neighborhoods. Across the state, the rates were 26% in neighborhoods of color and 23% in predominantly white ZIP codes.

Dallas County residents living in neighborhoods of color also had higher median medical debt — $846, $111 more than the median for those living in white neighborhoods.

Jonathan Lewis, a CPPP policy analyst and one of the report’s authors, said 1 in 3 Texans in neighborhoods of color are burdened by medical bills they can’t pay.

“You have a large segment of the population that is too poor to afford insurance and is having to receive medical care for things that, you know, are unexpected, and are then left with a medical bill that they can't afford,” he said.

A lack of health insurance

These disparities are the result of historic policies such as redlining, the practice of making loans and services out of reach for people of color, but they’re compounded by that population’s higher uninsured rates, Lewis said.

He added that it doesn’t help that Texas hasn’t expanded Medicaid, a joint federal-state health care program for low-income individuals. The expansion of Medicaid under the Affordable Care Act was intended to increase coverage among individuals who earn up to 138% of the federal poverty level.

The CPPP estimates that over a half-million adult Texans of color could be covered if Medicaid were expanded. But Texas lawmakers have staunchly opposed Medicaid expansion and led the charge against the act, filing multiple lawsuits.

Still, Medicaid wouldn’t necessarily help Torres, who can’t qualify for it. And he can’t get employer-sponsored insurance as a day laborer.

“I think it’s going to be impossible for me to pay $250,000,” he said. “I just hope I can get some sort of help or that they make some sort of affordable insurance for us immigrants.”

Oscar Torres poses for a photograph near his home in Dallas on Sept. 21, 2019. (Jason Janik / Special Contributor)

In Dallas County, 33.8% of Hispanics were uninsured, according to 2017 Census data. This was the highest uninsured rate among all race and ethnic groups in the county. It was also higher than the uninsured rate of Hispanics in the urban counties of Tarrant, Travis, Harris, Bexar and El Paso.

Opponents of Medicaid expansion point out that 12% of uninsured Texans are already eligible for Medicaid or another public program, according to the Urban Institute.

And most county and federal health care professionals don’t take immigration status into account, said David Balat, the director of the Right on Healthcare initiative for the conservative Texas Public Policy Foundation.

“People want more affordable care,” he said. “We shouldn’t double down on exacerbating the problem by focusing on insurance, but by implementing real solutions that are affordable and that increase both access and quality.”

Expensive care

Not having health insurance also means people of color are more likely to wait for an emergency to seek medical care, and emergency rooms are often the most expensive option, Lewis said.

Latosha Lewis, a 37-year-old home health aide (and who is not related to Jonathan Lewis), is unable to afford insurance on her $8-an-hour pay, so she visited a low-income health clinic for her head and neck aches.

Latosha Lewis, one of nearly 4.3 million people of color with medical debt in Texas, poses in Dallas on Friday, Sept. 20, 2019. She is a home health aide who can't afford health insurance on her $8-an-hour pay, so she went to the hospital when the pain became unbearable. (Brian Elledge / Staff Photographer)

When the pain persisted, she headed to a Richardson hospital on Labor Day of 2018. Doctors gave her a shot of pain medicine to cope with what they said was stress-related tension. She hasn’t been able to pay the $2,000 bill.

“When I get a medical bill, I just throw it away because when you don’t have the money, you just don’t have it,” she said. “Me and [people of color] in the community, we can’t afford medical bills because it depends on how much you make.”

People of color in Dallas County earn an average income of $58,243, which is $53,136 less than their white neighbors. At the state level, the difference in average income is $34,541.

Related: Here's how many Texans don't have health insurance, according to new census data

Unpaid medical debt furthers the divide in wealth, making it more difficult for people of color to obtain car loans or home mortgages, Jonathan Lewis said.

Latosha Lewis’ unpaid bills damaged her credit score, crushing her dream of getting a condominium, and her aches have returned because of the financial stress.

“I live from paycheck to paycheck,” she said. “This debt doesn’t help.”

Hope in local resources

Patients often aren't aware of the avenues available to them to pay their medical bills. One resource for Dallas County residents is the Parkland Health & Hospital System, which serves as the county’s public hospital.

To qualify for the Parkland Financial Assistance program, applicants must be below 250% of the federal poverty level, which is roughly an income of $31,000 for one person, and have no access to other health insurance or assistance programs, said Bart Ensley, director of patient access for the hospital system.

The program is open to people regardless of immigration status, and the hospital runs another program for individuals who are self-paid. Parkland financial counselors help screen applicants for other assistance programs from the state or nonprofits.

Ensley said 76,000 people are enrolled in the plan, with many in the coverage gap of people who make too much to qualify for Medicaid but can’t afford or access private insurance.

If Texas accepted federal funds to expand Medicaid, it would take the burden off Parkland’s charity program, Ensley said.

“That would be a great impact on Parkland because our charity program is just that — a charity,” he said. “So these services that we’re offering for people who can’t afford care, it’s a financial write-off. With the expansion of Medicare, that would allow us to actually get a payoff.”

Latosha Lewis didn’t know about Parkland when she went to the Richardson hospital, but she plans to go there for future medical issues. Through the social justice organization Faith in Texas, she has been sharing her story to advocate for more state and local resources for people with medical debt.

“I want someone to think of a plan or ideas on how they can create a policy for any hospital to help any people that are poor,” she said. “It can’t just be Parkland.”

The ACA requires nonprofit and public hospitals to have financial assistance programs but does not outline who or what can be covered.

State lawmakers could set these guidelines or help cap medical debt for low-income people, Jonathan Lewis said. They passed a law tackling surprise medical bills during this year's legislative session, but it only benefits insured patients, he said.

Baylor Scott & White Health also offers financial assistance at its institutions.

The company gives a 100% discount to patients with incomes at 200% or less of the federal poverty guidelines, said Sarah Knodel, senior vice president of revenue cycle at Baylor Scott & White Health. It offers a 90% discount to patients whose incomes fall between 201% and 500% of federal poverty guidelines if their medical bills exceed 5% of their annual income, she said.

Knodel said patients are told about the program when they arrive and can ask for financial assistance until a year after getting a bill, although the company will make exceptions. Torres said he didn't know about the program, but Baylor helped him apply for financial assistance after The News shared his story.

"As a Christian ministry of healing, we feel like this is our commitment to the community to make sure that we're serving all of our patients and making sure they have access to high-quality care," Knodel said.

Torres said taking $20,000 off his medical debt will help. But he said he's still struggling to see from his right eye, and doctors warn him his sight will only get worse unless he has a $4,000 follow-up surgery.

Even at a discounted rate, he said it would cost him $2,500 to have it done at Parkland.

“Everyone needs medical care, but, in the end, we end up in debt,” he said.