State Sen. Juan “Chuy” Hinojosa, D-McAllen; state Rep. Oscar Longoria, D-Mission; U.S. Rep. Filemon Vela, D-Brownsville; and University of Texas Rio Grande Valley School of Medicine Dean John Krouse joined The Texas Tribune on Tuesday for a conversation on health care in Texas. Here are the takeaways:

Uninsured rates are high in Texas — and it’s worse in the Rio Grande Valley. Texas still has the highest uninsured rate of any state, with 4.5 million people living without health coverage. And those numbers are only worse in the Valley, where the uninsured rate is twice that of the state as a whole.

“This part of Texas is even worse than the rest of Texas,” Krouse said. “We have among the worst primary care to patient ratios in the country. … The funding is woefully inadequate.”

“The challenges that we have are many,” Hinojosa said.

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Solving the doctor shortage. There are not enough doctors in Texas, especially in certain rural stretches of South Texas. Addressing that shortage will require training — and retaining — more physicians in Texas. UT-RGV’s medical school, which accepted its first class last fall, is “part of the solution,” Krouse said. But Hinojosa said the state needs to add more residency slots for post-graduate medical training to remain competitive — a problem that has plagued Texas in recent years.

Funding woes. Panelists emphasized that properly funding health care requires contributions from federal, state and local governments. But several of those sources are uncertain. Vela said “we are in a really bad place” as far as a potential repeal of the Affordable Care Act — whose rollback would leave 2.5 million Texans uninsured, the congressman  said. Both state lawmakers came out against “block grants” for Medicaid — a system that would issue states large sums of federal money to allocate themselves — arguing that such a system would be difficult to implement effectively.

“I don’t think block grants is the answer,” Hinojosa said.

And Harvey hasn’t helped. The astronomical costs associated with rebuilding after August’s devastating storm — expected to top $200 billion — will only exacerbate the challenges of funding health care at the state level, lawmakers said. There are “limited resources,” Longoria emphasized. “Whenever we have to pay for something, something’s going to get cut.”

Read related Tribune coverage:

  • Doctors offering direct primary care charge a monthly fee for services that can be handled in the office. But patient advocates warn it is not insurance and offers no coverage for hospital or specialist care. [Full story]

  • Under a new law that took effect Sept. 1, insurance companies may not cover mental health and substance abuse care differently than they cover medical care. [Full story]

  • Defendants in Texas and across the country are sometimes asked to reimburse the government for the cost of their court-appointed lawyer through a practice called recoupment. [Full story]

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