environment of independence rather than dependence," said spokeswoman Catherine Frazier. "Texas does provide an adequate safety net to those truly in need … and many individuals simply choose not to purchase healthcare coverage."Frazier pointed to several initiatives, including medical malpractice limits and a year-old program to subsidize insurance for small businesses. As of August, the program had insured 4,266 people.

Esperanza's patients have jobs, said clinic Chief Executive Mike Campbell. But because many businesses don't offer health benefits, demand at the clinic is skyrocketing. Esperanza saw 13,000 patients last year, up from 11,000 the year before. "We are at the breaking point," Campbell said.At Shannon Medical Center, San Angelo's largest hospital, 30% of patients coming to the ER lack coverage, close to twice the national rate.