Healthcare access isn't top of mind when people think of Collin County, an area known for growth and affluence.
But for the people who have been left behind as the county prospers, there are few places to go for healthcare.
Collin County has thousands of residents who lack medical insurance. About 11% of Collin County's roughly 1.3 million residents under age 65 are uninsured according to data from the U.S. Census Bureau. In certain parts of the county, like East McKinney, the uninsured rate is even higher.
The county has a program that provides healthcare for uninsured residents earning 100% or less of the federal poverty rate. That's an annual income of $15,960 for a single person. Qualifications depend on "income, what you own, where live, help you receive, and other items" according to the county's application. It's intended to help pay for medical care "on a short-term basis" according to the application.
More than a third of uninsured adults under age 65 have medical debt according a recent KFF health policy poll.
KERA requested an interview with Collin County about a month before this story published. The county said it doesn't do interviews on the indigent care program and asked that KERA send questions via email. The county told KERA via email it wouldn't provide responses for the story.
The funding for the indigent care program was about $6.8 million in the county's 2026 fiscal year budget, which totaled about $599.2 million. About 5.7% of the county's population — more than 70,000 people — lives in poverty, according to U.S. Census data. The county's goal for fiscal year 2026 was to assist 267 total patients according to budget documents.
Stephen Twyman, the founder of the nonprofit clinic CommonGood Medical in McKinney, said he had to convince people there were poor people living in Collin County when he started the clinic about a decade ago.
"They would believe that there was a few homeless people," Twyman said. "They would believe there were people who didn't have jobs. But they didn't really think there were very many, and they didn't think it was really a problem."
Convincing people of the need is less of an issue now, he said. The county's uninsured and unhoused population have grown with the rest of the county's population. And with fewer options for assistance at the federal, state and local level, clinics like CommonGood Medical have become the primary safety net.
Dramatic need
CommonGood Medical treated 1,060 uninsured patients in 2025 according to the clinic's annual impact report. Ruben was one of those patients. He asked that only his first name be used to protect his private health information.
Ruben has lived in Collin County for 30 years. He hasn't had insurance since 2009, the year before an accident at work shattered his legs and feet.
Ruben's employer paid for nine surgeries to repair his legs, hips and back. Then, he saw a doctor who helped with pain management. But when that doctor retired in 2021, Ruben couldn't find another provider to treat him because he had no insurance.
Losing that care, Ruben said, was life altering. His physical and mental health suffered.
"I could not participate in family functions," Ruben said. "The things that are supposed to bring joy to your life, I dreaded. I dreaded going to birthday parties, to Christmas celebrations, to Thanksgiving, those sort of things."
CommonGood Medical, he said, changed that. The comprehensive treatment Ruben received improved his quality of life. Before, he walked with a cane. Now, he rides his bike six to ten miles daily.
"That's very liberating for somebody who never left the house," Ruben said. "Now, I can pick my grandchildren up."
The average household income in Collin County is about $121,600, according to data from to the U.S. Census Bureau. Collin County is also home to major corporations, including AT&T and IBM, and sports franchises like the Dallas Stars and the Dallas Cowboys.
Growing cities like Plano, Frisco and McKinney have high-end entertainment districts and fine dining, and a new commercial airport.
The wealth gap in the county has increased as it has grown more prosperous, Twyman said.
"Collin kind of gets richer and richer, and yet more people don't have access to health care," he said.
Collin County is currently in the process of deciding its budget for the next fiscal year. Budget proposals recommend funding indigent care at $6.9 million for the 2027 fiscal year that starts on October 1.
The county needs to do more to provide aid to its uninsured population, Twyman said.
"They're currently helping the same number of indigent people per year that Dallas County is every two hours with their indigent care program," he said. "There is a dramatic need to improve and expand and increase access through our Collin County Indigent Health Care Program."
CommonGood Medical recently opened a new clinic in East McKinney. Gere Feltus, a McKinney city council member, said at the clinic's grand opening ceremony that it fills an important need. Feltus is a physician and runs Healthy Family Services of Texas, a nonprofit clinic in Lewisville.
"We have many blessings in this community, but there are a lot of people in need," Feltus said.
The new clinic, which includes primary care services, optometry and counseling, serves patients at or below 200% of the federal poverty rate, an income of about $32,000 annually for one person according to Health and Human Services guidelines, double the income requirements for Collin County's indigent care program.
The clinic, Twyman said, treats the whole person, physically, mentally and spiritually.
Providing that care in one place removes barriers to access, such as cost or access to reliable transportation, Twyman said. It's one of the reasons CommonGood Medical is building CommonGood Imaging, which will have mammography, ultrasound and x-ray capabilities.
Preventative care, which involves early treatment for chronic conditions to avoid more serious outcomes, isn't just good healthcare, Feltus said. It's also more cost effective.
"It is significantly less expensive to take care of someone outside of the hospital or emergency room," she said.
People without medical insurance are less likely to seek care early on because of the cost, said Stephen Love, the president of DFW Hospital Council. That, Love said, can lead to worse outcomes.
"Unfortunately, sometimes, that condition progresses and they show up at a clinic or an emergency room and it has progressed to a point where it would have been much better had it been intervened early on," he said.
Access Barriers
Healthcare options for the uninsured in Collin County are limited. The county doesn't have a county hospital like nearby Dallas or Tarrant County, which uses county and state funds to provide care for the counties' indigent, or uninsured, residents. Collin County's public hospital, Collin Memorial Hospital, closed in 1982.
Getting insurance from the state is also tricky. Texas was one of 10 states that didn't expand Medicaid under the Affordable Care Act.
Being low income, Love said, isn't enough to qualify for Medicaid in Texas.
"Many people think if you're hovering near the federal poverty level, then you're going to get your healthcare through Medicaid," he said. "That is simply not true. In Texas, generally speaking, you have to be pregnant, a child, or disabled to qualify for Medicaid."
Ruben, the patient at Common Good Medical, qualified for Medicaid — but he lost that care due to his immigration status. Ruben is a legal permanent resident alien.
Medicaid told Ruben he'd have to speak with immigration to prove his legal resident status, something he doesn't want to do with the increase in deportations.
"You can't even go to a courtroom for an immigration hearing without them hauling you away to a detention center or sending you out of the country and then letting you worry about how to get back," he said. "And these are people who are here legally doing everything right. You think I'm going to go and fight with Medicaid about that? No, not today, not this guy."
Ruben and his wife signed up for insurance under the Affordable Care Act, but he said none of the providers in their area would accept their insurance, so they stopped paying for it. And with his disability and age, Ruben, who's in his 60s, said finding a job that would provide insurance isn't an option either.
Most of CommonGood Medical's patients aren't unemployed, Twyman said. Many of them work multiple jobs but still can't afford medical insurance.
"When you look at cost of groceries and gas and maintenance for your car and transfer insurance rates and all these things, they're all additively, cumulatively preventing people from being able to pay for things that seem more optional, like health insurance," he said.
Cost of care
Both candidates for U.S. Senate have campaigned on lowering healthcare costs for consumers. Texas Attorney General Ken Paxton, the Republican candidate, proposed a $25,000 tax deduction for medical expenses and premiums at a campaign stop in Allen.
"We all know that Texans and Americans are struggling with expenses, including medical expenses," he said. "And I want to make it easier for people to pay those expenses."
James Talarico, the Democratic candidate, has pointed to cuts to Medicaid and Medicare as the cause of rising healthcare costs.
"People have seen their premiums go up a thousand dollars," Talarico said. "And it's just especially now when people are struggling to get by as it is, it's like the straw that's breaking the camel's back."
The One Big Beautiful Bill, which passed last year, made significant cuts to Medicaid and the Affordable Care Act. About 12 million less people are expected to have health insurance by 2034 according to a Congressional Budget Office report.
For providers, fewer patients with insurance means more uncompensated care, which Love said impacts hospitals' bottom line.
"When you run a business and run a hospital as a business, if you're not getting paid for a good portion of what you're doing, it's going to drive up the cost," he said.
CommonGood Medical doesn't use federal grants, Twyman said. But the clinic was still impacted by federal funding cuts.
"The competition for grant funding, particularly private funding, has increased as federal funding has decreased and costs have risen," he said. "And so you see more people applying for grants and relatively less per organization being awarded based on that competition."
Collin County, Twyman said, has the resources to fill the gap and help more of its uninsured residents. And that could lead to more outcomes like Ruben's, the CommonGood Medical patient who saw drastic improvement after consistent medical care at the clinic.
"I don't know that I could ever repay them for the life that they have given me back," Rueben said.
Got a tip? Email Caroline Love at clove@kera.org.
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