BEXAR COUNTY, Texas – For many families in Bexar County, the cost of keeping a roof overhead is no longer just a financial burden — it’s becoming a serious health risk.
New data from the Metropolitan Health District shows 1 in 6 adults in the county skipped medical care between 2017 and 2023 due to cost. It’s a trend experts said is closely tied to rising housing expenses.
Nearly 46% of households fall into the ALICE category (Asset Limited, Income Constrained, Employed), meaning they earn above the federal poverty level but still struggle to afford basic necessities.
For residents like Ernestine Hayward, 61, those numbers reflect daily reality.
“I’ve got 37 cents in my account right now,” Hayward said.
Living on a fixed income, she said, nearly every dollar goes toward rent, food, and medical care — often forcing impossible decisions.
“Am I going to have food? Am I going to have money to get to my appointments?” she said.
Hayward has sold personal belongings, including furniture, electronics and sentimental items, to cover out-of-pocket medical costs.
She is not alone.
Housing costs exceed affordability standards
City leaders said housing is considered affordable when it costs no more than one-third of a household’s income. But many families across Bexar County are paying far more.
“Affordable housing is the infrastructure of San Antonio,” said Siboney Díaz-Sánchez with the city’s Neighborhood and Housing Services Department. “We need to think about the ways housing affects people’s ability to access healthcare, education and food.”
When housing costs exceed that threshold, experts add that families are left with fewer resources for essential needs, including medical care.
Health impacts extend beyond finances
The consequences are not just economic.
“When you can’t afford rent, it affects your mental health, your stress levels, your well-being and those around you,” Díaz-Sánchez said.
Research shows housing instability is linked to increased rates of chronic conditions such as diabetes, hypertension and heart disease. Substandard housing conditions, including mold, poor ventilation and structural damage, can further worsen health outcomes.
Tyler Ferguson, CEO of Blueprint Ministries, said his organization sees those impacts firsthand while repairing homes for low-income residents.
“We see houses with gaping holes in the floor and subfloor,” Ferguson said. “Imagine being 70 years old and navigating that in the middle of the night.”
Beyond physical hazards, Ferguson said that poor housing conditions contribute to stress, anxiety and isolation.
“There are people who wake up every morning and can’t do anything about the condition of their homes,” Ferguson said. “That causes depression, loneliness and real mental health challenges.”
A system-wide issue
Experts emphasize that housing instability doesn’t just affect individual families — it impacts the broader community.
The stress of high housing costs can also be associated with increased emergency room visits, higher healthcare spending, and added strain on public services.
Frequent moves can also disrupt children’s education and long-term stability. Many people are having to choose between living comfortably and getting the medical care they need.
Collaboration and solutions underway
In response, the City of San Antonio and local partners are working to address the issue through coordinated strategies.
In 2022, city leaders adopted a 10-year Strategic Housing Implementation Plan outlining 36 strategies to preserve and expand affordable housing.
Voters also approved a $150 million housing bond aimed at supporting rental assistance, housing production and rehabilitation.
Programs such as Green and Healthy Homes focus on improving living conditions, while partnerships with Metro Health and community organizations aim to address both housing and health needs simultaneously.
Ferguson said collaboration is critical.
“One organization can never meet that demand on its own,” Ferguson said. “We have to work together to make a real impact.”
Local efforts are also focusing on practical, immediate solutions, from home repairs to rental assistance, while building toward long-term change.
“Making an impact over the next 10 years starts with what we do for one person today,” Ferguson said.
Why it matters now
As housing costs continue to rise, officials warn that the connection between housing and health will only grow stronger.
“This isn’t just about affordability,” Díaz-Sánchez said. “Housing impacts everyone, our economy, our health, and the stability of our communities.”
For housing, medical and community partnership opportunities, check out the City of San Antonio Neighborhood and Housing Services, the Metropolitan Health District and Blueprint Ministries.
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