Pretty sure my buddy is an American - I've known him almost all my life. I'm quite sure he's poor - he asks me for money a bit more than I'd like. The fake name thing was just a strategy he developed after going to the ER due to a blow to the head which caused him to forget his name; I'm sure there are many creative ways to get healthcare, but most of the of poor Texans (whom I'm also pretty sure are Americans considering I'm related to a few of them) I've known just go to the ER and ignore the bills. It's probably not the best system, but it's the one we've got I guess.
As to point 2) I thought about including the info in my previous comment, but it wasn't in your own source material and I'm a bit lazy. So here, I'll do it in this one.
> Texas is still the state with the highest percentage of uninsured residents, at nearly 17 percent, according to the most recent U.S. Census Bureau survey released Thursday. [0]
[0]https://www.texastribune.org/2023/09/14/census-bureau-texas-...
Speaking as a Texan (also pretty sure I'm American) who lives with some disability, I can tell you that I've looked at the systems and it's a real fear of mine that I'll end up as one of these statistics.