Most often, she says, patients "just end up in the emergency room" of a hospital in another county. "They're routed to a doctor that way. And I know that's not the best way to provide healthcare. It's more expensive."
Bustamante then tells me about her mom, who lived with Bustamante's older sister, who had an income and insurance.
One year, her mother needed surgery for a hernia that was causing her pain, and so she applied for Medicaid. "But my sister had a new van, and that disqualified my mom from getting Medicaid. If she would have sold the van, my mom would have qualified. Isn't that the craziest thing you ever heard?"
Her mother refused to go to the doctor because she didn't want to burden her sister.
She died in 2002 at age 65.
And her sister now has diabetes that has progressed to the point that she is on the liver transplant list. Soon, Bustamante says, her sister will move to El Paso to be close to the hospital when an organ becomes available.
By the end of August, however, she's being forced to retire from her job, and there's a question about whether she will still have health coverage, or whether she and Anna Bustamante will be able afford its copayments and premiums.
I asked Alma Bustamante what she thought about the progress made toward health reform in Congress and the President's speeches pushing for a public plan.
She said she really hadn't kept up with the details. "I really don't know much about it. I've heard something about it, but I can't really tell you much."
For Bustamante, I suppose, this is the way it is. Like she said, healthcare in the U.S. is more of a privilege than it is essential, at least for people in her part of west Texas. "Healthcare is a luxury," she tells me.
I wondered what the people railing against health reform in the town hall meetings might think if they just made a call to a little town like Sierra Blanca in Hudspeth County.