We don't need your federal dollars, thanks

It's stories like this one that make you want to pull your hair out. Texas, like all states, gets federal money to help pay for health care for uninsured children (Children's Health Insurance Program, called CHIP). This year, Texas is returning $285 million because it can't use it. This would be great if it were because all of the uninsured children have had their needs met, but it's not. It's because Texas can't afford to kick in its matching share because there are so many uninsured kids in our great state.

Federal data show Texas may have nearly 2 million uninsured children. Add adults, and nearly a quarter of the state's population is without health coverage.

Those families tend toward emergency-room care that hospitals often have to subsidize, or they go to clinics supported by charitable donations and state taxes.

State Democrats and child advocacy groups say Texas Republicans are unwilling to use the SCHIP program to its fullest potential -- a charge [state CHIP director Jason] Cooke called unfair. Currently, 508,000 children are enrolled, he said.

"Can we do better?" Cooke asked rhetorically. "We can always do better. But the fact of the matter is we've been out there enrolling kids very aggressively. And I think it's debatable as to whether we could use all that $285 million by enrolling more kids."

He said Texas shouldn't use the SCHIP funding because it was rolled over from the program's earlier years, before Texas had its program up and running. The state Legislature was out of session when Congress created SCHIP in 1997.

To spend all of the money now would temporarily drive up enrollment. Meanwhile, the state's inability to use the federal funds has triggered a reduction in its share to $302 million for 2002 to 2004 -- a $200 million annual cut.

"If you're planning a budget and you know your income's going to be lower, you don't take on commitments you can't meet," Cooke said.

OK, so we've got about 20% of uninsured kids enrolled. Guess that "aggressive" signup program could use a bit of assertiveness training. And we really can't go after all those uninsured kids because we have a big budget shortfall. Too bad back in 1997-98 when we were swimming in money we didn't try to come up with a way to fund this. We had more important things to pay for, namely a tax cut.

We can debate the merits of CHIP and budget priorities all day, but the bottom line is that we're paying for uninsured kids one way or another. Using the emergency room as the family doctor has got to be the least efficient way of paying for health care imaginable, so we're paying more for these kids than we should be. Of course, once it's a line item in a budget it becomes a target. How much better it is to diffuse the cost in a million hidden ways so no one really knows how big a bite is coming out of their own asses.

Posted by Charles Kuffner on October 16, 2002 to Budget ballyhoo