Where have all the CHIP enrollees gone?

I've spent a lot of time bashing the contract Accenture received to privatize services that were formerly provided by the Texas Health and Human Services Commission (THHSC). And they richly deserve it, as their performance has sucked, with none of the exuberantly optimistic savings panning out amid lost forms, unanswered calls, untrained staff, and so forth. Even some Republicans have called for Accenture's contract to be revoked.

The thing is, though, that firing Accenture would only fix a small part of the problem of drastically reduced CHIP enrollment. The real reason why CHIP's rolls have dropped 40% since 2003 is structural. The Legislature and Governor Perry, in passing HB2292, deliberately made it harder to apply and qualify for CHIP, and they did so for the express purpose of reducing its beneficiaries.

Rep. Garnet Coleman put together an information packet that puts all the pieces together. I've got a copy of it here (Word doc), and I strongly encourage you to read it. I'm going to highlight a couple of points from the section entitled "Changes in CHIP Enrollment Policies Made in 2003" to show you what HB2292 has done to the people who need help getting health insurance for their kids.

Prior to 2003, renewal forms were pre-populated with previously submitted information and only required the family to cross out inaccurate information and make corrections. Now, renewal forms are blank so the entire application must be completed anew every 6 months, including income, vehicle information, and bank balances. I just did my annual re-enrollment for benefits where I work. All of my information was pre-populated with the bennies I had this year. I only had to make updates where needed. If I did nothing - if I failed to even log onto the web page and click OK - I'd have gotten the same benefits in 2007 as I got in 2006. No such luck if you're on CHIP. You have to start from scratch every six months, and if you forget or screw up, you automatically get kicked off.

The point of CHIP is to provide a benefit for lower-income working families. It's not Medicaid. It's a program to give health insurance to the children of people who couldn't otherwise afford it. Before HB2292 in 2003, it didn't have an asset test, which means that those families could try to put some money aside to save for their kids' future college educations without it costing them their CHIP eligibility. Not any more: As of 2003, CHIP families with incomes at 150% of the federal poverty level can have no more than $5000 in total assets before losing CHIP. That includes savings, and most frustratingly, automobiles. There's a $15,000 exemption for a first car, and a $4650 exemption for a second, meaning that a family in which both parents work, one of them had better be driving a junker (or not driving at all) or it'll go against their ability to get health insurance for their kids. And you better hope your kids qualify for scholarships some day, because you can't save for their tuition costs. And this is what Rick Perry thinks about that:

He doesn't mince words when asked about matters such as Children's Health Insurance Program rules that count assets such as autos in deciding eligibility.

"If someone thinks that their car is more important than their kids, we're going to try to teach them a little personal responsibility here," said Perry.

Too bad if you need to get that car to get to work. You've got to choose: Food or CHIP? Rent or CHIP? How personally irresponsible of you to not want to face that choice.

Oh, and the income requirements for CHIP are now based on net income, not gross. Meaning that if you have to pay for child care while you (and your spouse, if you're married) are out working, there's no deduction for it. Too bad you weren't responsible enough to have a parent nearby that could mind your kids for free. That'll teach you.

I could go on, but you get the point. There's one other point that needs to be made, which is that we already have the money we need to get everybody who's lost CHIP coverage since 2003 back on. Go down to page 5 of that document I linked, and see about the $400 million in funds that were allocated for Medicaid and CHIP but never spent. That money has carried forward into 2007, and it would not only cover the 200,000+ former CHIP enrollees, it would leave almost $250 million still unspent. Since CHIP is insurance rather than coverage for actual health services, it's actually pretty cheap - $450 per child per year. (How much does your insurance cost you to cover your kids?) We could cover all thes kids and more if we wanted to. But we don't, and it's by choice.

And let's remember why we pared the CHIP rolls so vigorously:

In Texas, where more than 20 percent of children are uninsured, the highest percentage in the nation, officials in 2003 imposed new premiums, eliminated dental coverage and began requiring families to re-enroll their children every six months rather than yearly.

"There was a $10 billion [state] budget shortfall," said Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission.

That was then. And now?

Gov. Rick Perry, who is seeking re-election, predicted that the Texas Legislature will soon be sitting on its largest budget surplus ever, and he said he would like to use some of that money to cut state business taxes before they take effect.

During a campaign swing through deep East Texas, Perry said a booming Texas economy has caused the state Treasury to swell from growing sales tax collections, permit fees and other sources of revenue. He predicted the surplus would exceed $8 billion, taking much of the pain out of the appropriations process and making a business tax cut possible. Some Capitol insiders suggest the surplus could top $15 billion.

"Our budget surplus is going to be so friggin' big," Perry said. "So why not lower the [business] tax rate down to three-fourths of a cent, or a half-cent?...I'm all for that."

Why not restore CHIP to the way it was in 2003 when our deficits were "so friggin' big?" It's a choice. Rick Perry would rather spend that money elsewhere, even though CHIP costs would be a tiny piece of that so-friggin'-big surplus. Those are Rick Perry's priorities.

Vince is on this as well, and he has some extra linkage. The bottom line is that we're letting kids go without health insurance because Governor Perry isn't interested in fixing a problem he himself created. He's made his choice. And you can make yours.

Posted by Charles Kuffner on October 25, 2006 to Budget ballyhoo | TrackBack