January 26, 2009
It's 2009 and we're still arguing about CHIP

It's hard for me to believe that after all this time, and after all of the candidates who've lost elections over it, that the Children's Health Insurance Program, a/k/a CHIP, still has dedicated opponents. It's especially hard for me to believe that in this time of budget crunch, anyone would want to turn down the very generous federal matching funds that come with an expansion of CHIP, which by the way still isn't at the level it was in 2003 when it was so drastically cut back. Yet here we are.

The debate over children's health care this year will be as arduous as ever, but so is the ante: More than 160,000 Texas children whose cash-strapped parents can't get state help to pay medical expenses for maladies as common as chronic ear infections or as daunting as cancer treatment.

The argument among legislators will be whether to raise income-eligibility levels so that those children can join the 451,000 now covered by the Children's Health Insurance Program.

Supporters say reducing the number of uninsured youngsters -- now one in five -- would benefit not only the children's physical health but the fiscal health of Texas taxpayers. The federal government picks up 72 percent of the cost and providing health care in doctors' offices is almost always cheaper than treating children in public hospital emergency rooms.

Critics worry about undermining employer-sponsored health coverage and point to the growing costs for the state. CHIP enrollment increases over the past two years have driven the state's tab from $102 million to $267.5 million.

Putting that increase in context, that $165.5 million increase in state funding for CHIP represents 0.2% of the state revenue total. It also surely represents a far smaller total than what counties and hospital districts would have paid for emergency room visits by otherwise-uninsured children. Honestly, I want to understand the argument against this, but I just can't.

Well, there is this:

A pending federal bill that renews CHIP is expected to allow Texas to increase income limits so more can enroll. The current limit for a mother and two children of $35,200 could be increased to $52,800.
Sliding-scale proposal

State health and human services officials estimate the income expansion could draw 164,000 additional children to the program by 2012 at an annual cost to the state of about $100 million.

Rep. Ellen Cohen, D-Houston, said the price tag could be lowered if the middle-income families were charged premiums on a sliding scale. Cohen this week plans to introduce a bill that would expand CHIP and take advantage of the anticipated new federal funds.

"Since 2003, Texas has turned away almost $1 billion of federal matching funds by failing to invest in CHIP," Cohen said. "As a result, we are left with the highest uninsured population of children in the nation."

Cohen said getting the bill passed won't be easy in a tight budget year when competing needs include Hurricane Ike recovery, public education and transportation.

Gov. Rick Perry's spokeswoman, Allison Castle, said the governor does not support expanding CHIP's eligibility standards because of the higher income families who would be covered. She said Congress is trying to lure the state into expanding programs in tough times and doing so would put the state on a "slippery slope to socialized medicine."

Yes, I suppose I should have added the Slippery Slope To Solicalism! to my list of campaign issues for the 2010 GOP gubernatorial primary. You can be sure that whichever way Kay Bailey Hutchison eventually votes on the S-CHIP bill that's still pending in the Senate, she'll get bashed for it by Rick Perry. Because we can't have those looming specters in this state, nosiree.

In the current economy, where pay is being frozen for many workers, an automatic 3 percent raise should have been a blessing for Josh Hebert of Pasadena.

But he wants to turn back part of the hike because it bumped him over the CHIP limit.

The younger of Hebert's two daughters, 3-year-old Katie, suffers from brain lesions that have triggered deafness in one ear, digestive problems and a host of other symptoms. His employer plan would cost 30 percent of the family's monthly income and does not offer the type of comprehensive coverage that Katie gets through CHIP.

"It seems unbelievable that a cost-of-living raise can become a major crisis, but it is when our children's health hangs in the balance," said his wife, Kyla.

Yes, well, don't you understand that the Slippery Slope To Socialized Medicine is more important than your daughter's health? I'm sure Governor Perry and his supporters who care so much about the sanctity of life would be happy to explain it to you.

UPDATE: Rep. Ellen Cohen has filed HB787 to increase CHIP participation. The changes to the text of the statutes is simple:

[A] child who is younger than 19 years of age and whose net family income is at or below 300 [200] percent of the federal poverty level is eligible for health benefits coverage under the program.


During the sixth month following the date of initial enrollment or reenrollment of an individual whose net family income exceeds 285 [185] percent of the federal poverty level, the commission shall:

(1) review the individual's net family income and may use electronic technology if available and appropriate; and

(2) continue to provide coverage if the individual's net family income does not exceed the income eligibility limits prescribed by this chapter.

A press release from Rep. Cohen's office is beneath the fold.

State Representative Ellen Cohen filed House Bill 787 today to expand the Children's Health Insurance Program (CHIP) to cover more children and thereby maximize federal matching funds for Texas.

"In difficult times, Texas must make hard choices," Cohen said. "My hope is to work with members of both parties in making the needed expansion in CHIP. Clearly, this expansion isn't just money well spent; it is a needed investment in the health of Texas children."

The Children's Health Insurance Program provides a federal match of $2.52 for every dollar invested in the program by the State of Texas. Texas leads the nation in the number of uninsured children and to date has turned away almost $1 billion in matching funds. In Harris County, one out of every three people do not have insurance coverage. The uninsured then turn to emergency rooms which were stretched to capacity even before Hurricane Ike's damage to the University of Texas Medical Branch in Galveston.

"Property tax payers are tired of paying for expensive emergency care. Texas must do the fiscally responsible thing by ensuring emergency rooms are available for real emergencies and expanding access for more cost-effective preventative care. And we will do it in a way that serves the taxpayer as well as the patient," Cohen noted.

Cohen's bill would increase eligibility to 300% of the poverty level, maximizing the funds available from the federal program. Using a sliding scale of premium assistance, Cohen's measure would cover almost 100,000 additional children at a cost of between $15 to $20 million per year. Texas currently spends $267.5 million to cover 451,000 children in the Fiscal Year 2008 budget for CHIP.

Current federal legislation on the State's Children Health Care Program has passed the United States House of Representatives and should come before the Senate shortly where it is expected to pass by a wide margin. President George Bush twice vetoed similar CHIP legislation, but President Barack Obama has signaled his strong support.

Posted by Charles Kuffner on January 26, 2009 to Budget ballyhoo

This just points out the need for a national health care system that addresses problem states like Texas - Medicare/Medicaid isn't perfect but it works. Hopefully Congress will finally realize that the answer is simply to expand Medicare/Medicaid to all Americans.

As for this proposed plan, reality is the state will have to come up with $100 million to pay for it. And the Republicans have better things to do with $100 million than provide health care to children.

Posted by: Baby Snooks on January 26, 2009 6:39 AM

I wish someone would ask the Gov's spokeswoman to clarify what she meant by "socialized medicine." The term can mean different things. Maybe she was suggesting that expanding the income limit for CHIP would result in an eventual expansion to cover all kids regardless of income??

Posted by: hope on January 26, 2009 1:34 PM

UNLESS you have had the luxury of socialized medicine; why do we Americans think it is awful? It is not like CUBA! Socialized medicine saved my daugther's life, when we had PAID insurance in the US and they said it was nothing. Wait lists are MYTH for immediate care. Wait lists are for future surgery, eg: hip replacement scheduling. PAID private insurance in Europe has no deductible; runs approx. $120 per month for a family of four, includes optional plastic surgery! We pay $1,000 for a family of four with huge deductible etc. ROYALTY use socialized medicine and hospital care, why not Americans? Our taxes are higher than Europe, add it up.

Posted by: Sue on April 29, 2009 11:57 AM
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