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Why Texans Should Care

Misty James, a North Texas mom of three, works hard to keep her children happy and healthy, which often includes extra hours on the job and cutting costs to make ends meet. About six years ago, she found herself at a crossroads: Her income from her job in sales couldn’t cover her kids’ health insurance, so she made the painful decision to eliminate it.

While Isaiah, 12, Hannah, 4, and Jaxon, 2, were uninsured James says the only medical attention they received was through hospital emergency rooms’ free sick visits. Newly married at the time, she and husband Jason James searched for more affordable options to insure their kids’ healthcare but came up empty-handed. To add to their dismay, the family earned too much to qualify their kids for Children’s Health Insurance Program (CHIP) coverage, which provides health insurance to families whose income is modest, but too high for Medicaid.

Like many working moms and dads, James isn’t the type of person who easily takes a handout. “I work and I pay my own bills. I simply need health insurance for my kids that I can afford,” she says. “I will pay as much as I can for it.”

The family took another hit when Jason lost his job at a printing company in January. There was a silver lining, tarnished by the loss of income — at last the children were able to qualify for CHIP coverage.

With CHIP cards in hand, the family set out to catch up on missed doctor’s appointments, seeing a dentist first. James remembers being terrified by the news that Isaiah had a severe abscess, or infection, caused by a cavity. He required an immediate root canal, paid for by CHIP.

The episode put the family’s health in startling perspective — even if they couldn’t afford insurance, they also couldn’t afford the setbacks caused by its absence. And their private struggles have been playing  out in homes across the state, in families who wait for news from Austin and Washington.

Today in Texas, 1 and a half million children are without health insurance — the highest number in the nation — according to the Children’s Defense Fund of Texas. Legislators, advocates and parents set out to reduce those numbers during the recently concluded 81st Texas Legislative Session with a proposed bill to expand the state’s CHIP coverage to Texas’ middle-class families — working families like the Jameses who are unable to afford private coverage for their kids.

Despite support of both houses, the bill did not pass. Yet the proposed changes to Texas’ CHIP still continue to gain momentum: Thousands of Texas residents continue to flood the phone lines of Texas Finish Line Campaign, an organized group of CHIP expansion advocates from across Texas, as well as the offices of Gov. Rick Perry and Lt. Gov. David Dewhurst, requesting attention to this issue, according to the Texas Finish Line Campaign.

Should you weigh in? Just because you have private insurance for your children doesn’t mean you’re not affected — taxpayers are footing the bill for uninsured children in Texas. And the cost of caring for kids without heath insurance shows no sign of slowing.

Two-thirds of newly uninsured children in Texas are from families earning approximately $44,000-$66,000 annually — income levels that currently fall outside of CHIP coverage. Consider it a sign of the times, says Laura Guerra-Cardus, coordinator of the Texas Finish Line Campaign. “Health insurance coverage for a family of four can sometimes cost up to 30 percent of a family’s total income — averaging at about $1,000 per month,” she says. “Some families are even going so far as to request pay cuts in order to qualify their children for CHIP; or, on the other hand, people may choose to decline a raise so as to keep their current CHIP coverage.”

Two factors spurred Texas legislators into action on a bipartisan bill addressing CHIP: the state of the economy and President Obama’s reinstatement in February of federal funds supporting CHIP in the states. The bill would have provided coverage to approximately 80,000 middle-class Texas children, states the Texas Finish Line Campaign. Changes would have extended buy-in options to families earning two or three times more than the federal poverty limit, allowing parents to purchase coverage on a sliding-scale basis. The precedent for this new buy-in option has been set in 13 states, all of which have taken steps in the last six months to expand CHIP programs to cover more middle-class families.

Of course, the expansion of coverage comes at an expense: Adding buy-in options to CHIP would cost Texas approximately $40 million over two years; part of that cost would be met by about $100 million in federal stimulus funds, says Julia Easley, Dallas Area CHIP Coalition chairwoman. “The cost of the buy-in would be met with federal funds but would also be supported by the buy-in fee paid for by families,” adds Guerra-Cardus.

In addition to the expense, opponents claimed that the extension of CHIP would entice more parents away from purchasing private insurance as well as shift the state’s attention away from the poorest Texans, explains Easley.

But among the ranks of supporters were a number of private insurers, including Aetna. “Anytime steps can be taken to get people off of the uninsured role, it helps people understand the value of health insurance coverage,” says Shannon Meroney, Aetna’s regional manager of state government affairs. “There are certain sets of people who can’t afford the pricing and premiums of private insurance, and we feel that a buy-in option would be a way to bridge that gap.”

In the end, it was up to legislators to decide if it was worth the cost.

In the late spring, versions of the bill passed with overwhelming support in both the Texas House of Representatives and Senate (87-55 votes and 29-2 votes, respectively).

Legislators worked to combine the approved versions into one piece of legislation, but the clock was ticking. Final approval of the bill hinged on Perry’s signature. However, at a May 28 news conference, just days before the end of the session, Perry announced: “I would probably not be in favor of that expansion even if it came to my desk. I think the members know that.”

And so, the bill never landed on his desk. How did this happen, exactly (particularly with such wide support from legislators)? The bill “needed leadership intervention to speed up the process and get it to the governor’s desk before the end of the session,” Guerra-Cardus explains. “The leadership fell short of doing this.”

Walter Taylor, a Dallas-Fort Worth CHIP advocate, explains, “Perry made it clear that if the legislation made it to his desk, he would veto the bill — this [sapped] the motivation of legislators.” He adds, “The position from the governor was that it’s a higher priority to get those who are already eligible enrolled, a problem that would be addressed by hiring more employees for the enrollment offices.”
To this note, legislators did allot funds from the state’s budget to make way for 1,800 new jobs to address serious understaffing problems, Guerra-Cardus notes. “The number of applications is way up, while the number of staff members continues to decline because of fiscal stress. The new funds promised to the eligibility programs by the governor can be considered a small victory — overall it will help reduce procedural errors (with better trained staff) and get more eligible children coverage,” she says.

Perry could not be reached for comment on the situation that unfolded in late May, but said in a statement that he believes the bill lacked the “the vast support of the people of the state of Texas.” Guerra-Cardus and other advocates disagree, citing a poll of Texas residents that was conducted earlier this year by the Texas Hospital Association (THA), a trade group, showing that the issue of affordable health coverage is a “top priority for Texas voters.”

After the bill died, advocates immediately called for Perry to rope the bill into the July special legislation session. He refused and focused his efforts on bills addressing the financing of transportation projects.

According to the Texas Finish Line Campaign’s final statement released June 4: “Ultimately the bill was derailed not on its merits, but because time expired and the top legislative leadership — the lieutenant governor, speaker of the House and governor — failed to intervene and ensure the bill’s passage.”

The James children’s CHIP coverage will continue through December. In the coming months, James hopes her husband will obtain a new job — a hope that’s jaded with the fact that this added income will disqualify their kids from future CHIP coverage. “I hope that the state will see that it costs much more in the long run by not creating this buy-in. Until affordable options are available, families like mine have no choice but to use free sick visits at emergency rooms,” says James.

Until greater amendments are made to CHIP coverage by Texas legislators, taxpayers and private insurance companies will continue to foot the bill of uninsured children. The Texas Finish Line Campaign cites that 13 percent of private insurance premiums go toward paying for the cost of uninsured patients at community hospitals. As a result, taxpayers will face higher hospital district taxes, says Guerra-Cardus.

“A part of the problem [in the bill’s failure to pass] is that it does have a fiscal note attached, and Texas has a history of being a conservative state when it comes to spending,” Meroney says. “And, many people are playing a wait-and-see game because of what’s going on at the federal level with healthcare reform.”

In addition to costing Texans money, the state will bypass millions of federal funds that would match Texas’ investment in CHIP expansion, states the campaign.

“There is power in numbers,” says Taylor, the Dallas-Fort Worth-area CHIP advocate. “We’ve just got to remember that it’s about the kids, not politics, in the end.” Guerra-Cardus adds: “You can bet that we’ll be pushing for [the buy-in option] in the next session [in 2012]. People should keep calling their representatives and making their voices heard.”