YOU ARE HERE: LAT HomeCollections

The Nation

Texas Cutting Back on Poor Children's Health

Federal-state insurance plan has been a lifesaver, but budget cuts will change that for many.

June 01, 2003|Vicki Kemper | Times Staff Writer

CORPUS CHRISTI, Texas — This state, which already has the nation's highest proportion of residents without health insurance, is about to acquire a new distinction.

With its Legislature on the verge of approving a budget that closes a $9.9-billion deficit without raising taxes, Texas soon will also lead the nation in the number of low-income children dropped from publicly financed health insurance.

Destynn Hatcher -- who at 19 months old has a list of medical conditions, specialists and prescriptions as long as he is tall -- could be one of them.

He was born with a hole in his heart. At six weeks, he nearly died from a lung infection. He has battled pulmonary stenosis, pneumonia, apnea, severe dysphagia, pituitary dwarfism and a "failure to thrive."

Yet thanks to a federal-state health insurance program for the children of the working poor -- which pays for his surgeries, feeding tube, daily growth hormone injections, expensive medical equipment and regular visits to specialists -- Destynn recently gained a pound and grew 2 inches.

Half-standing, half-sitting in his baby walker, Destynn is alert and smiling. Blond hair is beginning to cover his misshapen head. If it weren't for the Child Health Insurance Program, Destynn's mother says, "he wouldn't be here."

But both houses of the state Legislature, as well as a budget conference committee, have approved a plan to impose stricter income limits and a stripped-down benefits package on CHIP, as the program is known.

Even if Brandy Hatcher's family still qualifies, CHIP will no longer cover much of the treatment and medical supplies Destynn and his four siblings depend on.

Nine-year-old Jessica, who has bipolar and attention-deficit disorders, will lose access to psychiatric care. Treynor, 3, who suffers from pervasive developmental disorder, will no longer get the leg braces and physical therapy he needs to walk properly. And Destynn will not receive expensive medical equipment or the nursing help that his mother -- whose nerve injury confines her to a wheelchair -- needs to learn how to use it.

Texas is one of more than 40 cash-strapped states, including California, that are cutting benefits and eligibility for Medicaid, the federal-state health program that covers 47 million poor Americans. Rising costs and a weak economy have made health care the fastest-growing item in most state budgets.

Far fewer states are cutting CHIP, the widely praised program created by Congress in 1997 that gives states matching funds to insure children whose parents earn too much to qualify for Medicaid but too little to afford private coverage.

But in Texas, the health-care ax is falling most heavily on children of the working poor.

The state's new two-year budget will keep about 170,000 Texas children off the CHIP rolls -- fewer than the 220,000 considered likely just a week ago but still a full third of those now in the program. And the parents of children still eligible for CHIP will face increases in their premiums and co-payments and a dramatic decline in the range of covered benefits.

While Texas and other states are cutting their health-care spending, Congress is considering a Bush administration proposal that would dramatically alter the states' Medicaid relationship with Washington.

The current structure gives states a strong financial incentive to spend their own money on Medicaid and CHIP, by putting up matching money. Texas, for example, gets $3 from CHIP and about $1.60 from Medicaid for each dollar it spends on its own.

Under the Bush proposal, Washington would give each state a lump-sum Medicaid payment unrelated to the size of the state's impoverished population or the level of its own spending.

Advocates of government spending on health care worry that that could lead to deeper cuts -- and growing numbers of Americans left without health insurance. Supporters of the Bush plan, however, argue that Medicaid spending is inefficient and out of control. They say the reforms will encourage states to tailor their programs to meet the most basic health needs of their poorest residents.

"The process was not easy, and the decisions were difficult," Texas Gov. Rick Perry said last week. "But Texas has produced a budget in the same way millions of families and businesses all across our state do -- by establishing priorities and living within our means."

Early in the budget process, a state House subcommittee proposed eliminating CHIP. In Texas, families earning up to $36,800 for a family of four -- double the federal poverty level -- qualify. And so the state's 513,000 CHIP kids are not all the poorest of the poor. Better to save the $428 million the state spends annually on CHIP, the lawmakers reasoned, and avoid deeper cuts in Medicaid services for the poorest elderly.

Los Angeles Times Articles