Senator Eliot Shapleigh - El Paso, Texas

Chairwoman of the Greater San Antonio Chamber of Commerce Brenda Vickrey Johnson

Sometimes a dollar is just a dollar, but in the case of the Children’s Health Insurance Program, one dollar equals $3.64. The fiscally responsible approach to funding a program in Texas should include the overall impact on the taxpayer at local, state and federal levels.

For example, for each state dollar invested in CHIP, Texas receives $2.64 in federal matching funds (which come, of course, from Texas taxpayers). And the reverse is true — if we do not put up the dollar, we actually lose our $2.64 to other states.

So far, Texas has forfeited more than $900 million in Texas federal matching funds by not fully funding CHIP. These funds have been returned to the U.S. Treasury and spent by other states. Most recently, the state sought to ‘save’ money in 2003 by removing 180,000 children from CHIP coverage. You saved a little in one pocket, but lost a lot in another pocket.

But the impact does not stop there. Cuts to CHIP and Medicaid affect the health and prosperity of every Texan, and especially the pocketbooks of local taxpayers. When children lose CHIP and Medicaid coverage and end up in county emergency rooms for care, local taxpayers pay 100 percent of the bill without the support of federal or state matching dollars.

Emergency room care is far more costly than preventive investment. If a child with an asthma attack can see a doctor when an attack is still mild, he or she can be treated for about $100. But if he or she cannot get early treatment and has to go to the ER for treatment of full-blown symptoms, the child faces a three-day hospital stay that costs more than $7,300, according to a 2006 survey of Texas hospitals.

Children without health insurance are 25 percent more likely to miss school because of illnesses, and Texas school districts lose $4 million per day in funding because of absenteeism. Small businesses are also feeling the squeeze of rising health insurance costs and are often unable to provide dependent care for their employees, as private health insurance premiums have increased by 87 percent over the past six years.

It doesn’t have to be this way. Before 2003 budget cuts, Texas had the most effective CHIP enrollment growth in the nation, with more than 500,000 children signing up and staying enrolled in coverage. CHIP was succeeding in reducing the number of uninsured Texas children and cutting emergency room utilization. According to a state commissioned report by the Institute of Child Health Policy, 20 percent of Texas children enrolled in CHIP used the emergency room as their primary source of care before enrolling in CHIP. Once enrolled, only 2 percent of children used the emergency room as a primary source of care.

CHIP and Medicaid provide effective and cost-effective care for children at a cost 31 percent lower than private health insurance. Texas has the highest rate of uninsured children in the nation, with one in five children — 1.4 million — lacking coverage. More than 80 percent of these children live in working families, but private health coverage is often too costly for families to afford, averaging $900 a month according to the Texas Department of Insurance. CHIP costs just $40 a month per child in state funds. We can cover every eligible child for $40 a month, or we can let the child go uninsured and pay for the $7,300 hospitalization.

The Legislature should allow children to re-enroll annually instead of every six months. Requiring parents to renew their children’s health coverage twice a year instead of once makes CHIP less effective and more expensive. The state spends double the money processing the same children’s paperwork twice. We need to save that expense and insure more children. Let’s do the fiscally responsible thing by considering the impact on Texas taxpayers at the local, state and federal level. CHIP is a wise investment for the Texas economy, for Texas children and Texas taxpayers.

Brenda Vickrey Johnson is chairwoman of the Greater San Antonio Chamber of Commerce.

Maribess Miller is chairwoman of the Greater Dallas Chamber of Commerce Health Care Advisory Council.