Senator Eliot Shapleigh - El Paso, Texas

AUSTIN — 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.

For Nikki Saldana of League City, there is no argument. An apartment complex manager who earns about $40,000, the single mother of two can’t afford her employer’s insurance and was turned down by CHIP because her yearly income is too high.
Emergency room trips

Her work coverage would cost $400 a month, which does not include the co-payment of $50 to see an ear, nose and throat specialist needed to treat 2-year-old Abigail’s severe allergies and ear infections.

Abigail had been covered under her grandmother’s employer health insurance until six months ago when Nikki Saldana’s mom left her job. Saldana’s 9-year-old daughter, Victoria, is on her father’s health plan.

Three times in this month alone, Saldana has taken Abigail, crying with pain from earaches, to local emergency rooms.

“It’s a long wait when I know what she needs is antibiotics for an ear infection. Calling a primary physician would be nicer,” she said.

Saldana, 29, would be willing to pay for health insurance if it were more affordable, maybe half the cost of her employer’s plan.

Families now covered by CHIP can select from a network of doctors similar to those under private plans.

There are no monthly premiums but families pay an annual enrollment fee of $50 and most co-payments for doctor visits or prescription drugs range from $3 to $10.

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.”

Lt. Gov. David Dewhurst said his priority is to enroll as many as 900,000 youngsters who are eligible under current income guidelines but not yet enrolled in CHIP or Children’s Medicaid, a separate program which serves about 1.8 million Texas children living in low-income households.

Though expensive, the state should make the investment, he said.

“At the end of the day it’s the moral thing to do, and over the long run, its the most economic thing to do,” Dewhurst said.

Some critics say government-subsidized health care encourages families to drop their private health coverage to go to the cheaper government program.

But only 1.8 percent of families who applied for CHIP last month said their children had prior insurance, state health and human services officials said.

Children living in middle-income families are increasingly joining the ranks of the uninsured. That is largely because employer-based health insurance premiums have more than doubled since 2000. The average annual cost to employees is $3,355 and the cost to employers is $9,325, for a total cost of $12,680, according to the Kaiser Family Foundation.

Only half of Texas private-sector employers offer insurance, and among small businesses, the percentage drops to 34, the federal government reports.
Pasadena family

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.