Senator Eliot Shapleigh - El Paso, Texas

If enrollment in a state and federal insurance program for children increased in 37 states during the second half of 2003, how is it that the rolls for the overall Children's Health Insurance Program declined during that period?

The answer is that enrollment declines were so dramatic in a few states that they outweighed the collective gains, according to a report issued last month by the nonpartisan Kaiser Commission on Medicaid and the Uninsured. One state in particular plunged CHIP rolls downward for the first time in the program's six-year history: Texas.

Texas dropped so many children from the affordable CHIP program that it alone accounted for more than half of the national decline. No state — not even Mississippi — was worse than Texas when it came to denying children from lower-income families health insurance. The CHIP program for low-income working families covers only the children in a family.

So far, 149,000 Texas children have been dropped from the CHIP rolls. Sure, state leaders can brag that they saved a few dollars by denying coverage to kids whose parents can't afford private health insurance. But that is a penny-wise, pound-foolish policy that is costing Texas taxpayers more.

Sick children don't evaporate; they go to emergency rooms or health clinics instead of doctors' offices, typically after their illnesses have advanced. The treatment is more expensive and Texas counties are constitutionally obligated to pay for indigent health care costs. So those expenses aren't declining — they are just being shifted to local taxpayers.

But if those children were covered by the CHIP program, they could be treated earlier by doctors. Early treatment and preventative checkups would lower their medical costs. But the big savings to Texas taxpayers comes mostly from CHIP's unique financing. For every $1 Texas invests in CHIP, it receives $2.59 in federal money. Local dollars can't be leveraged that way, so counties have to foot the entire load, which drives up local taxes.

In its research, the Kaiser commission found that the 11 states that shrank their CHIP rolls did so mostly because of budget constraints. Nearly all of the enrollment decline happened in three states: Maryland, New York and Texas. Certainly some enrollment declines were legitimate. New York, for instance, properly transferred many CHIP kids who were eligible for Medicaid to that program, which insures impoverished families. That wasn't the case in Texas. The declines are the result of a creeping, mean-spirited attitude that has settled over the Capitol.

The Legislature and governor that once gave Texas one of the nation's most progressive CHIP programs now has recoiled under the pretense of shrinking state government and taxes. Texans witnessed this last year during the legislative session when it became clear that there was ample money to maintain Texas' CHIP program, yet state leaders cut it.

Gov. Rick Perry and the Republican-dominated Legislature cut it back by increasing monthly premiums on children, forcing eligible kids to wait three months before their coverage begins, eliminating income deductions (such as child care) that keep families within income limits, yanking dental coverage for all CHIP kids and other changes aimed at pushing children off CHIP. State officials were tight-fisted when it came to Texas children, but loose in handing over money to the private company that ran CHIP for the state in rural areas. It has come to light that the state health and human services agency overpaid Clarendon National Insurance Group by $20 million.

That kind of stinginess is difficult to square when you consider that Texas has the nation's highest rate of uninsured children. Yes, more than Mississippi, which expanded its CHIP program.

If state officials are unable to do the right thing by Texas children because they care about their health and welfare, then they should do the math. CHIP saves money for taxpayers. Restore it.