Senator Eliot Shapleigh - El Paso, Texas

California Gov. Arnold Schwarzenegger made headlines this week when he unveiled a sweeping plan to insure every person in the Golden State, regardless of their immigration status.

California follows Massachusetts, which passed universal health care legislation last year. There, health insurance is required and penalties can ensue if one is not covered, much like requiring drivers to have car insurance.

On Wednesday, Sen. Ted Kennedy, D-Mass., expanded that notion by calling for universal coverage on a national level.

"Insurance coverage is down. Costs are up. And America is heading to the bottom of the league of major nations in important measures of the quality of care," Kennedy told the Associated Press.

Texas knows a thing or two about being at the bottom of the league.

The Lone Star state has a greater percentage of uninsured than any other state at 25 percent. Texas admits twice the number of people to emergency rooms as the rest of the nation.

According to the Code Red Texas report issued recently by a broad coalition of health experts, 1 million Texans do not receive adequate care for chronic diseases. About 2,500 uninsured Texans die prematurely.

And much of the financial burden falls not on the ill, but the healthy. Insurance premiums go up, and local property taxes pay for emergency room visits — which cannot be denied to anyone, covered or not.

As members of the Express-News Editorial Board, my colleagues and I get the opportunity to hear from community leaders on a variety of issues. In advance of the legislative session, we've met with several people involved in health care. The picture they've painted is bleak.

In Texas, people can qualify for Medicaid only if they have an obscenely low income. A working parent with two children must make no more than $3,696 a year to qualify.

For a full-time worker, that breaks down to $1.77 an hour. Any more than that, and the parent must either find a way to buy insurance or go without.

Too many go without. They end up in emergency rooms sicker than they need to be and costing more to treat.

Many children qualify for the state's Children's Health Insurance Program, or CHIP. But that, too, is broken. In a shortsighted policy aimed at not raising taxes, the Texas Legislature in 2003 enacted deep cuts in the program. Those cuts resulted in Texas losing millions of dollars from the federal government, which matches each state CHIP dollar spent with $2.63.

Those cuts were rolled back some two years ago, but Texas is still not leveraging all the federal dollars available.

The cuts are magnified by the fact that medical providers are being reimbursed at lower levels for Medicaid services, so many stop treating Medicaid patients altogether.

As for the CHIP cuts being an alternative to tax hikes, that's little more than smoke and mirrors. All Texans shoulder the burden when the uninsured go to the emergency room.

There is something drastically wrong with this cycle.

For many, ensuring Texans — young, old and in between — is just the right thing to do. Others may believe this amounts to little more than liberal-minded charity best left to the private sector.

In either case, there is a strong economic argument to be made for extending coverage to the poorest Texans. According to Code Red, 10 percent of Texans consume 80 percent of the health care dollars.

As the Legislature continues to chew on the many significant needs facing the state, they should not let extended health care coverage go by the wayside.

They can do so by expanding Medicaid and CHIP to leverage more dollars; considering some sort of risk-based state pool to allow small businesses to buy affordable insurance; and taxing hospitals to inject more dollars into the system.

Increasing funding for health care may not be as voter-friendly as vowing to hold the line on taxes.

But it's gutsier, more honest and more effective.