Senator Eliot Shapleigh - El Paso, Texas

In 1989, Congress made major improvements to Medicaid, which insures the nation's poorest kids. It ordered states to actively reach out to parents to educate them about the importance — and the availability — of preventive health care for their kids.

In addition to keeping the nation's most vulnerable citizens healthy, lawmakers were also looking to save money because it is far less expensive to prevent many maladies than to treat them.

But Texas officials refused to do much in this regard, so San Antonio attorney Susan Zinn sued in 1993 on behalf of 941,072 Medicaid-eligible children who didn't get medical checkups and 1,000,059 who didn't get dental services.

In 1996, state officials signed a consent decree promising to live up to the law. But it wasn't over for Zinn and co-counsel Jane Swanson. After state officials failed to keep their promises, the pair returned to the courts to compel them to do so. And the Texas attorney general opted to fight them at every step of the way.

Senior U.S. District Judge William Wayne Justice ruled for the kids, but the 5th U.S. Circuit Court of Appeals overturned him.

Zinn and Swanson wouldn't quit, however, and by the time Frew vs. Hawkins reached the U.S. Supreme Court, more than 15 federal judges had rejected Texas' arguments.

In the end, so did the Supreme Court justices — unanimously.

But Texas' lawyers have continued to avail themselves of every delay possible to keep Texas from having to live up to its promises.

Last week, Supreme Court justices refused to review their decision in the case.

So, on April 9, Judge Justice will begin hearing "corrective action plans and related remedial motions." Zinn and Swanson aren't seeking damages, only reform.

And it isn't only that the Legislature is in session that makes the two public-interest lawyers hopeful that poor kids will finally get the medical and dental care they need.

"The courts have said that this program of preventive care for children is one of the most important health programs Congress has ever enacted," Swanson says.

And during the 13 years that state officials have kept Texas' poorest children from getting preventive health care, their numbers have grown dramatically.

"In 1993, it was about 11/2 million (children affected by Texas' Medicaid shortcomings)," Zinn says. "Now it's about 2.8 million children, which is about a third of our state's children. It's important to the public health of our state."

And in so many cases, a stitch in time will certainly save nine.

Will kids thrive if bad toothaches make it hard for them to eat, or to concentrate in school? And dental checkups are relatively inexpensive, as are sealants that help prevent decay.

"And checkups are particularly important for teenagers because they need the guidance about risky behavior," Swanson says.

"In 2005, 73 percent of (eligible) teens did not get one medical checkup, and over 60 percent did not get one dental checkup when they should have two per year."

We should also ask: Why — and at what human cost — has Texas steadfastly refused to provide inexpensive preventive health care to so many kids for so many years?

"Carla Frew, one of the original plaintiffs," Swanson says, "is now an adult with a child of her own."

And what will happen if Texas is again ordered to reach out to the poor and provide preventive care for their kids, and state officials again renege on their obligations and continue to resort to legal delays?

"They've been all the way up to the Supreme Court twice and lost both times," Zinn says.

"We certainly hope we won't have to go through this again."

But if need be, they will.