Senator Eliot Shapleigh - El Paso, Texas

Carlos Guerra

Over the decades that politicians have used "the children of Texas" to justify all sorts of political shenanigans, they have taken the child-friendliness out of Texas — especially for the children of impoverished and working-poor families.

Since 1964, when Medicaid became law, Texas has been miserly about providing health care for its most vulnerable.

As early as next month, however, that historic stinginess may trigger a fiscal crisis.

Twenty years after Medicaid was added to the nation's social safety net, Congress extended it to insure, first, toddlers, and in 1989, all children from families living in poverty. Both expansions made good sense.

Inadequate medical care for infants and toddlers can have lifelong implications. But when older kids don't get timely preventive care, it can also have a profound economic impact.

Today's children are tomorrow's work force, and their health and educational attainment will determine Texas' global competitiveness. A child's sick-day school absences will diminish academic success.

And what can we expect children to learn if they have toothaches or earaches, or don't have the glasses needed to read?

Medicaid coverage for children whose families live at or below the poverty level was intended to address these issues.

The program is jointly funded with state and federal money, with the federal share matching what the state appropriates.

States administer the program and have some leeway on eligibility determination and level of care. But federal law also mandates certain types of coverage — and it requires states to actively reach out to eligible families to prevent their children from being hobbled for life for lack of timely medical care.

From the beginning, however, Texas chose to be tightfisted about its Medicaid spending by limiting its outreach efforts and refusing to provide some types of care mandated by law.

State officials also made applying for Medicaid as complex as possible, requiring applicants to fill out long, complex forms and provide one or more affidavits from third parties.

This pattern was repeated in Texas after Congress passed the Children's Health Insurance Program in 1997 to provide health care coverage for children of working-poor parents who earn too much to qualify for Medicaid but who still can't afford to insure their children.

CHIP is also funded with a state-federal match system, but its federal match is even more generous than Medicaid's.

Since CHIP didn't become available until after the Texas Legislature had adjourned — and then-Gov. George W. Bush would not call a short special session to authorize CHIP enrollment — two years passed before any kids were signed up.

Then, in 2003, the Texas Legislature offset a $10 billion budget shortfall by making massive cuts to both Medicaid and CHIP.

But since 1993, when attorneys Susan Zinn and Jane Swanson sued Texas because 941,072 Medicaid-eligible children didn't get medical checkups, and 1,000,059 didn't get dental services, their legal challenge has been winding through the federal court system.

After Texas agreed to settle in 1996, state officials reneged on their deal and took the two lawyers all the way to the U.S. Supreme Court twice.

But Texas has lost at every court along the way, and now the state's appeals are exhausted and the case is back in the court of Senior U.S. District Judge William Wayne Justice. He is expected to order Texas to provide health care for Medicaid-eligible children very soon.

But in the 13 years since the suit was filed, the 1.5 million children who were illegally denied Medicaid services are now 2.8 million. And living up to court orders may cost as much as $5 billion.

Wouldn't it have been cheaper to do the right thing all along?