Texas could shed its distinction of having the nation's highest percentage of uninsured children if proposals that advanced at the state Capitol last week become law.

One proposal would allow certain families earning more than the income limit for the Children's Health Insurance Program to pay to join. Another would allow families to stay in children's Medicaid for a full year rather than having to reapply every six months.

The CHIP proposal could add 80,000 children to that program, and the Medicaid one could add 258,000 children to the federal-state health insurance program, though estimates vary.

"That would certainly take us out of last place in both percentage and number," said Anne Dunkelberg, associate director of the Center for Public Policy Priorities, which acts as an advocate for low- and middle-income Texans.

On average nationally, 12 percent of children are uninsured, but in Texas, it's 22 percent, followed by 20 percent in Florida, according to U.S. Census data.

There are 1.5 million uninsured children in Texas.

"That's an unacceptable number, from a moral standpoint and an economic standpoint," said state Rep. Patrick Rose, D-Dripping Springs, chairman of the House Committee on Human Services.

Changing that is the top priority this session for several children's advocacy groups, and the Texas Hospital Association and Texas Medical Association have joined them in calling on the Legislature to expand Medicaid by changing the enrollment period to a full year.

For more than a decade, Texas has had the highest — or nearly the highest — percentage of uninsured children. Meanwhile, states that used to have similar percentages — such as New Mexico and Oklahoma — have significantly lowered them.

"They did some aggressive things to increase coverage of kids that we just didn't keep up with," Dunkelberg said.

What's held Texas back, she said, are policy changes adopted during a budget crunch in 2003 combined with problems with the state's sign-up operation that have suppressed enrollment.

In 2007, lawmakers loosened restrictions imposed in 2003 on CHIP. That helped add 120,000 children to CHIP in six months. Now, some lawmakers are seeking to make similar changes to Medicaid.

Rose's panel on Tuesday passed a proposal by state Rep. Sylvester Turner, D-Houston expanding the Medicaid enrollment period to 12 months. Advocates say that children fall off the program every time families have to re-enroll — either because parents don't submit the application materials or because of state processing errors.

The measure — as spelled out in a provision Turner attached to the House version of the state budget — would be paid for from Medicaid dollars Texas is expected to get as part of the federal stimulus package. The change would expire after two years.

Critics of the Medicaid proposal say the six-month eligibility period is a good way to make sure that only eligible children are enrolled. Supporters say it would keep children from having gaps in coverage; they also say it would reduce the workload for the Health and Human Services Commission, which has struggled to process applications within the 45-day federal guideline.

"We have the money," Turner said. "I can't think of a better use than to provide health care for our children. And bear in mind, these are the poorest of our children."

A family of four in Texas can earn up to $22,050 and qualify for Medicaid; for CHIP, the income limit is $44,100 for a family of four.

About 466,000 children are enrolled in CHIP, and about 1.9 million are enrolled in children's Medicaid. More than 700,000 are thought to be eligible for CHIP or Medicaid but not enrolled.

Meanwhile, the CHIP proposal was approved last week by both the House Human Services Committee and the Senate Finance Committee.

Lt. Gov. David Dewhurst, who presides over the Senate, said that he'd like to focus on enrolling children who are already eligible for CHIP or Medicaid.

"But I also support looking at ways we can implement a CHIP buy-in program for parents so they don't lose medical coverage if they earn just a few dollars more than allowable under the program," Dewhurst said. Such a program "helps those parents take on more responsibility for their children's health care."

Under the proposal, families earning between the current income limit and a certain ceiling ($66,150 for a family of four) would pay monthly premiums on a sliding scale according to their income. For example, a family of four would pay $88 to $120 a month.

The human services committee passed the bill 8-0, but it was unanimous only because Rep. Bryan Hughes, R-Mineola, stepped out of the meeting room for the vote.

Committee members "worked really hard to put a bill together that wouldn't just pass on a party-line vote," Hughes said. "I didn't want to poke them in the eye."

But he said he couldn't vote for it. "My concern is that as we pull more children out of private health insurance, we raise the cost of private health insurance for everyone else," Hughes said.

Andrea Whitman, a health care policy analyst at the Texas Public Policy Foundation, which supports limited government, said that CHIP "was created to provide health insurance to children of the working poor."

"Extending CHIP to families making up to $66,000 per year morphs the program into an expensive entitlement for the middle class," she said.

But the bill's Senate author, Kip Averitt, R-Waco, said his proposal is a fiscally responsible way to address a serious problem in Texas.

"These are hardworking families who have jobs, pay their taxes but just don't make enough money to afford the high cost of health insurance," Averitt said.

He said it doesn't make sense that people making just a bit more than the current income limit don't qualify.

Tyson and Kandi Johnson's family fell into that situation. The Johnsons and their three children — who live in Mabank, southeast of Dallas — were in CHIP until two years ago, when their oldest son turned 19.

At that point, CHIP started considering the Johnsons a family of four rather than five, and they no longer qualified, said Tyson Johnson. He said they were a few hundred dollars over the annual income limit.

Tyson Johnson, an operations manager for a brick distributor, said he looked into private health insurance, but it wouldn't cover his 10-year-old daughter's "pre-existing condition" — Williams syndrome, a rare genetic disorder.

As for the future, "I don't know what to do," he said. "As we speak, there's nothing out there."

Since the Johnsons were disqualified from CHIP, Kandi Johnson, who used to work part time because of her daughter's special needs, now works full time. The family, which used to earn about $43,000 a year, now earns about $55,000, Tyson Johnson said.

The CHIP proposal may help the Johnsons, but the House bill's author, Rep. Garnet Coleman, D-Houston, said he wishes the measure did more. For example, he would like to have loosened CHIP restrictions on the value of families' vehicles but said he was forced to compromise with members of the Human Services Committee.

"Why do we have to penalize families to allow them to have healthy children?" Coleman asked.

The bills: House Bill 2962 by Garnet Coleman, D-Houston, and Senate Bill 8 41 by Kip Averitt, R-Waco
What it does: Allows certain families earning more than the current CHIP limit to join the program. A family of four earning between $44,100 and $66,150 could qualify. Unlike the existing CHIP program, families would pay monthly premiums on a sliding scale based on income and family size (about $88 to $120 a month for a family of four). In the current program, families pay an annual fee ($50 a year or less per family) plus co-pays ($3-$10 for most doctor visits and prescription drugs) but no monthly premiums.

More info: The House bill also creates a buy-in option for former CHIP families that now earn too much to qualify. They'd pay the full cost of the program - about $150 per child per month. A family of four earning between $66,150 and $88,200 a year could qualify.
Impact: Could add 80,000 children to CHIP.
Cost: $38 million in state funds over two years.

The bill: House Bill 1541 by Sylvester Turner, D-Houston What it does: Adds children to Medicaid by expanding the enrollment period for the program from six months to 12.
More info: The measure would expire in two years.
Impact: Could add 258,000 children to Medicaid.
Cost: $297 million over two years. Turner wants to pay for the program using Medicaid money that is expected to come to Texas from the federal economic stimulus package.