More than 5 million Texans — a daunting 26 percent — have no medical insurance. Of these, 2 million are working adults who cannot afford coverage. They are the ostensible beneficiaries of Gov. Rick Perry's proposal to subsidize private health insurance premiums.

Perry's approach echoes that of President Bush, which would divert $30 billion from payments to safety net hospitals to "Affordable Choices" grants to help states make private insurance more affordable to the working poor.The idea is that, once they obtained insurance, they would seek preventive care and avoid overusing emergency care in safety net hospitals such as those in the Harris County Hospital District. The problem with this approach is that not only is it complicated, it will probably not attract the very people it is designed to serve.

Financing Perry's Healthier Choices insurance pool every two years would require diverting $375 million, or 40 percent, of the state's allotment of safety net hospital funds, called DSH payments. Creating the subsidy pool also calls for $250 million generated by income from the proposed sale of the state lottery. That's not all. In order to preserve the financial viability of the safety net hospitals, the plan requires $350 million in new state general revenue that would draw down $875 million in federal matching funds. This money would be used to increase the Medicaid reimbursement to safety net hospitals to more closely reflect the actual cost of care.

This complicated formula requires Medicaid reform legislation to divert the DSH funds, a hefty new appropriation for Medicaid and the wild card element of a state lottery sale.

If all this came to pass, workers earning up to 200 percent of the federal poverty level would receive up to $150 per month to help purchase insurance, either from employers or in the individual market. The benefit has more purchasing power when applied to an employer's plan with rich benefits than it would if used to purchase individual catastrophic insurance with a high deductible.

Those eligible to participate in Perry's plan likely would find themselves in the individual market, where the subsidy would scarcely cover a bare-bones plan with a high deductible. Texas already offers such a policy with its Consumer Choice plans, but insurance companies have not sold many such policies because the premiums are fairly high relative to the benefits.

Such basic policies don't offer much of an assist for preventive, routine care. It seems probable the public hospitals would remain the safety net for care that remains out of reach.

A proposal with so many deficits — one that is unlikely to pass the initial public policy hurdles, attract its target beneficiaries or achieve the desired shift from emergency to primary care — is disheartening. Five million uninsured Texans deserve a better plan with a greater chance of reducing the problem.