Kids and Health Care: Politics & Children's Health Coverage Introduction
Health care remains a heavily regulated industry; so, the posturing pronouncements of windbag politicos matter. And, when it comes to keeping children healthy, the windbags generate a lot of hot air.
Texas serves a good, windy example. In early 2004, state legislators in Austin voted to make their state's CHIP more difficult to join. They enacted a so-called "$5,000 assets test." This financial qualification would apply to new or renewing CHIP applicants; it asked the following questions:
1) Does the family have a combined gross family income above 150 percent of the federal poverty level? (If no, the family qualified for the Texas CHIP; if yes, the program would ask more questions.)
2) Does the family own more than $5,000 in assets, which includes all of the following: cash balances in checking and savings accounts; investments or other financial service accounts not part of an IRA or 401(k) retirement plan; and vehicle values above $15,000 for the first and $4,650 for each additional vehicle.
Federal poverty level guidelines vary depending on the size of the family; but for a family of four, the income level for the cut-off of automatic qualification was about $38,000 a year. Early estimates predicted that some 5,000 families would be pushed out of the Texas CHIP by the new qualifications.
The implied message in the measure: Use your savings or sell your second car to buy commercial health insurance for your kids, instead of using the CHIP.
Advocacy groups like the Children's Defense Fund of Texas immediately leapt to criticize the assets test as something that would penalize working families for having two cars or saving for higher education.
According to U.S. Census data, Texas already had the highest rate of uninsured children in the country before the $5,000 assets rule -- with 22.6 percent of children lacking coverage. (And about 90 percent of uninsured Texas children had at least one parent who worked full-time.)
Doctors pointed out that the $5,000 assets rule wasn't the only thing chasing kids out of the Texas CHIP. An earlier change -- which had removed dental and vision coverage from the plan -- had confused many member families. They thought the cuts meant all coverage was gone; so, they didn't renew their participation. (In Texas, CHIP families have to renew their participation every six months.)
Public health experts in Texas predicted that, if the monthly decline in CHIP enrollment continued at the same rate as it had in the first six months of fiscal year 2004 (an average of 4.7 percent every 30 days), enrollment would drop to about 300,000 by the end of fiscal 2004 -- less than the official budgeted enrollment average of 346,818.
But doctors on the Lone Star State noted ruefully that the CHIP reductions were simply rearranging the same expenses. Kids not covered by Texas CHIP can see a doctor at a clinic or go to the emergency room -- and the costs would be shouldered by a separate state plan covering medical care for the indigent. "It's the same old story," said one Dallas-area M.D. Instead of coming to the doctor's office and eliminating problems early on, uninsured families wait until an appendix bursts or a cut gets infected before going to the emergency room. "And the state pays more, there. [The Texas CHIP] should be open to every kid who needs it. It's the 'ounce of prevention' factor."
