The numbers are staggering. In Dallas County alone, there are an estimated 149,000 uninsured children. Statewide, the number is about 1.3 million. CHIP is a federal program, established by the U.S. Congress in the Balanced Budget Act of 1997, under which states are eligible to receive matching funds over the next 10 years through the state established health insurance program for children. Texas' share of this federal program is $423 million for this biennium. The Legislature plans to contribute matching funds of about $151 million per year from the tobacco settlement.
Some of the major issues that must be decided by the Legislature include (1) How should Texas administer CHIP, (2) What funding proposal should the Legislature adopt, and (3) What level of eligibility should the Legislature allow. In other words, how to most effectively spend federal and state money on heath care insurance for needy Texas children.
As to the administration issue, under the Averitt/Janek plan the Texas Healthy Kids Corporation (THKC) would enroll children and manage the program. THKC is already screening and enrolling children for the program we set up two years ago and already reports to the Texas Health and Human Services Commission. Others believe that THKC should be left alone as a private/public partnership and that a new program should be set up to administer CHIP funds even though it could take 6 to 12 months longer to get the first children enrolled.
On the level of eligibility, one proposal, loudly and forcefully supported by some of our colleagues, is to cover all children up to age 18 in families with incomes below 200% of the federal poverty level ($33,400 per year for a family of four). The problem is that nobody is sure how many children would be covered and whether the money available would cover them all. If more than expected enroll do we want to see babies on a waiting list while 17 year olds, with adult bodies, are receiving services? To me this is a very troubling issue and one where there will be much debate and political posturing.
One suggested solution is to design the program to give first funding priority to children ages 0 - 12 years old. After there is an understanding of the funds needed and if there is money available, we would also cover children up to the age of 18.
A major concern is that the federal funding runs out in 5 years. This could leave the State with the obligation to fund a large and inefficient program if it is not set up carefully at the outset. Accordingly there are proposals to require families to make some payments and to encourage them to obtain private insurance as their income rises.
The income from the tobacco settlement and the federal matching funds gives us an opportunity to provide health insurance for the youngest members of our society. Do we want to use a free market approach as much as possible or do we want to set up a new Medicaid style government program? As Republicans, the idea of setting up new "entitlements" should generally send us all running, but when we are talking about children, the debate changes significantly. Our state and nation has decided we are going to provide healthcare benefits for the most needy in our society, Medicare for the elderly and Medicaid for the poor. As a Legislature, we must look at how we spend our taxpayers' hard earned money and prioritize it where it can do the most good at the least and most efficient cost.
With my background in the healthcare industry, I know that spending money on preventative healthcare in the beginning of life will tremendously reduce the costs that we will otherwise spend later in life. By aiding children in their must vulnerable time, we substantially reduce the need to care for them later. For that reason, I support the funding of healthcare insurance for children whose families are unable to provide for themselves. On the level of funding, because of the variables involved, I think that the state should agree to fund up to 200% of the poverty level only for children up to age 12. We can always reevaluate the funding level depending on participation, and additional funds available.
I do want to dispel some of the myths that I have heard from constituents as reasons not to support CHIP. No coverage of abortion, prenatal care or family planning have been included in the CHIP State Plan proposal. Second, the CHIP plan will not give these children the "cadillac" of all insurance plans. It provides for an HMO plan, and does not give the applicant their choice of programs.
As always, I encourage you to contact to my office with your thoughts about this issue. Please contact my office at P.O. Box 2910, Austin, Texas, 78768-2910, or E-mail me at kenn.george@house.state.tx.us.