Happy child and mom getting health care at Texas Children’s Hospital.
President Bush vetoed a bill that would have expanded and provided additional much needed funding for the Children’s Health Insurance Program (CHIP) (despite it passing Congress) and hasn’t got an alternate plan. This is a serious problem for the 9.4 million uninsured children in the US, 4 million of whom are uninsured directly as a result of President Bush’s veto.
In response, the Children’s Defense Fund has teamed up with Cover the Uninsured as part of their Healthy Child Campaign. Today, Moms Speak Up is honored to present our question and answer interview with Laura Guerra-Cardus of the Children’s Defense Fund.
Julie Pippert Question: Your organization, Children’s Defense Fund, is sponsoring a Cover the Uninsured week. Tell us a little about what that is and what you hope to accomplish with it.
Laura Guerra-Cardus Answer: Led by the Robert Wood Johnson Foundation, Cover the Uninsured Week (CTUW) is the nation’s largest mobilization on behalf of America’s 47 million uninsured. Since 2003, the Week has brought together business owners, union members, educators, students, patients, hospital staff, physicians, nurses, faith leaders and their congregants, and many others to speak out on behalf of the uninsured and demand that our national leaders make the issue of the uninsured their top priority.” (Click here to learn more.) Thousands of events across the nation take place on this week and in general focus on public education and enrollment events.
Keep reading to learn more about Cover the Uninsured Week, Children’s Defense Fund, and what Laura thinks about the state of the uninsured in the US…
Laura Guerra-Cardus Answer (continued): Public education – Some people, for example, still don’t know that nearly 90% of all uninsured families have at least one full time working adult. Others are still not aware that the only option for health coverage for many responsible hard working families is to pay 30% or more of their take-home salary towards their family’s coverage.
One fact that I have recently noticed that many people are not aware of is that while there may be some plans that seem reasonably priced at first, because they are not comprehensive, they result in high out of pocket costs and are again not accessible to many families.
Enrollment events – In Texas more than half of the 1.5 million uninsured children are currently eligible but not enrolled in existing public/private partnerships such as CHIP and Children’s Medicaid. Thus, reaching out to and enrolling eligible children is a principal focus of Texas and many other states for CTUW.
Most of the events throughout Texas can be found listed here. (Other state events available at Web site too.)
For CTUW, we, the Children’s Defense Fund – Texas, along with its co-grantees, Center for Public Policy Priorities and Texans Care for Children, and a collaboration of policy makers, advocates, business leaders and families joined together to launch the “Texas Finish Line Campaign”, a plan to reach the Finish Line and provide access to affordable and comprehensive health coverage for all Texas children.
The main aspects of the plan involve:
- Enrolling all eligible uninsured kids by eliminating bureaucratic roadblocks
- Reaching more uninsured kids by providing all children access to affordable coverage
Attached is a fuller explanation of these SOLVABLE issues.
One of the things that we hope to get out of CTUW and the Campaign Launch is awareness that unlike many of the problems children face today, the fact that they are uninsured is a problem we can SOLVE. We hope that people will join our campaign by signing on and advocating for children’s health coverage. To find out more about the campaign and how to get involved go to www.TexasKidsWin.org.
To view the enormous amount of press coverage for the launching from across the state, click here.
JP Q: How many uninsured children are there in the US? What are the chief obstacles uninsured families face to accessing insurance and health care?
L G-C A: There are 9.4 million uninsured children in the United States. More than 10% of them, 1.5 million, live right here in Texas.
While specific obstacles vary across states since each have different administrative policies and income limitations, most obstacles surround two key issues. One is bureaucratic red tape that makes it difficult for eligible families to get and stay enrolled. The second, is that there is an ever growing number of families whose children do not qualify for CHIP because they make over the income limit yet do not make enough to afford self of employer sponsored coverage. The average cost of private health insurance for a family of 4 is more than $900/month.
In Texas, three roadblocks are standing in the way of getting health coverage to Texas kids who are already eligible:
1. The enrollment system is understaffed, under-trained, and under-equipped.
When families apply for CHIP or Children’s Medicaid their application doesn’t always get processed quickly enough or correctly because:
- The state doesn’t have enough workers processing applications;
- the worker shortage and high numbers of new workers means many aren’t yet adequately trained; and
- Some eligibility computer systems are too slow and others make errors.
As a result children experience significant gaps in coverage where their chronic diseases flare up and the community cost of uncompensated care increases; parents spend up to several hours on the phone trying to work out their paper work and resubmit their application numerous times; and eligible children are erroneously denied coverage.
The problem is that the more uninsured children there are, the higher the uncompensated cost to hospitals and safety net providers. These costs are then passed on to EVERYONE through local property taxes and increased premiums. In fact, Texas has one of the highest health care premiums in the country. That means that we are paying thousands more for the same health coverage then other states, because we have such high uncompensated care costs.
To eliminate this roadblock, the Health and Human Services Commission needs to hire additional workers to enroll children quickly; fully train both the old and the new workers; and speed up the computer systems and eliminate computer errors.
2. Some families are still trapped by red tape.
Until 2007, Texas families had to enroll eligible children in CHIP twice a year, adding costs for the state and doubling the chances that an uninsured child would fall through the cracks. The legislature eliminated that requirement last year, but only for CHIP. Now, we need to do the same for Children’s Medicaid and cut the red tape that still reduces enrollment of eligible children.
When CHIP’s 12 month coverage went into effect, we saw an enormous increase in the number of children enrolled in CHIP (over 50,000 children in just 2 months). From this, and experience in other states, we know that it is ESSENTIAL to provide 12 month coverage for Medicaid if policy makers are truly committed to enrolling the 850,000 eligible children in Texas.
3. For lots of families, CHIP and Children’s Medicaid are the best kept secret in Texas.
Many parents of eligible children either don’t know about CHIP or Medicaid or are intimidated by an enrollment process that can still be complicated.
Texas needs to do a better job of letting these families know that coverage is available for their kids and of making that coverage easier to access. Specifically, Texas should:
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- Increase investment to enlist local organizations who know the community in spreading the word to parents; and
- Let eligible kids across Texas enroll at school– an approach proven to work in Houston.
Check out our national best practice model that works with school districts to identify eligible uninsured children: CDF’s 100% Campaign.
JP Q: What is CDF doing to remove those obstacles?
L G-C A: First, as described above we are coordinating, along with the Center for Public Policy Priorities and Texans Care for Children, the Texas Finish Line Campaign. This is a statewide campaign to assure that every child has access to affordable health care coverage. In particular we are advocating the move to 12 month eligibility for Medicaid to decrease the red tape keeping eligible children from getting or keeping their coverage; and, the creation of a buy-in option for CHIP, where families can pay on a sliding scale basis if they do not have access to affordable self or employee sponsored coverage.
Please visit our website to sign-on and participate in the campaign. We will be educating policy makers on the need and economic benefits for covering children and providing recommendations on how we could achieve this.
Second, CDF is also implementing and expanding the 100% Campaign. As part of the 100% Campaign, the Children’s Defense Fund of Texas has joined the Houston Independent School District (HISD), St. Luke’s Episcopal Health Charities, Memorial Hermann Healthcare System and Texas Children’s Hospital to develop a comprehensive program to identify every uninsured student at HISD and link them with health coverage. This program has already been named a national best practice by the The American Association of School Administrators (AASA) and is being distributed to principals across the country. We encourage you to engage your schools in replicating CDF’s 100% campaign and are available for assistance. This one action could result in thousands of children receiving health coverage.
Third, we have partnered with businesses such as HEB, Fiesta, McDonalds and others to hold extremely successful enrollment drives. Our last enrollment drive with HEB reached nearly 1,500 children in Houston in just one day. HEB has committed to replicating enrollment drives in the 5 largest cities across the state.
Fourth, we are also just beginning the process of organizing statewide coordination for Back To School events in August.
JP Q: I understand you’ve been very busy promoting the Cover the Uninsured event. Can you share some or all of the places and ways you’ve been able to get your message out to the public and decision-makers?
L G-C A: Most of the events through out Texas can be found here. You can also see CDF in the news here.
JP Q: What kind of response have you gotten from the public and decision-makers as you discuss the issue of children lacking insurance, the issues the uninsured face, and the obstacles to accessing insurance and health care?
L G-C A: In general the nation has expressed overwhelming support for children’s health coverage. At the national level, even though Bush vetoed two bills that would have provided about 4 of the 9 million uninsured children in the US with health coverage, the bills passed both the House and Senate with an overwhelming bipartisan support. The House fell just a few votes short of the two-thirds margin needed to override the President’s veto.
It’s important to note that apart from Senator Hutchison, the entire Republican delegation voted against the bill, which would have covered four million of the nine million uninsured children in America. Attached you will find an alert on the CHIP veto update with the names of Texas lawmakers who voted against CHIP.
Also attached is a letter by Rep. Culberson that gives a sense of what is being said about Texas families on the CHIP program.
As seen in Rep. Culberson’s letter concerns about crowd out and misperceptions about health coverage are major issues. To clarify, children on CHIP or Children’s Medicaid must be U.S. citizens or legal permanent residence. Also, crowd out has not been significant in the Texas CHIP Program. According to the Texas Health and Human Services Commission, only 1% of new enrollment consisted of children in families that dropped other health coverage to obtain CHIP.
Additional clarifying facts:
- The CHIP legislation focuses on covering low-income uninsured children who are currently eligible for but not enrolled in coverage. Four out of five of the uninsured children who would gain coverage under this legislation are already eligible for SCHIP or Medicaid.
- The bill does not call for CHIP coverage for children in families at higher income levels. Instead, it reduces federal matching funds for children at higher income levels and provides states with incentives to cover the lowest-income children.
- The bill prohibits new waivers from covering parents and non-pregnant adults and specifically implements a phase-out coverage plan for non-pregnant and childless adults currently enrolled.
- The bill requires states to verify a child’s documentation of citizenship or legal residency to determine CHIP eligibility. Children must be legal permanent residents or U.S. citizens to receive coverage.
- CHIP uses private doctors and private health care plans to provide services to children.
- Crowd out, or the shifting of children from private to public coverage, is minimal in the proposed legislation. The Congressional Budget Office estimates that two-thirds of children who would gain coverage under this legislation are uninsured. CBO director Peter Orszag has said that the legislation is “pretty much as efficient as you can possibly get” to reduce the number of uninsured children.
In Texas one of the greatest supporters for Children’s Medicaid, CHIP and solutions to provide health coverage for children is the business community. They understand that it does not make economic sense to leave 1 out of every 5 children uninsured.
“Providing cost effective health coverage for children is the basis of a good business plan,” argues Lan Bentsen, co-founder of a Texas based international oil and gas company and the co-chair of the Children’s Defense Fund Advisory Board. “It does not make fiscal sense to leave one out of every five children uninsured when, instead of getting preventive care, these kids turn to emergency rooms for treatment. Costly uncompensated health care costs are then absorbed by local tax payers and individuals though increased premiums.”
“As a matter of simple fiscal conservatism, I hope Texas will, in the future, take full advantage of available federal matching funds to bolster our state health care system and relieve increasing pressure on taxpayers who found county hospitals. CHIP, given the available match, makes sense for our children’s health and economic sense for our taxpayers.”–U.S. Senator Kay Bailey Hutchison
“The Metro 8 supports funding the Texas Medicaid/CHIP programs at a level that maximizes the availability of federal matching funds. We believe the Legislature should implement policies to enroll every eligible child in Medicaid/CHIP.”
Consider these interesting economic facts:
- When children lose CHIP and Medicaid and end up in county emergency rooms for care, local taxpayers pay 100% of the bill. If a child with an asthma attack can see a doctor when an attack is still mild, he or she can be treated for about $100. But if he or she cannot get early treatment and has to go to the ER for treatment of full-blown symptoms, the child faces a three day hospital stay that costs more than $7,300, according to the Harris County Hospital District.
- Texas receives $2.64 in federal matching funds for every $1 invested in CHIP and $1.54 in federal funds for every $1 invested in Medicaid. Due to cuts to CHIP, Texas has lost $893 million in federal matching funds that have been returned to the U.S. Treasury and spent by other states.
- According to the conservative economist Ray Perryman, for every state dollar removed from CHIP and Medicaid, local taxes must rise 51 cents, private health insurance premiums increase by $1.34 and retail sales decline by almost two dollars.
See attached for more about how insuring kids saves all of us money.
JP Q: How do you think the coming election will affect your goals for uninsured children?
L G-C: The increased voter turnout expected in the coming elections is a huge opportunity for Texans to have their voice heard and support leaders who prioritize the needs of our children and the efficient use of our tax dollars.
JP Q: Lastly, what would you like to see interested people do to get involved and help your efforts? What are the different ways they can help?
L G-C: The best way to get involved will be to visit our website Texas Finish Line Campaign website. Here you will have the opportunity to sign-on to the campaign, recruit others to sign-on, share your story or help us collect stories of families that have experienced barriers enrolling their eligible children or miss the income limit for CHIP and are left with no affordable options. On the website you can also sign-up to get trained on application assistance so that you can help others in your community and also check to see if you qualify for CHIP or Children’s Medicaid.
For more information, explore our presentations, fact sheets, and 2007 family publication “In Harm’s Way” by clicking here.
Editor’s Note:
I’d like to thank Laura Guerra-Cardus for taking the time to provide all of her answers and so much great information.
Also, Ms. Guerra-Cardus referred to several fact sheets and documents in her interview. I’ve attached those here for your convenience and information.
Julie Pippert also writes for her personal blog, Using My Words, and for MOMocrats.
