Texas continues to have the highest rate of children without health insurance. A recently released report from Georgetown University McCourt School of Public Policy found that 21 percent of all uninsured American children live in the Lone Star State.
The report determined that, for the second year in a row, Texas’ health insurance rates are trending down.
“Texas has the dubious honor of being the only state in the country where the uninsured rate is in double digits,” says Joan Alker, who co-authored the report. “Texas historically has a stingy children’s coverage program. All the reasons coverage rates are getting worse are present in Texas.”
Alker cites many reasons why the numbers keep climbing, including cuts to the Children’s Health Insurance Program (CHIP) and other actions by the Trump administration against the Affordable Care Act. That said, a prime driver of the high rates is the fault of Texas and its labyrinthine and cruel execution of Medicaid.
In Texas, once a child is approved for Medicaid they are covered for six months. At the conclusion of that six-month period, the state requires parents to file income updates monthly to continue the coverage.
If for any reason the state determines there is a problem, they send out a letter giving parents 10 days from the time the letter is generated — rather than 10 days from receipt — to respond with the necessary paperwork.
There’s no time off for weekends or holidays, which can be a problem if a parent needs to acquire paystubs or other proof of income to satisfy the state’s already difficult-to-reach income threshold for eligibility.
This has led to many children being removed from the Medicaid rolls, despite still qualifying for the program.
According to Adriana Kohler, Senior Health Policy Associate at Texans Care for Children, the paperwork is inaccurate 33 percent of the time, leading to 50,000 Texas kids annually being dropped from their coverage.
Dropped kids can be re-enrolled later, but doing so causes obvious coverage gaps that can seriously affect treatment.
“The new data should be a wake-up call for state and federal leaders,” says Kohler. “This is bad news all around.”
Texas children health insurance crisis could be solved by legislature
Some obvious fixes suggested by the experts that the state legislature could institute include signing children up for 12 months of continuous coverage rather than six months and requiring parents to file updated paperwork just once a year, similar to re-enrollment with employer-provided health insurance.
Barring that, the state could open the window that parents have to respond from 10 days to 30 or more. Children could be automatically enrolled in CHIP if they fail the eligibility requirements for Medicaid since they would still likely qualify.
The state could also expand Medicaid to the recommended ACA guidelines of all citizens under 138 percent of the federal poverty level.
The current leadership’s refusal to consider this initiative has been a political hot potato for Republicans hoping to thwart the health care reforms of former President Obama.
It’s estimated that at least 700 people die in Texas each year the state continues to refuse the expansion of Medicaid.
“The state legislature must make healthcare a priority next session,” says Kohler. “No child should be forced to go without care because their parents picked up an extra shift at work or changed jobs.”
Both Kohler and Alker are quick to point out that rumors and conspiracy theories involving Texas’ rate related to coverage of undocumented immigrants are false. Medicaid is only available to United States citizens.
“This is a problem for kids of all backgrounds, across the states,” says Kohler. “It affects cities and rural areas, all ethnic kinds. These are all citizens, but they are being denied access. Some might say the high rate is because of illegal immigrant kids, and that’s just not true.”
Alker does point out that recent government animosity against immigrants might be affecting the legal citizens of Texas, though. Parents of kids who are citizens are hesitant to utilize the programs their children are entitled to out of dread it will lead to their families being broken up.
“There’s a chilling effect in immigrant families,” says Alker. “These families with a mixed-status where the child is a citizen but the parent is not? They’re scared of interacting with the government for fear of being deported.”
Texas’ growth will partially depend on the state is willing to rectify the problems it has with health coverage for its citizens. For kids especially, it can lead to a better future as more productive citizens.
“It’s important for kids to have coverage,” says Alker. “It leads to lower incarceration rates, higher graduation rates, and better economic outcomes.”