Insuring children
Lawmakers can still do more to meet the goal of health coverage for every young Texan.
Although Texas lawmakers have access to their honorary “physician for the day,” we presume during this first week of the 2017 session to offer them medical advice from one of the world’s most venerated pediatricians, a native Texan named T. Berry Brazelton. Born in Waco 98 years ago, “America’s pediatrician” was for decades professor of pediatrics at Harvard Medical School and remains deeply involved in public policy issues regarding children’s health.
Brazelton continues to remind us that we need to invest in the health of our children, for their benefit and ours. “Science has shown that deprivation in the womb has lifelong negative effects on health,” he wrote not long ago. “So does adversity during early childhood. We know now that access to quality health care — at the beginning of life and during pregnancy — can help prevent both.”
Access to quality health care means access to physicians. It means access to information about how to live healthy lives, as children and adults. It means access to preventive measures that are invariably less expensive than treatment after the fact.
The key to access is health insurance. Without insurance, parents of modest means will postpone visits to the doctor, hoping against hope as they listen to the nagging cough or measure the high temperature that the young body will heal itself. If not, they’ll wait until the last minute before taking their child to a costly hospital emergency room. At a time when the number of uninsured children is declining across the country, including Texas, lawmakers can still do more to meet the goal of coverage for every young Texans, as a recent report from the Georgetown University Center for Children and Families illustrated. The center offered a comparative assessment of children’s health coverage rates in the two states with the largest population of uninsured children, California and Texas. About 28 percent of all uninsured children (984,000) live here and in the Golden State.
California embraced the Affordable Care Act, while Texas resisted the ACA, refused to establish a state-based marketplace and rejected funds for Medicaid expansion. The percentage of uninsured children in California declined by four percentage points, from 7.4 percent in 2013 to 3.3 percent in 2015, a decline that sent California from No. 36 among the states to No. 14. Texas also made progress. Thanks in large part to Obamacare and the state’s Children’s Health Insurance Program, the number of uninsured Texas children fell by an estimated 100,000. That’s a decline from 12.6 percent in 2013 to 9.5 percent in 2015, although the state was still ranked 50th in both 2013 and 2015. The national average was 4.8 percent in 2015.
Texas is not going to establish statebased insurance exchanges — now that Obamacare is in the crosshairs, Republican lawmakers are eager to note. Texas is not going to expand Medicaid, the joint federal-state health insurance program for the poor and disabled. It too is fatally flawed, those same GOP lawmakers will tell you. Even without a miraculous GOP replacement for Obamacare, Texas lawmakers, for our kids’ sake, still can push to expand coverage by negotiating a plan with the federal government to cover workers who don’t have insurance coverage through their employers, just as Arkansas and other red states have done. Obviously, kids benefit when their parents are healthy.
Anne Dunkelberg, associate director of the Austin-based Center for Public Policy Priorities, points out that Texas can lower its rates of uninsured by improving outreach and enrollment for children, particularly in rural areas. She urges more effective partnerships between state agencies and community organizations, whether schools, faithbased organizations or philanthropic groups. Texas also could extend coverage to young Texans regardless of their immigration status.
More than 7 million children live in Texas today; that’s 1 in 10 children living in the United States. One in 4 Texas children live in poverty, a condition that often has lifelong health consequences, whether it’s asthma, obesity, diabetes or learning disabilities. Every Texas youngster needs to be covered.
We must make investments in our future for our children’s health, for this state’s economic health. A wise old man from Waco will tell you that they’re one and the same.