A Texas-size crisis as kids’ lack of health coverage rises

For more than a decade, the number of children with health insurance was on the upswing across the nation.

That happy news hasn’t lasted, especially in Texas.

A new study from the Georgetown Center for Children and Families shows that Texas children led the way in a three-year national downturn in children having health coverage — a time span that happens to coincide with Donald Trump’s presidency.

From 2016 to 2019, the uninsured rate for children in Texas rose from 9.8 percent to 12.7, which accounts for one-third of the total national increase in kids without health care.

In that same time period — the economically rosy, pre-pandemic years — the national uninsured rate for children rose from 4.7 percent to 5.7 percent.

That Texas children are the least insured in the country — as they have been for years, but especially now — is cause for shame. A big part of the drop involved declining enrollment in Medicaid and the Children’s Health Insurance Program, or CHIP, both federal health insurance programs for low-income families.

“It’s terrible news,” said Dr. Laura Guerra-Cardus, deputy director of the Children’s Defense Fund — Texas. “What we’re seeing is the largest jump in loss of coverage since the ’80s. And each number represents a child who is likely missing needed care.”

A missed immunization. A missed appointment that might detect a developmental disability, making it harder and costlier to treat later. Studies show adults who received Medicaid as kids were more likely to graduate high school, go to college and earn higher incomes.

In other words, access to health care means a brighter future for Texas’ youngest citizens. The study laid the blame for the state’s high rate of uninsured children on several factors.

For one, Texas is among 12 states yet to expand Medicaid. Studies show when low-wage working adults can get Medicaid, their children are more likely to have insurance as well. Twice as likely, compared to kids in nonexpansion states. Second, in 2016, Texas cut funds for Medicaid and CHIP outreach and enrollment assistance. Both programs are complicated to enroll in, and people need help.

Third, the Trump administration’s “anti-immigrant rhetoric and policies” have scared away many families, who fear applying for federal health insurance for their U.S. citizen children will jeopardize their quest to get a green card, Guerra-Cardus said. It won’t.

But here’s the most galling reason: Texas, encouraged by Trump, instituted a policy that requires families to submit to multiple “eligibility reviews” throughout the year to keep their kids enrolled in Medicaid. Ostensibly, this is to make sure parents aren’t earning too much for their children to qualify. But Guerra-Cardus said most parents with children in the program toil in lowwage jobs, such as restaurant work, and their income doesn’t fluctuate much.

“Families can get these requests five times a year, and if they fail to respond within a 10-day window, their child is automatically disenrolled,” she said. “It places a disproportionate burden on the very families that lack the time and experience to navigate these things.”

Ana Maria Garza Cortez, who oversees Medicaid eligibility at local CentroMed clinics, said the renewal process is overwhelming. “Families tell us they would rather lose coverage and reapply,” she said. “But then they have a coverage gap.”

The study found the insurance decline was an equal-opportunity debacle — while Hispanic children suffered the highest rate of being uninsured in Texas, no demographic group was spared. How the COVID-19 pandemic has affected all this is unknown. While children’s enrollment in federal health care nationally has increased during the coronavirus, because of rules that forbid disenrollment during a crisis, it’s not clear what will happen when things go back to “normal.” If Texas doesn’t fix the flaws in its system, it will likely revert to business as usual, Guerra-Cardus said. Legislators have the power to change things when they meet in January, she said. Expand Medicaid. Abolish midyear eligibility reviews. Refund outreach. Fight false information designed to scare immigrant families.

Texas politicians talk a good line about how much they care for children. Prove it, we say.