On the Lege
CHIP: How About Competence?
In a reversal of traditional Capitol good-cop, bad-cop roles, the House pulled off a remarkable feat early this month by overwhelmingly approving a bill to correct serious flaws in the reform-weary Children's Health Insurance Program. The decisive vote came four years after the Legislature slashed funding and imposed wayward privatization experiments on segments of the Health and Human Services Commission, which ultimately made Texas a poster child for how not to save a buck on the backs of kids.
Now, with the economy more flush and the House uncharacteristically owning up to its CHIP mistakes, the Senate leadership, ordinarily known for its calm, rational approach to tackling sticky issues, is going to the mat over House Bill 109, the fixer-upper bill brought by Houston Rep. Sylvester Turner (one of a minority of Democrats who broke party rank to vote to re-elect Republican Speaker Tom Craddick, thereby keeping his position of speaker pro tem). Turner's bipartisan House success means little in the upper chamber. The Senate, led by Lt. Gov. David Dewhurst, is resisting House efforts to return CHIP to its original 12-month enrollment plan, which proponents say is necessary to replenish the CHIP insured rolls and avoid losing precious matching federal dollars. With his eye on a 2010 gubernatorial run, Dewhurst favors the current six-month enrollment requirement, which health-care advocates say defeats the program's purpose, because it leaves too many children in the lurch when paperwork processing goes awry or a deadline is missed. The HHSC implemented the six-month requirement in response to the Legislature's slash-and-burn directives on social-services programs. Drawing on the knowledge that 25% of CHIP recipients either leave or are dropped from the program at the end of each 12-month period, HHSC officials came up with a strategy for unloading even more kids from its rolls reduction by regulation.
"They reasoned that if you doubled the number of children [dropped from CHIP] by having families enroll every six months, you'll have twice as many kids leaving the program," said Anne Dunkelberg, a health-care policy expert with the Austin-based Center for Public Policy Priorities. As a consequence, Texas CHIP enrollment is currently 184,000 children below the levels of September 2003, when the health-insurance program was just beginning to blossom. With the Republican takeover of the Legislature, down went CHIP. In the long run, the six-month rule threw a wrench into the state's goal of whittling down the state's grotesque number of uninsured children, which currently tallies 1.4 million. "Not only did they open a second drain in the bathtub without turning up the faucet," Dunkelberg said, "they turned the faucet down."
It's unlikely that the Senate Finance Committee will schedule a hearing on HB 109 before Dewhurst finalizes his position and gives committee Chair Steve Ogden the green light to proceed. Like Dewhurst, Ogden and other GOP Senate leaders are reluctant to sign off on a bill that would provide 12 months of continuous CHIP coverage, although Jane Nelson, who chairs the Senate Committee on Health and Human Services, appears more open to the proposal.
There is a strong political flavor to the whole CHIP debate, especially since Dewhurst could draw U.S. Sen. Kay Bailey Hutchison as a gubernatorial opponent. Hutchison has been extremely critical of the Legislature's missteps on CHIP, which only recently led to the firing (by "mutual agreement") of Accenture, the contractor hired to make the eligibility component of CHIP and Medicaid run more efficiently. Her arguments for shoring up CHIP don't square well with the conservative Republican base that opposes more social spending, but they would presumably play better in the general election.
Dewhurst wants to position himself somewhere to the right of Hutchison to appeal to the GOP base without looking like a complete bad guy. But his resistance to a proposal that would provide continuous health coverage to low-income kids contradicts his Texas Children First legislative program. Instead, the centerpieces of Dewhurst's "child-friendly agenda" are his proposals to send pedophiles to death row (which won Senate approval on Tuesday) and to throw the book at cyber-sex junkies. Dewhurst spokesman Rich Parsons says that while his boss does prefer the six-month enrollment plan, the question remains under ongoing discussion with legislative leaders. "What he's really interested in doing," Parsons said, "is looking at a system that takes the debate away from six months versus 12 months and goes to a continuous enrollment with periodic status checks." No one is certain how that would work, exactly. "It's all still very conceptual," Parsons said.
Meanwhile, the legislative clock is moving ominously toward the end of the session, May 28, and there is a gnawing fear among legislators that they'll have very little to show for one of the headiest, yet least productive, sessions in recent history. One major waste of time has been the legislators' fixation with assigning blame on the CHIP goofs instead of looking for ways to get the program back on track, Dunkelberg said. "At this point, I'm very, very concerned that we're going to come out of the session without addressing the fact that we don't have either a private or a public component of our eligibility system for CHIP or Medicaid that works."
Another problem is the lack of adequate staffing to handle the eligibility process, thanks to the state's premature pink-slipping of thousands of state employees. "We have an eligibility system that is barely functioning with 6,800 workers" down from an estimated 8,000 in 2004 "and about a quarter of them are temporary employees with a lack of expertise," Dunkelberg said.
"We're not talking about progressive politics here," she added. "We're talking about competent government."