Read My Chips

What George W. Bush Is Not Saying About Children's Health Insurance

Read My Chips
Photo By E.R.N. Reed

Even by the odd standards of the Texas Legislature it was an odd moment: Governor George W. Bush, leaving the press pack last April and walking onto the House floor to embrace the only openly gay member of the Legislature. "Congratulations," the governor told Rep. Glen Maxey, D-Austin, as he draped both arms over Maxey's shoulders. "You shoved it down our throats."

If "down our throats" seems a peculiar choice of words, the governor often says peculiar things when he's off-script. He was referring to the federal/state Children's Health Insurance Program (CHIP), and the fact that Maxey had prevailed in increasing the number of Texas children who would qualify to purchase the low-cost health insurance the program offered.

Then the conversation got even stranger, with Bush telling Maxey that what George Bush as governor says in public about gays and lesbians did not pertain to Maxey. Maxey -- who also happens to be George and Laura Bush's state representative -- turned to a small group of reporters and told them what the governor said, asking them to sit on the information until after the veto deadline. A spokesperson for the governor has since denied that Bush made the comment about gays. And it probably doesn't matter. Bush isn't likely to win much of the gay and lesbian vote anyway. But the CHIP issue might come back to haunt him between now and November.

What Maxey shoved down Bush's throat was health insurance eligibility for a then-estimated 500,000, rather than 300,000, children -- a big win for the Democratic House Caucus. And a big loss for Bush, who spent much of the early session fighting for the lower number -- although since his presidential campaign began, his press office has repeatedly boasted that he signed the bill providing health insurance for almost 500,000 kids. "It's shameless to take credit for something he wasn't supporting," Maxey said.

Bush did sign the bill. And he can claim to have supported it. But he drew the eligibility line at 150% of the federal poverty level -- which excluded some 200,000 children of working-poor families from buying low-cost health insurance -- an eligibility level that few states even considered. In New Jersey, for example, Republican Governor Christine Todd Whitman had worked with her state legislature to establish eligibility at 300% of the federal poverty level. In Florida, Governor (and George W. sibling) Jeb Bush had agreed to 200%. Only two states set eligibility levels lower than that. Yet the governor of the state with the second highest number of uninsured children in the nation was taking a hard line on 1.4 million kids who are often shut out of doctors' offices.

That didn't surprise the handful of Democratic legislators and health-and-welfare advocates who drew Democratic House Speaker Pete Laney into the 1999 fight to set eligibility at 200%. Because by 1999, all of them were familiar with a backstory on the governor and the children's insurance program. CHIP is a federal health care initiative passed in 1997 to provide insurance for children whose families earn too much to qualify for Medicaid but too little to afford health insurance. It is a three-to-one match, bringing in roughly three federal dollars for each state dollar spent.

Because the 1997 biennial session of the Texas Legislature ended before the program was available, Bush was left with two alternatives: call a special session in 1997, or implement the program himself and secure funding when the Legislature convened in 1999. He did neither. And advocates of the program didn't press him in 1997 because they feared that if Bush implemented the program himself, he would set up an eligibility level that would exclude even more children than he tried to keep out of the program in 1999. "We didn't push it in 1997 because the governor was talking about 133%," Maxey said. Consumers Union lobbyist Lisa McGiffert agrees: "Initially, he said he would go to 133. That was the word from his Health and Human Services Commissioner, but everyone knew it was the governor's position." So program advocates waited until the Legislature convened and they could take their fight public.

The 1999 CHIP fight was not George W. Bush's finest moment. He kicked off the session proposing an "emergency" $45 million tax break for oil-and-gas producers. He was returning more than $1 billion of a budget surplus to taxpayers in the form of nominal property tax cuts. The $179 million state allocation to fund CHIP had been set aside from early installments on $17 billion in proceeds from the state's lawsuit against tobacco companies. And the governor couldn't explain why he opposed more generous eligibility levels, which would provide insurance for more than a third of the state's uninsured kids. "I want to make sure that the most needy children are taken care of first," Bush said -- on the same day the House was debating his emergency oil-and-gas tax relief bill.

So the speaker, the public-interest lobby, and Bush's own state rep shoved children's health insurance down the governor's throat -- making insurance available to roughly 500,000 rather than 300,000 children. But it was only a partial victory for uninsured kids. And Bush's administration hasn't made matters better since then. "There was not a single FTP [full-time personnel] funded to run the program," said Ann Dunkleberg of the Austin-based Texas Center for Public Policy Priorities in June. She also observed that having 675 Dept. of Human Services employees eliminated by Bush's welfare reform program will make it even more difficult to get kids insured. Two months later, Dunkelberg's warning seems like an understatement.

With no public agency implementing the program, every piece of the CHIP operation has been contracted out to private firms. Enrollment began in April and by early summer, the company the state had hired to take applications was lagging behind federal enrollment target goals. So Burch & Davis, the private firm doing enrollment, resorted to a novel approach to attract applicants -- telethons held in collaboration with TV stations in media markets around the state. Since May 1, about 80,000 children have been enrolled, 17% of the 428,000 goal that funding should cover. But the state and its uninsured children have already taken one big hit. Texas now stands to lose $449 million in federal funds because it failed to meet enrollment targets established by the Feds. The money will be reallocated to states that have met CHIP enrollment goals.

"There are aggressive efforts underway to enroll children in CHIP," Bush spokesperson Dan Bartlett told The New York Times last week.end story

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George W. Bush, Glen Maxey, Christine Todd Whitman, Jeb Bush, Pete Laney, Jeb Bush, CHIP, Ann Dunkleberg, Dan Bartlett, Dan Bartlett, Texas Legislature

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