Naked City

Who Pays for CHIP Cuts?

Apparently, it wasn't enough to cut 100,000 children from the state's Children's Health Insurance Program via Lege-mandated changes in eligibility – that is, rationing by regulation. The Texas Health and Human Services Commission has now proposed adding an assets test for CHIP, a program aimed at families that earn too much for Medicaid but can't afford private insurance. Under the proposed rules (borrowed directly from the food-stamps program, which is aimed at even poorer people), CHIP families could not qualify for the program if they have more than $5,000 in assets – even though the central principle behind CHIP is to help keep the need for health insurance from driving working families deeper into poverty.

At public hearings early this month, CHIP clients and community advocates expressed alarm that the HHSC seems determined to continue slashing the program – even though enrollment has already declined from 505,000 to fewer than 400,000 in less than a year and continues to drop. Administrators at HHSC project that the asset rules would mean roughly another 5,000 families would lose coverage – although it's quite possible that's a radical underestimate, since it's not even certain the commission is paying much attention.

The federal government pays Texas $2.59 for every state dollar spent on CHIP, so the cuts have already meant statewide losses in the millions for health care, resulting in heavier burdens on local health care providers and funders. (The city of Austin and Travis Co.'s public health system, for example, will lose more than $18 million in federal and state CHIP funding.) Yet deputy executive commissioner Tom Suehs officially concluded that the proposed asset rules will have "no fiscal implications" for local health and human service agencies or governments.

Asked how he came to that curious conclusion, Suehs said his fiscal note uses "standard language" to address the question and that the agency "doesn't really have the tools" to determine whether there will be local fiscal impacts. "We're primarily focused on the impact to the state," Suehs said, and his fiscal note predicts savings of $320,000 in the first year and then $1.15 million annually through 2008 – not accounting for the federal money being turned away. So when Suehs concluded, officially, that there will be no local impact, he says he actually meant something quite different: "We don't know." Make what you will of the HHSC's other official projections, not to mention its honesty.

The institutional cynicism of the new rules is further reflected in associate commissioner Jason Cooke's official description of the "anticipated public benefit" of the new rules: "to ensure that health coverage is only available to children whose families are least able to afford health coverage." Texans can all certainly sleep easier knowing that the emergency rooms are filling, at a premium, only with the undeserving poor.

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CHIP, Childrens Health Insurance Program, Health and Human Services Commission, Tom Suehs, Jason Cooke

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