In the shadow of the ex-governor’s State of the Union address, the state of Texas health care took a public relations beating last week, as the U.S. Supreme Court unanimously rebuked the Texas approach to Medicaid, and last year’s harsh legislative budget cuts begin to take effect on the most vulnerable Texans and their families. On Jan. 14, the court ruled that the state of Texas must comply with the 1996 consent decree it signed in settling a 1993 class-action lawsuit by a group of East Texas parents (during the Ann Richards administration) demanding that preventative care be provided for children covered under federal Medicaid programs. Under the settlement, Texas said it would improve its delivery of such preventative programs as medical checkups and routine dental care, blood screenings for anemia and toxins, and childhood vaccinations for what were then about 1.6 million children. The state (under then Gov. Bush) kept its word so poorly that the families returned to court in 1998, and in 2000 Judge William Wayne Justice ordered the state to comply with its own agreement.
The state (by then governed by Rick Perry) promptly appealed, not on the grounds that it had upheld its agreement — but that it didn’t have to do so because it enjoys sovereign immunity from federal enforcement of the agreement. The Supremes overturned a 5th Circuit ruling in favor of the state and ordered that Texas must submit to the decree. “Federal courts are not reduced to approving consent decrees and hoping for compliance,” wrote Justice Anthony Kennedy. “Once entered, a consent decree may be enforced.” The state hasn’t yet decided if it will go back to the lower courts for further negotiation or, after a decade of delay, finally live up to its agreement.
While Texas sorts out that burden, nearly 100,000 children have been dropped from the Children’s Health Insurance Program since last May’s legislative budget cuts — primarily through rationing by regulation — reducing that program’s enrollment to 416,000 for January. The CHIP program is for families earning too much to qualify for Medicaid, but not enough to buy private insurance — and new state rules forbid them to own more than $5,000 in total assets. Enrollment reductions were projected to total 169,000 by mid-2005, but at this rate that number of children will be eliminated or surpassed much more quickly — no doubt local emergency rooms can easily accommodate them. The reduction figure does not include those additional children who would have been enrolled under the previous rules, a projected 330,000 by 2005.
This article appears in January 23 • 2004.
