Tax Cuts Before Tots
Candidate Bush is pushing his compassion, but poor kids in Texas
have not seen much of it
By MICHAEL WEISSKOPF
George W. Bush had a simple fiscal policy as Texas Governor: he
called for meeting the people's "basic needs" and returning
what's left to "the hands who earned it." But it didn't work that
way for Ray Haros, a poor kid from Austin's barrio in need of
health insurance. While Bush delivered $2.7 billion in tax
relief, Ray got left out of the equation.
Ray, 6, a slender boy with large brown eyes, who has been
diagnosed with depression and attention-deficit disorder, should
be under regular care by a doctor. The Haros family income, which
rests on the mother's $5.35-an-hour job at a local candy plant,
is low enough to qualify him for Medicaid. But for reasons all
too common in Bush's state, Ray receives nothing from the federal
and state insurer of the poor. Like 734,000 other uninsured Texas
youngsters who live in poverty, he relies on the uncertain
charity of free clinics and social workers who scrounge for
medicine to help him. Of all Texas kids who are eligible for
Medicaid, nearly 40% do not participate, putting Texas last among
the 10 largest states, according to Census Bureau projections for
2000 compiled by the American Academy of Pediatrics.
Uninsured kids have become campaign props in this year's
presidential contest. So far, most of the political debate on the
issue has focused on the Governor's handling of the federal
Children's Health Insurance Program, with Bush taking credit for
extending this benefit to 423,000 low-income children, and
Democrats slamming him for a slow and halfhearted start-up of the
plan. But citing CHIP's performance as evidence that Bush is
ignoring child health is not really convincing, since 39 other
states have done just as badly as Texas in using federal funds
allotted to them. The real failure in Texas, the one for which
the state stands out, is its poor record of reaching the much
larger pool of kids who are too poor for CHIP but eligible for
Medicaid. These are families of four with incomes at or below the
poverty line of $17,000.
To be sure, Bush inherited a huge gap in Medicaid enrollment from
his Democratic predecessor. When Bush took over in 1995, Medicaid
officials failed to reach about 30% of eligible children,
according to the Center for Budget and Policy Priorities, a
nonpartisan Washington group. The percentage grew as Texas
families, forced off cash assistance by new welfare laws, were
not told that their children still qualified for Medicaid.
Nevertheless, Bush put an emphasis on tax cuts rather than
spending to expand eligibility and break down barriers to
enrollment. Democrats contend that the Governor showed his
priorities when he opened the 1999 legislative session by
declaring a $45 million tax-relief bill for oil-stripper wells to
be an "emergency."
It was the legislature, not the Governor's office, that pushed to
extend Medicaid's reach. In 1995 lawmakers sought to widen the
net to an additional 303,000 kids by expanding eligibility to
families at 133% of the poverty level. First, the state had to
obtain approval from Washington. It sent its plan within the
statutory deadline and received a response from federal
officials, who asked the usual large number of questions. But
instead of a prompt follow-up, Bush's regulators waited nearly a
year to submit a revised version. Another volley of paperwork
continued until August 1997, when Congress passed the CHIP
program, overtaking the state plan. But even then, Bush took his
time to start up CHIP, although the program requires less of a
state contribution than Medicaid (25% versus 40%). When CHIP
finally did start, last May, a total of five years had passed
since the legislature first attempted to cover many of the same
youngsters.
The delay freed Texas from having to spend billions of dollars in
matching state grants, leaving enough money for Bush to pass $1
billion in tax relief in the 1997 legislative session. Two years
later, he set his sights on even bigger tax cuts. To make the
numbers work, Medicaid spending had to be contained. The
Governor's office fought a bill to require automatic
re-enrollment in Medicaid of kids still eligible after their
parents were dropped from welfare rolls. And under pressure from
Bush allies running the appropriations committees, Texas
legislators accepted projections of a steep decline in patient
demand for Medicaid. Bush succeeded in passing another tax cut,
this one amounting to $1.7 billion. But the Medicaid forecasts
proved overly rosy, leaving the program with a $400 million
deficit. The state health department is looking for ways to
offset it. One idea is to take more than $17 million from
hard-pressed programs for disabled children.
To insure kids like Ray Haros, advocates for the poor say, will
take more than money. Ray had Medicaid until his mother got a
job three months ago and stopped receiving cash aid. Rene Haros'
income was low enough for her five children to remain eligible
for Medicaid. But no one told her that unless she asked for it,
they'd be cut off. To re-apply, she has to navigate a complex
and intrusive process. She must go to an interview, fill out as
many as 19 forms, reveal family assets and document everything
from children's births to job histories of adult household
members. Once approved, Ray's mother will have to return to the
state office every six months to update her children's
eligibility.
Federal law does not impose such tough entry requirements, nor do
most states--38 have stopped in-person interviews, 40 have given
up scrutiny of family assets, and 15 offer year-round coverage
without eligibility updates. "[In Texas], we're literally
discriminating against the poorest of the poor," said Democratic
state representative Garnet Coleman.
Bush campaign spokesman Dan Bartlett said the Governor places a
"high priority" on child health, as seen in his support of CHIP,
and that the state is considering, among other things, making it
easier to stay on Medicaid by eliminating in-person interviews
every six months. But when the public health committee of the
Texas house began discussing simpler rules last January, Bush's
point man on fiscal issues tried to nip it in the bud.
Appropriations committee chairman Robert Junell had legislative
budget analysts project the costs to the state and made sure each
legislator saw the eye-popping numbers: $600 million over two
years. Democratic representative Glen Maxey saw the unsolicited
analysis as an end run to scare off undecided members. "It's a
higher mountain to climb," Maxey told TIME. And he, for one, has
little hope of climbing it.
--With reporting by Hilary Hylton/Austin
LOST OPPORTUNITY?
Bush and Poor Kids
He helped secure tax cuts by underfunding Medicaid, causing a
$400 million shortfall in the program
He delayed on state law to expand Medicaid coverage for 303,000
new kids. They went five years without insurance
He fought efforts to require automatic Medicaid coverage for kids
from families forced off welfare rolls
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