TEXAS: High Uninsured Rate Underscores Bush’s Record

      The importance of health care in the election agenda may not bode well for GOP presidential candidate George W. Bush, who, as governor of Texas since 1995, "has not made health a priority," the New York Times reports. Currently more than one-quarter of Texans are uninsured and the state is home to some of the nation's highest rates of AIDS, diabetes, tuberculosis and teenage pregnancy. According to the Kaiser Commission on Medicaid and the Uninsured, 27.5% of Texans ages 19 to 65 lacked insurance in 1998, compared to the national uninsured rate of 19.7%. In 1994, one year before Bush became governor, 27.8% of Texans were uninsured compared to 18.6% nationally. Despite the opinions of most public health experts in the state, the Bush-appointed Texas Commissioner of Health, Dr. William Archer, downplayed the role of health insurance and indicated that the uninsured still were receiving care. He said, "I think insurance is important. But I don't think it's the most important thing." Archer also has accused Texas physicians of opposing preventive care because it will hurt their practices down the line. Archer also has stirred some controversy by attempting to shift away from traditional services offered by his office and focus on the cultural causes of unhealthy behavior. He indicated that part of the state's high teen pregnancy rate stems partly from the large Hispanic population that does not believe "that getting pregnant is a bad thing." Archer said, "If I were to go to a Hispanic community and say, 'Well, we need to get you into family planning,' they say 'No, I want to be pregnant,' it doesn't work very well." Archer also defended the state's unsuccessful effort to enroll the 598,000 children eligible for Medicaid into that program. He said, "The problem is that the Legislature knows that if we are successful, and we got all those kids registered, they would not balance their budgets any more. It's not one person saying, 'Don't do this.' It's not one agency saying,'Don't do this.' It's sort of 'Why would we all rock the boat at this point?'"

Uninsured Kids
      Most health professionals disagree with Archer. Clair Jordan, executive director of the Texas Nurses Association said, "Uninsured children end up in the most costly place, the emergency room." State Rep. Elliot Naishtat (D) agreed: "The biggest health problem in Texas is the exorbitant number of people, primarily children, who have no health insurance." One of the biggest barriers to Medicaid enrollment, according to the Henry J. Kaiser Family Foundation's Executive Vice President Diane Rowland, is that the application process makes Texas "one of the most difficult states for someone to figure out how to get enrolled." However, the number of the state's uninsured children may soon drop, as Texas officials will finally expand efforts to enroll children in the Children's Health Insurance Program (CHIP) enacted by President Clinton in 1997. Bush originally fought to limit coverage to children whose families' incomes were 150% of the federal poverty level, while the federal program allowed children up to 200% of the poverty level to enroll. At a recent press conference, Bush would not explain why he pushed for 150%, but said, "I signed the 200% bill." State officials estimate that nearly 420,000 children will be enrolled in CHIP over the next year (Clymer, 4/11).