Even as Gov. George W. Bush, the presumptive Republican presidential nominee, moves ahead in opinion polls, the large number of Texans without health insurance is emerging as an issue that could become a political liability for him as the November election approaches.
Texas ranks No. 1 in the U.S. in terms of the percentage of its population–24.5 percent, or nearly 5 million people–lackinghealth insurance. With 1.4 million kids, or one out of every four children, uninsured, the state is near the bottom of the heap nationally, second only to Arizona.
“Health care has absolutely never been a priority for Bush,” said state Rep. Glen Maxey (D-Austin), a leading proponent of a new Texas insurance program for poor children. While he claims the governor did little to push the program, Bush’s campaign staff disputes the charge.
Bush’s critics have grown increasingly vocal since he unveiled his first major health-care proposal–refundable tax credits meant to help 44 million uninsured Americans purchase private coverage–several weeks ago. Leading the charge is Vice President Al Gore, the presumptive Democratic nominee.
While conservatives lauded Bush’s private sector approach to reducing the ranks of the uninsured, many policy experts warned that his proposed credits of up to $2,000 per family would not come even close to the actual cost of health-care coverage (typically more than $5,000 a year per family). A lack of affordability is the primary reason most families go without insurance, experts note.
What role health care and specifically coverage for the uninsured will play in the fall campaign remains unclear, although in the past health care consistently has ranked as one of voters’ top concerns. Bush’s potential vulnerability may draw attention to the topic. The Gore campaign already has derided his record in Texas as “political malpractice.”
Bush advisers say the governor’s record shows that he supports access to affordable health care for all Americans. His approach to the uninsured has been incremental, dating back to insurance reforms enacted in Texas in the mid-1990s, they say.
In the background of the political scuffle between Bush and Gore, complex reasons underlie why so many Texans do not have health-care coverage and the difficulty of finding an effective solution to the problem.
Consider the situation of Lena Ramirez’s family in a poor northeast Houston neighborhood. The family’s seven children, ranging in age from 5 to 16, are typical of uninsured kids in the state: Hispanic, with working but low-income parents, living in two-parent families.
Lena’s husband, Henry, 35, a carpenter who grew up in a tough Houston neighborhood, made about $26,000 last year. It was a good year by their standards, but still provided barely enough for food, shelter, clothing and other family essentials.
“I do my best for my kids,” Henry said. “I just thank God they don’t get real sick.”
Henry has been to a doctor only once in more than 17 years, that for an aching tooth. He received a prescription for a painkiller, which he couldn’t afford to have filled.
Henry’s boss doesn’t offer health-insurance benefits and pays Henry in cash. The last time Lena tried to get her children on the Houston program for poor people without insurance, known as the Gold Card, she said she couldn’t qualify because she couldn’t supply proof of the family’s income.
Medicaid, the joint state/federal program for the poor, also turned her down months ago when she applied on behalf of the children, noting incorrectly that Henry earned too much.
The standard to qualify for Medicaid, a $10.3 billion program in Texas, is set at the federal poverty line, which this year equals $31,550 for a family of nine, more than Henry earns. But, he says he can’t afford to take off from work to dispute Medicaid’s decision with caseworkers.
“We just go along without it,” Lena said in the living room of the small one-story house the family rents for $575 a month. When one of the kids gets a sore throat or a fever, she borrows a couple of days’ worth of antibiotics from her sister, who has Medicaid, or buys over-the-counter medicine. Mostly, she stays away from doctors’ offices because “they give you a bunch of hassles if you have no money.”
The Ramirez’s story is typical. According to a 1999 report by Families USA, a Washington-based consumers’ group, 56 percent of children without health-care coverage in Texas are Hispanic. Some 63 percent live in households headed by someone who works full-time. Nearly two-thirds live in intact families. And almost 45 percent aren’t officially poor, by federal standards.
A cluster of economic and social trends underlie these statistics. According to the Austin-based Center for Public Policy Priorities, Texas has lower wages on average than other states, and more people who are working, but still poor and barely scraping by, especially Hispanics. According to an analysis of census data by the Urban Institute, 38.9 percent of Texans are low-income, compared with 27.2 percent of people in Illinois. Poverty rates for the state are also above the national average.
This reflects Texas’ economy, where growth is concentrated in the poorly paid service sector, agriculture is under strain, and more workers are employed in small businesses that tend not to offer insurance benefits to workers. Texas also has fewer manufacturing jobs or unionized workers with good benefits packages than other states.
Immigration is another factor. While 9 out of 10 Texas children without insurance are U.S. citizens, 240,000 live with non-citizen parents, many of who are afraid to seek government services. Some of these families come from countries without a tradition of health insurance and don’t understand its value.
According to a March report from the American College of Physicians and the American Society of Internal Medicine, more Hispanics than any other group, 35.3 percent, are uninsured nationwide.
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The consequence, the report warns, is that Hispanics without health-care coverage aren’t getting needed medical care, do not obtain preventive services such as immunizations and often live with illness and die younger. Hundreds of scientific studies have documented that being uninsured has adverse health impacts.
John Goodman, a health adviser to Bush and member of the state’s task force on the uninsured, is skeptical of these studies. From what he hears, people get care when they need it from publicly funded hospitals and clinics.The state spends more than $4 billion a year for people without insurance, “more than enough,” he says.
Even Bush’s critics recognize that Texas’ conservative “pull yourself up by your bootstraps” culture doesn’t favor more government intervention. The legislature is notoriously stingy: the state ranks 50th in the nation in per capita spending.
Texas has one of the most restrictive Medicaid programs in the nation, said Diane Rowland, senior vice president of the Henry J. Kaiser Family Foundation. Currently, about 600,000 children in the state are impoverished enough to qualify, yet are not enrolled in the program.
“The caseworkers make you feel real bad, like you are a roach. You find a lot of families don’t go because of the way they’re treated,” said Cleotilde Amador, 46, a health-care outreach worker employed by Harris County whose two children, ages 14 and 9, didn’t have health coverage until a month ago, when she got the job.
Bush’s office said the state was reaching out aggressively to families and recently had increased funding for doctors and hospitals that treat Medicaid patients.