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Sara Neese, RN (standing and on the cover), vice president of administration for Cook Children’s Health Plan says that in a six-county North Texas region that includes the heavily populated Dallas and Tarrant counties, CHIP rolls have been reduced by 32% since September.

Rosalind Bryant, RN, a pediatric nurse practitioner in the hematology / oncology clinic at Texas Children’s Hospital in Houston, says she’s seen firsthand how recent cuts in the Texas Children’s Health Insurance Program (CHIP) program are heaping new miseries on kids who have suffered too much already.

Bryant, who treats many sickle cell anemia patients, has watched as an increasing number of financially strapped families are forced to forgo such preventive measures as routine eye exams that could determine if disease-related retinopathy is advancing in their children.

One distraught mom told the nurse that her son had suffered respiratory symptoms at home and later complained of ear pain, symptoms she had tried to treat with home remedies because there was no money in the budget for a doctor visit. “Well, he woke up in the middle of the night screaming in pain a few nights later and then she had to take him to the ER,” Bryant said.

The child recovered, “but because he had a hematological problem … his care requirements were much greater and the bill was tremendous,” Bryant said. “That’s just one example of how these cuts are going to come back to bite us. And in the meantime, theyjust going to do more harm to children.”

A dubious ranking

According to 2002 Census data, 22.6% of Texas children — about 1.4 million — lack any type of health care coverage, the highest rate of any state in the nation. The Texas CHIP program, instituted in 1999, has served as an insurance safety net for children whose family’s income exceeds Medicaid limits but remains too low to afford private health insurance. But hikes in copays and a litany of other new fees and restrictions imposed in the last year have winnowed down the state-reported CHIP enrollment numbers from 507,000 last September to about 358,000 today.

Several grassroots coalition groups, many with nurses leading the charge, have formed in the past year to stem the rollback against Texas children, and restore CHIP funding to previous levels.

Margie Dorman-O’Donnell, RN, MSN, cochair of governmental affairs for the Texas Nurses Association and a nurse with a Dallas/Fort Worth area health care provider, says the cuts strike at the very foundation of good health: preventive care.

“We are shortchanging tomorrow’s citizens in the state of Texas with limited care today,” she said. “Kids will miss school because they’re sick, their parents will miss work and miss wages, and employers will suffer lost productivity.”

Dorman-O’Donnell says the cutbacks are disheartening for nurses “because they can’t find the resources these children need and it’s exasperating to see the shortsightedness of it all. Public health nurses and pediatric nurses are especially frustrated because they are all seeing the direct consequences of these children being shortchanged.”

The CHIP cuts are part of wholesale spending reductions in the Texas Health and Human Services Commission designed to alleviate a $10 billion general fund budget shortfall the Legislature tackled last year.

The changes that were pushed through included changing the $15 annual CHIP program fee to a monthly $15 charge; eliminating vision, dental, hospice, and most mental health benefits; and removing child support, child care, and work-related expenses from coverage guidelines. Formerly annual eligibility reviews for families enrolled in CHIP coverage now will take place every six months.

This month, a new asset test will reportedly knock another 5,000 children off CHIP rolls. Families with more than $5,000 in total assets – which include savings and checking accounts – would be disqualified if their income exceeds $28,275 a year, or 150% of the poverty level. The new CHIP asset policy is more restrictive than Children’s Medicaid.

Leaving money on the table

What frustrates many advocates is that Texas is losing far more in matching federal funds than it saves in withholding state money, say Dorman-O’Donnell and other Texas caregivers.

About $550 million in matching funds will go unused because of the 2003 budget cuts of about $206 million from the program. “Texas has left money on the table that could have been matched because it was unwilling to find money in the budget,” Dorman-O’Donnell said. “And we are going to be paying a lot more as a society in the future than we will be saving in the present.”