Written by Fatima Syed and Paul George
What happens when a child becomes sick?
The events may be all too familiar: mom gets a call from the school nurse because her child has a fever and sore throat. She leaves work early, taking him to their pediatrician who reassures her that with rest and antibiotics he will be healthy and back to school in a few days.
Now a different scenario: the child isn’t taken to their pediatrician because they don’t have one and he doesn’t get any treatment. The strep throat worsens, leaving the child at risk for a serious complication and putting other children around him at risk of catching the infection. In Texas, over 10,000 children fall into this scenario, which seems ludicrous in a city dotted by minute-clinics and the world’s largest medical center. But the undeniable reality is that for many children, even basic healthcare is out of reach.
The Affordable Care Act increased healthcare coverage; however, at 19.1%, the Lone Star State boasts the highest rate of uninsured residents, many of whom are excluded from Medicare, Medicaid, and even the Children’s Health Insurance Plan due to their status as immigrants – including thousands of children, both documented and undocumented ¹. These kids rely on a patchwork of safety net hospitals and clinics that are limited by inadequate funding. For example, for a state with 254 counties, Texas has just 73 Federally Qualified Health Centers (FQHCs), which offer health services to patients with limited access. While the ACA included some additional funding for FQHCs, it simultaneously reduced other funding, such as funding for disproportionate share hospitals, assuming that a better-insured patient population wouldn’t need charity care. For children with no path to obtain insurance, these measures chip away the already meagerly-funded options.
In large part because they lack insurance, undocumented children are less likely to obtain care, particularly for minor illnesses. These untreated illnesses can have serious, sometimes fatal, outcomes, necessitating ER visits and more intensive, costly treatment. Research has shown that being uninsured leads to lower vaccination rates, forgoing of necessary medical and dental care, and overall higher mortality, which helps explain why despite arriving as healthy as their peers, undocumented children’s health deteriorates the longer they live in the US ².
This coverage gap translates into significant financial consequences. In 2013, uncompensated care (care that is provided but unpaid because the patient lacked insurance and was unable to self-pay) cost Texas $5.2 billion, the majority from expensive ER visits and lengthy hospitalizations ³. Other states dealing with a similar burden have recently opened Medicaid coverage to all children in poverty, a fiscally feasible decision as children cost about half as much as adults to cover. Also, a study examining Medicaid expansions from the 1980s and 90s found that children who received Medicaid became adults with higher wages and cumulative tax payments ⁴. Ultimately, increasing healthcare options for these children would reduce the strain on our state’s and local counties’ budgets from uncompensated care.
So how can we support the Texas economy and give every kid a chance at a healthy childhood? Simply put, include all needy children, regardless of documentation, in government-sponsored insurance coverage. As a state, Texas decided that every child deserves an opportunity to an education; a natural extension is an equal opportunity to basic healthcare. Such inclusion would mean all kids could visit a pediatrician instead of the ER for minor illnesses, as well as get annual checkups to ensure they’re healthy and protected against vaccine-preventable diseases.
As we begin 2017 with a new president and a new national healthcare bill currently being debated and reformed, it’s clear that there will be many opportunities for change, many driven at the state level. Though it will take a concerted effort from Texas lawmakers and citizens to unify behind the goal of increasing healthcare options for our children, it’s our state’s pioneering, relentless spirit that’s cultivated our enviable economic growth. With this same spirit, we can help realize the vision that someday, for every single Texas family, a child’s sore throat means nothing more than a quick trip to the family doc.
¹ “Evaluation of Uncompensated Care and Medicaid Payments in Texas Hospitals and the Role of Texas’ Uncompensated Care Pool.”
² “Calling the Shots: Immunization Finance Policies and Practices”; “The Health of Immigrants in New York City”; Newacheck et al., “Health Insurance and Access to Primary Care for Children.”
⁴ Brown, Kowalski, and Lurie, “Medicaid as an Investment in Children.”