Sick State Budgets, Sick Kids
The New York Times
January 9, 2004
OP-ED COLUMNIST
By BOB HERBERT
While headlines continue to tell us how great the economy is doing,
states across the U.S. are pulling the plug on desperately needed health
coverage for low-income Americans, including about a half-million children.
Even as the Bush administration continues its bizarre quest for ever
more tax cuts, the states, which by law have to balance their budgets, are
cutting vital social programs so deeply that tragic consequences are inevitable.
The cruel reality is that Americans at the top are thriving at the expense
of the well-being of those at the bottom and, increasingly, in the middle.
A new report by the Center on Budget and Policy Priorities shows that 34
states have made potentially devastating cuts over the past two years in
public health insurance programs, including Medicaid and the very successful
children's health insurance programs known as CHIPS. More cuts
are expected this year.
"Almost half of those losing health coverage (490,000 to 650,000 people) are children,"
the report said. "Substantial numbers of low-income parents,
seniors, people with disabilities, childless adults and immigrants
are also losing coverage. Cutbacks of this depth in health insurance coverage for
low-income families and individuals are unprecedented."
The worst of the cuts are in Texas. "The Lone Star State has adopted deep
cutbacks in its State Children's Health Insurance Program that will
cause about 160,000 children - one-third of its SCHIP caseload - to lose
coverage," the report said.
Texas is also making Medicaid available to fewer pregnant women,
a dangerous move that increases the number of women without coverage for
prenatal care and the actual deliveries. "All told," the report said, "Texas
is eliminating coverage for between 344,000 and 494,000 children and
adults. Census data showed that, even before these changes, the percentage
of people who were uninsured was higher in Texas than in any other
state."
A loss of health coverage frequently leads to a reluctance to seek needed care.
"In poor or low-income families, where there is not a lot of
disposable income, people will avoid going to the doctor or getting
a prescription," said Leighton Ku, one of the authors of the report. "Certain
diseases can then become much more severe. With children, it's likely
that they won't get treatment for ear infections, asthma, diabetes -
conditions that can ultimately lead to hospitalization."
When treatment can no longer be avoided, the financial consequences
can be ruinous. Medical expenses are one of the leading causes of
bankruptcy in the U.S.
Officials at the center noted the case of a woman in St. Louis who works
but whose annual income is below the poverty line. Under eligibility rules
in effect until 18 months ago, she would have qualified for Medicaid. Under
the new rules, she does not.
The woman became ill and was told upon her release from the hospital
to seek follow-up care. But without any health insurance, her medical bills
have been overwhelming. According to the center, "[The woman] has
occasional abdominal pain but is not getting any treatment. She intends to
declare bankruptcy because she cannot pay the $47,000 she owes
in medical bills, but so far has been unable to save the funds needed to pay for a
bankruptcy filing."
People caught in this kind of squeeze often find themselves "sicker,
much poorer, or both," said Robert Greenstein, the center's director.
It seems extremely strange that in the United States of America, the richest,
most powerful nation in the history of the world, we are going
backward in the 21st century in our ability to provide the most
fundamental kinds of health care to ordinary people, including children.
The health insurance cutbacks would have been even worse
if not for the $20 billion in emergency state aid that was reluctantly approved by the
Bush administration and the Republican-led Congress last year.
Despite the economic upturn, states are still struggling. They face a collective
budget deficit of $40 billion to $50 billion for the coming fiscal year,
and there is little sentiment among Republican leaders in Washington for
another round of fiscal relief.
Maybe the nation itself needs a doctor. Shoving low-income people,
including children, off the health care rolls at a time when the economy is
allegedly booming is a sure sign of some kind of sickness in the society.
Copyright 2004 The New York Times Company
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