Perry and foes have different views on health care

Perry's record under scrutiny in election year

2006 ELECTIONS: HEALTH AND SOCIAL SERVICES

By Corrie MacLaggan
AMERICAN-STATESMAN STAFFSaturday, August 26, 2006

Here's Gov. Rick Perry's perspective: Texas children are safer today than a year ago, thanks to Child Protective Services reforms; more children are covered by public health insurance than in 1999; and the state is giving low-income Texans more ways to apply for help while saving taxpayers money.

Here's the reality, according to Perry's three main gubernatorial challengers: the privatization of public assistance enrollment is a nightmare; children are being recklessly dropped from public insurance programs; and the Child Protective Services reforms didn't go far enough.

Those are the vastly different ways Perry, a Republican, and his chief opponents — Democrat Chris Bell and independents Carole Keeton Strayhorn and Kinky Friedman — view the state on key issues related to Texas' social safety net.

In a state with the nation's lowest percentage of insured residents, these issues are crucial not only because they involve the most vulnerable Texans — the elderly, the poor, people with disabilities, abused children — but also because spending on health and human services represents about a third of all state spending, nearly $25 billion per year.

Critics have blamed Perry-backed policy changes from 2003 and a new privatization plan for a decline in enrollment in the state's Children's Health Insurance Program and children's Medicaid. Those programs provide low-cost or free health coverage for children in low- and moderate-income families.

CHIP enrollment was about 500,000 in September 2003, when the state began scaling back some benefits, requiring clients to re-enroll more often and looking at the value of their cars and other assets to determine eligibility. Enrollment was just less than 300,000 this month.
"There's a common misperception that changes in 2003 caused a decline in the number of children covered by the state. It's just not true," said Stephanie Goodman, of the Health and Human Services Commission. "While CHIP enrollment did decline, increases in children's Medicaid more than offset that decline. In fact, from 1999 to 2005 we doubled the number of children covered by the state."

This year, however, the number of children on both insurance programs dropped after the controversial privatization plan began and the state faced staffing shortages.

Bell said that "the state can try to misrepresent the figures as much as they want, but . . . we have a crisis in the state when it comes to the uninsured."

The Children's Defense Fund estimates that of the 1.4 million uninsured children in Texas, more than 700,000 are eligible for state insurance. A family of four can earn up to $40,000 and qualify for the insurance.

Strayhorn said: "It's so disingenuous for anyone to say that everyone eligible is on."

Perry spokesman Eric Bearse said that declining enrollment in public health insurance programs "is a positive thing that reflects a growing economy." He said 4,000 people were removed from the CHIP program last month because their income was too high.

"We do not think that we can justify to taxpayers providing a subsidized health insurance benefit for families that may be driving expensive cars like Lexuses and Escalades," Bearse said.
Friedman, who says health and human services issues have been "swept under the rug, ignored, slashed and burned" in Texas, soon plans to unveil details about a plan to tax insurance companies, hospitals and medical procedures to pay for health care available on a sliding fee scale to Texans who don't have access to affordable health insurance.

Contractor criticized

The privatization plan that's getting election-year scrutiny involves the state's more than $800 million, five-year contract with a private group to handle a call-in enrollment system for food stamps, Medicaid and other public assistance programs.

The group — Texas Access Alliance, anchored by Accenture LLP — hit snags in its call center pilot program that began in January in Travis and Hays counties. Some of the 3 million Texans on public assistance have been inexplicably denied benefits, received services late or faced other problems. Officials have indefinitely stalled the program's statewide rollout.

Bell, painting the privatization as a plan envisioned by Strayhorn and approved by Perry, says he'd return the enrollment tasks to the state. "The contract has been a disaster," he said.

But Strayhorn, who as comptroller is investigating the contract, said her 2003 recommendation that the state use call centers referred only to CHIP and children's Medicaid eligibility — not all programs. She says the call centers are a "perfect storm" of "wasted tax dollars, reduced access to services and profiteering at the expense of Texas taxpayers."

The plan is supposed to save the state $646 million over five years.

Perry's office acknowledged that savings have not been achieved but is confidentthey will be. "The problems are all solvable," said Nora Cox, Perry's assistant director for budget, planning and policy.

Libertarian gubernatorial candidate James Werner has called for "a stronger dose of accountability" but said recent problems show the state should be moving toward privatization. "By contracting these services, we have shone the light of day on what would have otherwise been an obscure state activity."

Foster care reforms

Gubernatorial candidates have also been debating the progress of Child Protective Services reforms mandated by the Legislature in 2005 after a series of deaths of children in dangerous situations known to state workers.

Since September, the agency has hired more than 2,000 workers and investigators' average daily caseloads have dropped from 47 in January 2005 to 35.9 in May, the agency said.

Some gubernatorial challengers say that's not enough. Strayhorn points to a disproportionate increase of rapes and deaths in the foster care system — 48 in 2005, compared with 30 in 2003 — to show the system "needs to be turned upside down." There were 32,000 children in the system last year.

Meanwhile, Bell points to then-Gov. George W. Bush's declaration that Child Protective Services was in crisis in 1998, when the average caseload was 24. "How could it be a crisis at 20-something when Bush was governor and some sort of solution when it's almost 40?" Bell said.

But Perry's camp said the state has changed the way it measures caseloads. "The agency has gone from being indicted by a grand jury to being a model in the nation of how to do child welfare," Cox said. "That's tremendous, and it's something we're tremendously proud of."

cmaclaggan@statesman.com; 445-3548

Note from Blogger:

Geez, isn't this what we have been trying to tell you, and them, for YEARS now? You know, I had imagined an increase in the crime rate, but I guess it was just too horrible for me to think about the increase in the children who were hurt.