When lawmakers ended this year’s legislative session, they had addressed their biggest goals: They tamped down property taxes, overhauled school finance laws and gave teachers a pay raise. By various measures, the session was a success.
To health care advocates in the state, however, it was a missed opportunity.
“We are deeply disappointed that health care coverage was not prioritized at all this legislative session,” said Laura Guerra-Cardus, deputy director of the Children’s Defense Fund of Texas.
The state’s uninsured rate has recently started climbing again, after some progress during the Obama administration. Guerra-Cardus said she others tried to get lawmakers to take this seriously at the start of the legislative session, which ended last Monday.
In particular, groups said they thought lawmakers would be open to addressing the uninsured rate among children in the state.
“We tried to draw attention to the fact that our child uninsured rate – while already being the worst in the nation – actually got even worse in 2017 for the first time after 10 years of modest improvement,” Guerra-Cardus said. “We got some traction there.”
Advocates garnered bipartisan support for House Bill 342, which could have stopped a lot of children from getting kicked off Medicaid every month.
After a child has been in the program for six months, state officials send letters to families every subsequent month asking for proof of income. Adriana Kohler, a senior health policy associate with Texans Care for Children, said it's hard for families to keep up with the paperwork.
“I think there is not enough time for kids and their parents to send their paperwork back,” she said. “Letters and proof of your income … everything needs to be submitted within 10 days of being generated.”
Sometimes families have even less time, Kohler said, because those letters can take awhile to actually get to them.
Data shows more than 4,000 children are being removed from Medicaid every month. Advocates say about nine out of 10 of these kids get kicked off because of paperwork issues and red tape.
That’s why Kohler and others were pushing lawmakers to let children stay on the program for a year at a time.
As HB 342 made it through the Legislature, it was tweaked a little. Anne Dunkelberg, a program director with the Center for Public Policy Priorities, said the final version would have cost the state nothing.
But it died in the Senate anyway.
“It was an opportunity to do something without a cost to the state budget that could really have made a difference for uninsured kids in Texas,” she said, “and we left it on the table.”
Dunkelberg estimates about 50,000 Texas children will continue to get kicked off Medicaid every year now.
Kohler says lawmakers also failed to pass a bill that would have expanded Medicaid coverage to women who have babies. In Texas, women currently lose Medicaid coverage two months after giving birth. House Bill 744 would have covered them for a full year – something highly recommended by a task force working to curb maternal deaths.
“The [Texas Maternal Mortality and Morbidity] Task Force has spent two years looking at case data, looking at what’s going on in Texas," Kohler said. "They presented their findings, and their No. 1 recommendation is to increase access to care before, during and after pregnancy."
Ultimately, Dunkelberg said, the bill was really just a stopgap measure. To truly tackle maternal mortality, she said, women should be getting health care before they get pregnant.
“We had this beautiful low-hanging fruit that got some bipartisan support,” she said. “But it was not important enough to our leadership.”
And so, that bill died, too.
Dunkelberg said she wasn’t entirely surprised the bills died. She was, however, a little hopeful going into the session that bipartisan interest in dealing with maternal mortality might lead to serious action.
But that’s not how things played out.
“It became fairly apparent early on in the session that anything that was going to make a dent in our uninsured rate just was not getting traction with the leadership,” she said.
The state’s uninsured rate is a long-standing problem, Guerra-Cardus said, and it’s been hard to get lawmakers to care about it.
“To be honest, it’s hard to even get many people in the Legislature to even admit that we have a health care coverage problem here in Texas,” she said.
Guerra-Cardus said polls show most Texans want to expand Medicaid to more low-income adults, but there’s barely been a conversion about expanding the program in the state through the Affordable Care Act.
“Elected officials have been able to run for a really long time without having to necessarily respond to the will of the majority of the people, because of the way our system is set up,” Guerra-Cardus said.
That's why health care advocates in the state say they plan to start putting their efforts toward a community-organizing project called the Health Care Activist Leadership Network.
“We are just going to have to reach out to people all over the state and say, ‘Whether you are a Democrat, an Independent or a Republican – if you want your leaders to do anything about our uninsured problem, you are going to need to tell them this," Dunkelberg said, "because they are not saying a peep about it."