Capitol Chronicle

Last week, Gov. Perry announced that he is "increasing" funding for mental health care and substance abuse programs under the Children's Health Insurance Program, "pending federal government approval." That sounds like good news, but in the dispiriting doublespeak of Texas government, it's almost exactly backward. In fact, because the federal government was hinting that it would not approve already-announced Texas cuts to those programs, the governor ordered a partial restoration in hopes that the feds will wink and nod.

Two-thirds of CHIP money is federal, and the feds require "appropriate coverage" for the program's low-income participants (working families who earn too much to qualify for Medicaid but who still can't afford private health insurance). Federal administrators had looked askance at the Legislature's elimination of mental health coverage for the half-million children in the program, and in decorously bureaucratic language asked the state what the hell was going on. "Please clarify how the state will assure access to services for the covered population," federal administrators demanded in August, "when mental health services will be provided 'as funding permits' and will be limited to 'children and adolescents with a diagnosis of mental illness who exhibit serious emotional, behavioral, or mental disorders.'"

Apparently, the state couldn't find a way to "clarify" how waiting until a teenager is a clear and present danger to himself or others constitutes rational mental health care, and so Perry announced $16.9 million in mental health funding -- only $5.3 million of which is actually state money, since the federal government provides the rest. The governor's office insists that it intended to find new money all along, and that the nudge from D.C. was not a factor. Believe that if you wish, but however you slice it, even after the "restoration," mental health coverage for some 500,000 children has in fact been cut by a third from levels previously enacted under that profligate liberal, Gov. George W. Bush. In Perryspeak, the word "cut" is translated as "enhancement," as in, "We have directed the Health and Human Services Commission to enhance the mental health services available to Texas children covered by CHIP."

None of this, of course, addresses the 169,000 additional children who would have been covered by CHIP until the 78th Legislature, with Perry's eager encouragement, decided to "balance the budget without new taxes." There was that little matter of slashing teacher and school-employee health care stipends, of course, to provide school districts with $1.2 billion in cynically redefined "new money." Perhaps those custodians and administrative assistants whose families can no longer afford insurance can apply for CHIP, and then stand in line for the governor to decide if and when "funding permits" their children to enroll.

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Peter Robbed, Paul on Dole

Welcome to the New Texas Lottery, where you pays your money and you takes your chances. A similar sleight of hand was accomplished with Medicaid provider rates, already too low to sustain adequate care in the border areas most in need of it. From $167 million in new federal funds, the state "restored" rate cuts to nursing homes, doctors, hospitals and other providers that had ranged from 2.2% to 5% -- but only by half, and only for 2004. Some of that money went toward "restoring" the 15% reduction in community care service hours for the aged and disabled -- again, for 2004 only, after which the state apparently presumes those same Texans will be 15% less aged and disabled.

While the governor and Health and Human Services Commissioner Albert Hawkins take credit for doling out federal money in increments, public advocates and Comptroller Carole Keeton Strayhorn have identified somewhere between $700 million and $1 billion newly available for health and human services. Yet every attempt, through three special legislative sessions, to wrench the Legislature's attention from congressional re-redistricting long enough to appropriate some of those monies was met with stony rejection from the leadership, intent on shifting that constitutional authority to the governor's office.

And if you'd heard Texas is broke, and wondered where that piddling $5.3 million for children's mental health is coming from, that's another story. The official source, according to the governor's press release, is "state funds saved through the consolidation of administrative functions in the state's 12 health and human services agencies." That's yet another massive prestidigitation going on over at the HHSC, where 12 state agencies are magically being morphed into five over the course of a few months, largely out of public view. The transformation is being billed, of course, as a great leap forward in efficiency and cost-effectiveness, but the plan (implementing House Bill 2292) emphasizes centralization, privatization, and more simply, elimination of social service programs -- and the corollary elimination of thousands of state jobs.

There is a sort of logarithmic mad logic to the enterprise -- abolish or diminish dozens of programs helping to keep working poor people from destitution, and then add thousands more to the queue.

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Taxpayers and Neighbors

Since roughly 25% of Texans (20% of adults) are entirely without health insurance (before these cuts took effect), and unemployment is at roughly 6%, it won't do to dismiss these fellow citizens as "a burden on the taxpayers." The people who use these programs are taxpayers, and indeed pay Texas taxes at a percentage rate of their income three and four times that of their wealthiest neighbors. We are "balancing" our budget at their expense -- and their employers, by failing to pay living wages or to provide insurance, are simply transferring those costs to the public at large, as they do the educational, infrastructural, and environmental investments that make their enterprises (and their profits) possible.

At the Travis County level, some 4,700 children will do without health insurance because of the cuts to CHIP; 200 pregnant women a month will do without prenatal care because of cuts to Medicaid; 345 medically needy a month will just have to find help somewhere else (see the Brack emergency room); and overall we will have roughly $50.5 million less in available state health care dollars for a system already strained beyond capacity.

How does the governor put it? "Texas will continue to explore new and innovative ideas to increase health care access and maximize federal funding ... without increasing the burden on taxpayers."

Forgive me if I'm finding it difficult to be grateful.