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Sick State Budgets, Sick Kids

As states cut health care programs, the poor get sicker.
Common Dreams

Published on Friday, January 9, 2004 by the New York Times

Sick State Budgets, Sick Kids
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.

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