State Sen. Kip Averitte seeks to expand health insurance for Texas children

Waco senator from the state wants families earn substantially more than the poverty level to be able to obtain subsidized health insurance for children - for a price.

Kip Averitte Sen, R-Waco, filed a bill that would expand the state Children's Health Insurance Program to include families with incomes up to three times the federal poverty level. At present, family income must be less than twice the poverty level to qualify for the program.

The cost of coverage remains the same for families earning less than 200 percent of poverty threshold. It is $ 50 or less per family per year, with a co-payment of $ 3 to $ 10 for most of doctor visits and medications.

Those who fall within 200 percent to 300 percent - or about $ 44,000 to $ 66,000 for a family of four - would pay more. Premiums are not included in the exact bill. They will be determined by a sliding scale based on income, Averitte said, but should be limited to less than 5 percent of its income for a family.

The coverage would be available to these families, if they do not have access to affordable through health insurance of an employer.

"These are people who work hard at their jobs, pay taxes and do the best they can, but simply can not afford the high cost of health insurance," said Averitte.

CHIP is designed for families who earn too much for their children to qualify for Medicaid but too little to afford commercial insurance. Averitte was the co-author of the bill that created the program in Texas and was a lawyer for him in legislative sessions.

The new bill is a need to increase the program Averitte said. A major problem with CHIP, it has the quality of a cliff, he said. Families lose coverage, even if they are over $ 1 the income threshold. Legislators heard testimony from people who have asked their employees not to grant a salary increase or who have refused overtime because the income for their children lose coverage, he said.

"This is simply not the American way, and we need to fix this," said Averitte.

The expansion would cost the state $ 30 million to 40 million, Averitte said. But long-term savings would far outweigh that, "he says.

The costs of emergency care

As things are now, children are uninsured often receive care in emergency rooms of the hospital. That care is expensive, he said, with hospitals and local authorities the cost of food.

People with insurance also pay for treating uninsured through higher insurance premiums, Averitte said. About 13 percent of private health insurance premiums to pay for care without compensation, according to a report issued earlier this month by the Children's Defense Fund of Texas.

"This is a fiscally responsible way to address this problem," said Averitte its plan, contained in Senate Bill 841.

Averitte said he was not sure how many children would be newly eligible for coverage under his plan. The bill analysis by the Center for Research of the Senate found that the 516,000 of Texas' 1.5 million uninsured children live in families that earn over 200 percent of poverty threshold. Averitte but has no breakdown for how these children come from families whose income is 300 percent or more of the poverty threshold.

Initially, the bill included language that would allow families with incomes of more than three times the poverty level to buy coverage of the program, if they do not have access to health insurance through an employer. Only 49 percent of private sector companies in Texas, provides health coverage for employees. For small businesses, this figure falls to 32 per cent.

Families with higher incomes would have been required to pay the full premium for coverage, as well as other expenses such as co-pays and deductibles. The premium was based on the average cost for a child under the plan.

This part of the bill is "on hold", however, Averitte said. State officials have said they fear that allowing families with higher incomes in CHIP could attract more risk enrolled. For example, children do not receive employee-sponsored coverage because of the cost of pre-existing conditions would be likely to cover whether the program was expanded, he said.

It would be a problem because it could affect other bonuses included in the plan whose coverage is subsidized by money, Averitte said. The intention was for the repurchase program with nothing fresh to families with higher incomes, he said.

Averitte said he is working with state officials to try to circumvent these obstacles. But he is not sure this can be accomplished in this legislative session, he said.

Dr. Dan Stultz, president of the Hospital Association of Texas, praised the bill. Even if the coverage can not be made available to families with higher incomes, expanding the program to pay some, "he says.

Good for hospitals?

Hospitals are losing millions of dollars each year on care without compensation, Stultz said, especially when the uninsured to receive routine treatment in the emergency room. If providers could be reimbursed at least part of the costs of such care through CHIP, it would make a big difference, "he says.

Plus, there are economies of children in care until their conditions get more serious and expensive to treat, "said Stultz.

"For me, it's a wise thing," he said.

Monica Arechiga, who lives in the Bellmead area, said she hopes that legislators Averitte pass the bill. Three of her four children to receive coverage through CHIP, which takes a lot of stress from his family, "she says.

Arechiga's husband is unemployed, unable to find work after being in school to get his commercial driver's license. She is a nurse, but can not afford to provide to children through his employer, the plan, she said.

Last year, when her children are not on CHIP, a son of Arechiga broke his collarbone and had to go to the emergency room. The bill was steep this visit, she said, it is good to know the family will not face with a big tab if another incident occurs.

Yet Arechiga said she sometimes feared that a wage increase or other change in the family of the situation could cause children to lose coverage. Another nurse in his office which is a single mother of a child is not when she applied for CHIP, "she says. She said she had heard from patients about how they are caught between not qualify for CHIP and not being able to provide coverage of routine.

"I think many people are worried about this," said Arechiga.
By Cindy V. Culp Tribune-Herald staff writer