Children's Health Insurance: An Open Letter To The Governor Of Texas


Lisa Laudermilk is a homemaker, part-time preschool teacher, and the mother of four sons. Concerned with the skyrocketing costs of medical services and health insurance, as well as unfair policies and recent budget cuts within the Children's Health Insurance Program in the state of Texas, Lisa campaigns to raise awareness regarding the consequences of ill-advised public health care policy.

Dear Governor Perry:

My family was forced to terminate the health insurance coverage we had through my husband's employer because the monthly premium increased to $1,000 out of our pocketbook. It became a choice between having health insurance and feeding our family. Since then, I have been investigating individual health policies in an effort to find an affordable policy for us. I am currently pregnant and was told that insurance companies will not accept an application on anyone in my family until after the baby is born—a ridiculous policy in my opinion. Having learned this, I decided to investigate the Children's Health Insurance Program (the nationwide effort to provide health insurance to children whose families make too much money to qualify for Medicaid, but cannot afford commercial health insurance, regulated and maintained by each individual state) hoping we might at least be able to insure our children through a state program such as this. Unfortunately, we were denied this coverage because they determine eligibility solely on a family's gross monthly income (without considering everyday living expenses), and my husband's income exceeds the state's set limit.

The Texas Health and Human Services Commission website describes the Children™s Health Insurance Program (CHIP) as "a national program designed for families who earn too much money to qualify for Medicaid, yet cannot afford commercial insurance... and to help Texas families obtain affordable coverage for their uninsured children." In light of this stated goal, I am extremely disappointed and displeased to discover that CHIP benefits, like those of Medicaid, are based entirely upon a family's gross monthly income. It seems that a more fair approach in determining eligibility would be to consider a family's expenses such as house payments, mandated homeowner insurance payments, car payments, mandated car insurance payments, and something as simple as grocery bills, in addition to their monthly income. I find it hard to believe that CHIP was truly designed to help families. Instead, it seems to punish those who go into debt striving to be educated, productive, and valuable citizens in their community.

Children are our most vulnerable and valuable assets. It is unfair to deny them affordable health insurance based entirely on their parents' monthly income. What about families whose employers do not offer health insurance benefits, and who cannot afford to purchase private coverage? What if an employer does offer a group health plan, but a family cannot afford the monthly premiums? In our case, our gross monthly earnings exceed the state's eligibility threshold for CHIP benefits. Because of the cost of everyday living expenses, however, we are reduced to terminating our health insurance and worrying every day that a member of our family will require medical care, incurring tremendous medical bills and perhaps strain on our already tight budget to the breaking point. Unfortunately, families who lack the resources to afford commercial health insurance are subject to outrageous medical bills simply because they do not have the protection of an insurance company to provide a cap on the amounts charged for services rendered.

Now, in addition to the unfair policies used in determining eligibility for the Children's Health Insurance Program, I find more unfair policies in the form of recently proposed revisions to the program. These revisions seem designed to increase costs to parents, reduce costs to the state, and reduce benefits to children. I cite the following examples posted on the TexCare Partnership website:

  • Elimination of deductions to income so that CHIP eligibility is based even more completely on gross income.
  • Implementation of an assets test for families at or above 150% of the Federal Poverty Level.
  • Increases in cost-sharing (i.e., co-pays and monthly premiums).
  • A change in the term of coverage from 12 months to 6 months (children will need to renew in CHIP every 6 months).
  • Establishment of a 90-day waiting period between eligibility determination and the beginning of health coverage.
  • Elimination of some covered CHIP benefits (e.g.: mental health services, dental, vision, hospice).
  • Implementation of a Preferred Drug List (PDL), with prior authorization required for prescribed drugs not on the PDL.

It seems that CHIP is no longer a program aimed at the best interests of children, but one designed to pad the state's pocketbook while cynically maintaining the appearance of service to the public. I wonder how fast policies would change if those responsible for current CHIP policy (unfair!) and the proposed changes (even worse!) experienced the same difficulty that my own family does in obtaining high-quality health insurance. While the new proposal would eliminate mental health, dental, vision, and hospice services from CHIP coverage, most group and individual commercial health insurance plans offer these as a matter of course, in addition to regular check-ups and required immunizations. All of these are vital to the well-being of a child.

Moreover, why establish a 90-day waiting period between eligibility determination and the beginning of health coverage, when many of these children need coverage at once? Even commercial health insurance can become effective immediately. Additionally, the implementation of a Preferred Drug List (PDL), with prior authorization required for prescribed drugs not on the PDL, poses serious risks to the life, health and safety of a child requiring medication not on this list. Who can predict when the doctor will diagnose a life-threatening illness requiring immediate medication? If that medication is not on the state's PDL, how long would that child have to wait for his medicine?

Governor Perry, of my four sons, which would you have die waiting for your bureaucracy to approve his medication?

Please consider the children whose families struggle continuously to buy groceries, pay their bills on time, and strive to have money left over to meet rising health care costs. I encourage you to consider seriously the consequences of lowering the quality of the services provided by the Children's Health Insurance Program. Your kids won't face those consequences... but mine will.


Lisa Laudermilk

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