Dewhurst doesn’t waste sympathy on the uninsured

Austin American-Statesman, February 8, 2007

Just when I think I can no longer be shocked by what an elected official says, Lt. Gov. David Dewhurst goes and proves me wrong.

In January, on the floor of the Texas Senate, amid a debate on changing the application renewal requirement for Medicaid and the Children’s Health Insurance Program, Dewhurst — perhaps affected by the cold outside — proclaimed, “I don’t think most people in Texas have a lot of sympathy for someone that can’t fill out a two-page application every six months.”

It’s hard to know where to begin. Shall it be with the notion that a good way to rein in the state budget is to erect artificial barriers that discourage low-income working people from getting health insurance for themselves and their children?

From the standpoint of cost-benefit analysis, it makes sense. The Legislature answered a $10 billion deficit in 2003 by cutting services and requiring people to re-enroll every six months rather than once a year. Since then, enrollment in the Children’s Health Insurance Program (CHIP) has dropped by more than 37 percent, and Medicaid enrollment by more than 118,000 in 2006. Texas has the highest rate of uninsured children in the country — more than 1.4 million. That saves the state money.

It’s hard to fathom any elected official saying such a thing, much less the leader of the Senate. Dewhurst’s statement reflects a stunningly callous take on the role of government. Is it the business of government to extract good behavior, to make unreasonable demands, then punish those working people least likely to keep up with paperwork by cutting off health insurance — for their children?

In the last policy development class that former Rep. Barbara Jordan taught, I learned that elected office is a high calling, and that good policy is made when lawmakers are guided by the public interest.

Uninsured children are at greater risk of developing health problems, miss more school and require one of their parents to miss work (for many, unpaid) to care for them. Uninsured Texas children hurt the state’s economy, education funding, hospitals and public health.

It’s a given that every infant born in a Texas hospital will receive neonatal intensive care if needed. Questions about insurance arise later, and that’s the way it should be. The care they get is cutting-edge and high-tech yet tender. What’s not certain is whether a child, after discharge, will receive relatively inexpensive primary care in the right setting or in the right amount. Questions about insurance for primary care arise before the appointment is made.

Since I’ve cared for sick and premature babies in Texas, 14 legislative sessions have come and gone. I keep watching and hoping that laws will pass that have the effect of expanding — not shrinking — the insurance rolls. I want to know that the babies I have cared for, as tenderly as I can, will have the same access to primary care that they’ve had to neonatal intensive care.

At discharge, when I wave good-bye to the low-income families of the babies I’ve cared for, I feel a knot in my stomach envisioning them in a crowded emergency room for a fever or a sore throat. I, for one, think it’s in the public interest that Texas insure more children, not fewer.

How the insurance issue will play out this session will come down to leadership, and Dewhurst has made it crystal clear where he stands.
Mr. Dewhurst, try being a real leader.

Try letting the public interest be your guide.

Toni Inglis, MSN, RN CNS (retired), FAAN, a lifelong Austin resident and retired neonatal intensive care nurse and editor of NursingNews, writes a monthly opinion column for the Austin American-Statesman editorial page.