WASHINGTON — The population of Americans younger than 18 has grown in the last decade, but federal spending on children declined in 2011 for the first time since the early 1980s. The situation in Texas is even more severe, according to research and advocacy groups that have been studying children’s issues.
One in every 11 kids in the U.S. lives in Texas, said a 2012 report by Kids Count, a project of the Annie E. Casey Foundation. The report concluded that the overall well being of these children is ranked 44th in the country, factoring in economy, education, health, and family and community.
Between births and movement into the state, the youth population has grown more than the nation as a whole between 2000 and 2010, according to Census figures. Nearly 1 million more children live in Texas now compared with a decade ago, while the total nation’s youth population grew by less than 900,000.
“Lost funding”
The children’s budget is the amount of government money spent on services that primarily benefit kids, like Children’s Medicaid, education, nutrition and special needs. As far as children’s services go, things aren’t looking up.
The state budget is projected to decline 3 percent this year and next, compared with 2010-11, according to the left-leaning Center for Public Policy Priorities in Austin. They attributed much of the decrease to the discontinuation of resources funded by the federal stimulus, which passed Congress in 2009.
The Urban Institute, a nonpartisan think tank in Washington, D.C., also said federal spending will continue to decline in years to come as funds from the federal stimulus are exhausted.
The CPPP estimated federal aid to Texas for the children’s budget will be slashed by 17 percent in 2012-13. They expect $2 billion, or 13 percent, will be taken from health. The majority of health funding goes to Children’s Medicaid and the Children’s Health Insurance Program.
“When Congress talks about cutting entitlements or changing Medicaid, those are situations where Texas would not make up for lost funding,” said Eva DeLuna Castro, the senior budget analyst for CPPP.
How Texas will react to a decline in federal funds has yet to be determined. The Legislature, which determines the state budget, will not reconvene until January.
“It would really be up to the Texas Legislature to decide whether any additional state money would be necessary to make up for federal funding cuts and keep these programs where they are now, or whether we would need to take other steps to try to absorb the losses,” said Geoff Wool, a spokesman for the Texas Health and Human Services Commission.
“A long way to go”
Kids Count said in its report that 26 percent of Texas children were living in poverty in 2010, higher than the national rate of 22 percent. Ten years before, only one in five Texas children were living in poverty.
The statistics for minority families are even more staggering. According to the Texas HHSC, 38 percent of Hispanic children live with families whose incomes fall below the poverty level, along with 31 percent of black children.
Higher poverty rates mean an increased need for health care assistance. The HHSC reported 47 percent of state’s children were enrolled in Medicaid or CHIP as of September. But when federal funding is slashed, Texas has to foot the bill and make cuts of its own.
This presents a major problem for a state that is left trying to tackle one of the highest uninsured rates in the nation. In 2010, less than 10 percent of children in the U.S. didn’t have insurance. The HHSC said that in the same year, 16 percent of kids in Texas were in the same predicament.
The state has moved to improve the situation. Between 2009 and 2011, Texas added around 445,000 children to its Medicaid and CHIP programs, which are operated by the state.
“They’ve made progress but still have a long way to go, with well over a million kids without health insurance,” said Bruce Lesley, president of the children’s advocacy group First Focus.
However, increasing the number of kids who get health care assistance might not be very effective if the system is flawed.
“Getting more kids on Medicaid is a huge thing,” said Frances Deviney, the director of Kids Count for Texas. “It’s great to have the Medicaid card, but can you get in to see the doctor?”
Deviney is referring to the drastic drop in practitioners who accept new Medicaid patients. This month, the Texas Medical Association reported Texas physicians who do accept new Medicaid patients plummeted from 42 percent in 2010 to 31 percent this year.
More practitioners are bowing out of Medicaid because of further cuts to Medicaid payment rates. According to the TMA, these payments cover less than half the average cost it takes to provide the service.
“Any time you cut rates, that’s going to really affect the financial health of the doctor’s office to even be able to stay in business,” Deviney said. “Doctors have to be able to, at a minimum, cover their costs. They’re having to make tough choices.”
“We aren’t choosing to invest”
No matter how many Medicaid cards there are in circulation, advocates say, when health care is hard to come by, children are at risk. They can’t see a doctor when no one in the city or county takes new Medicaid patients. And, just like all problems that are ignored, their health issues can get worse with time.
“When they can’t get care in the community, they end up in the emergency department in the hospital,” said Arlene Wohlgemuth, the executive director of the conservative Texas Public Policy Foundation.
Because of state budget cuts, public schools are also having a difficult time providing health services to children in need.
“School districts, when faced with decreased state education funding, are having to make hard decisions about the provision of health care,” said Laurie Combe of the Texas School Nurses Organization. “The solution in many school districts is to downgrade the level of health services provided to students.”
“You can’t get returns on investments you don’t make, and currently we aren’t choosing to invest in kids,” Deviney said.
Texas aims to be a leading state in the country. It boasts its status as the No. 1 state to do business, but does not fair well in children’s well being. However, its influence on policies affecting children has a great impact.
“Texas is definitely the canary in the coal mine for the next generation,” Lesley said. “The state harbors the vast majority of the growth. What happens to this generation of kids in Texas will determine the kind of trouble our country’s future will see.”