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Deep Health Care Problems under Rick Perry’s Watch

Deep in the heart of Texas
September 14, 2011

With the media hyper-focused on Texas governor Rick Perry’s not-too-flattering comments about Social Security, health care in his state seems like a woeful orphan in Medialand. That’s why Noam Levey deserves a shout-out for his recent Los Angeles Times story dissecting what’s really happening in Texas when it comes to caring for the sick. Levey presents a devastating account of health care in the Lone Star State. His nut graph:

In the 11 years the Republican presidential hopeful has been in office, working Texans increasingly have been priced out of private healthcare while the state’s safety net has withered, leaving millions of state residents without medical care.

Perry has said Texas could manage its own health care. Levey shows the facts are otherwise. More than one-quarter of all Texans lack health insurance, and it’s no surprise why. Over the past seven years, insurance premiums in the state have risen more quickly than they have in the nation as a whole. Levey visited a community clinic in San Angelo in West Texas, and found it was filled every day with uninsured Texans. Even though most of the patients have jobs, their employers don’t offer health coverage. The clinic served 13,000 patients last year, and that number was up from 11,000 the year before.
The Centers for Disease Control and Prevention says that over the past decade infant mortality has risen in Texas while declining nationally. That statistic confirms much of my own reporting in Texas. Dr. Fernando Guerra, the former health commissioner in San Antonio, told of the lack of pre-natal care for teen mothers and the dearth of follow-up care for their babies after they are born, particularly in low-income Hispanic areas. I once interviewed a woman whose infant granddaughter was sleeping on the sofa next to me while I did the interview. There was no other place for the baby to sleep in the family’s tiny house. The grandmother whom I was interviewing had a job with insurance, but she told me the copayments and coinsurance were so high that she didn’t go to the doctor, even though she was a diabetic at age forty-two.

Even after these babies become toddlers and school-age children, state statistics indicate that they may not be well-cared for, medically speaking. Using numbers from The Commonwealth Fund, Levey reported that almost of one-third of the state’s kids did not receive an annual physical exam or a teeth cleaning in 2007. And that, of course, ties in with the state’s Medicaid and Children’s Health Insurance Program (CHIP), which spend less per enrollee than forty-one other states and the District of Columbia. Dr. Kenneth Shine, who heads the University of Texas health system, told Levey “The philosophy has been the less public expenditure, the better. And some people will just have to make do.”

I interviewed a mother named Mary who was trying to stay afloat financially. She told me how difficult it was to put her children on the rolls. The kids were on again and off again since they had to reenroll every six months. One time, CHIP refused to put her children on because she didn’t have updated income tax information on file. Her youngest daughter was eligible for Medicaid, but sometimes she bounced back and forth between CHIP and Medicaid. As I got in the car to leave, I looked back at Mary staring at the sky. Her lined face made her look older than she was. I could only imagine her financial struggles and how hard it was to keep her children healthy.

Levey noted that Perry promotes Texas as a model for a private-sector health care solution. Businesses can offer private insurance and empower working people to make their own health care choices because of the state’s low taxes and limited government. Sometimes those choices may not be in the best interests of their health. Mary’s husband, who had a nagging cough for weeks, tried to get treatment at a community clinic but was turned away because the family owed money for services the clinic had given one of the children. He chose to treat his cough with over-the-counter remedies because he had no spare cash to pay the outstanding bill.

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Perry often touts his reform of the state’s malpractice system, which the past president of the Texas Medical Association maintains has helped doctors stay in practice. “We now have much better access to care,” he told Levey. But Levey reported that Texas still has “among the fewest physicians per capita in the country” and that the governor and legislature slashed funding for physician training to less than half of what it was ten years ago. There have also been cuts to community health centers. No wonder the clinic wasn’t wild about treating Mary’s husband.

“We have to reinvest in a commitment to public health relationships,” Dr. Guerra said during our interview. “It’s a no-win situation for many of these families.” But Levey reports that isn’t the direction that the governor has taken the state’s health system. Dr. Jane Rider, a past president of the Texas Pediatric Society, put it this way: “It seems like we’re leading the way into a downward spiral.”

That seems like fertile territory for the media once they get over Perry’s attack on Social Security—which, of course, is easier to report than a story about the state’s lack of services to poor people.

Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.