AUSTIN -- More than 1 million Texas children remain without health insurance, and those kids are not getting the care they need.
The startling condition of the state's children came into vivid focus last week with the release of the annual Kids Count survey. The analysis of official state and federal data by the nonpartisan Center for Public Policy Priorities found that 1.2 million Texas children have neither private nor public health insurance.
Almost 40 percent of Texas mothers received little or no prenatal care, and 1 in 7 babies was premature, statistics show. The difference between being insured and uninsured is stark: 90 percent of insured kids are healthy, while only 58 percent of kids without insurance are considered healthy.
With 25 percent of Texas children living in poverty, a rate that consistently runs 5 percent above the national average, Texas ranks 41st in the nation in the number of uninsured kids, even though the unemployment rate is lower than the national average.
When uninsured kids get sick, their parents have no place to take them other than a public hospital's emergency room, which by law cannot turn them away.
And if those parents cannot pay the expensive bill? The taxpayer picks up the tab.
"A large percentage of those kids will end up in the emergency room as their primary source of care, which is hugely inefficient and ridiculously expensive," said Dr. Skip Brown, a medical professor and director of a pediatrics center at the University of Texas Medical Branch in Galveston. "When you go to the emergency department, those guys are not there to be primary-care providers."
Brown said the children also miss out on the most important factor of good care: a doctor who knows the patient's medical history.
Children with asthma and diabetes -- chronic diseases best treated by a family doctor on a routine basis -- are many, if not most, of the kids who show up in the emergency room.
"There are kids missing out on care," he added.
About half of the uninsured children would qualify for Medicaid or the Children's Health Insurance Program if they applied, according to the Annie E. Casey Foundation. Many of the parents don't know they are eligible, have not bothered to apply or the state has not finished processing their applications.
From 2007 to 2010, Texas Medicaid and CHIP, which is for kids not quite poor enough to qualify for Medicaid, grew by 10 percent and did a good job of treating kids, according to an official review released last week. Texas' programs consistently scored above the national average in treating asthma, diabetes and mental-health issues. Customer satisfaction was consistently high, according to the independent assessment by the University of Florida.
However, the Legislature cut state spending on Medicaid and CHIP by $2.03 billion for 2012-13, according to a budget analysis by the Center for Public Policy Priorities. More than $800 million of those cuts will be to reimbursement rates for doctors who agree to treat poor or disabled children.
The reduction in payments to doctors treating Medicaid patients will make it harder for patients to find care.
Brown, who has practiced medicine for more than 30 years, said he remembers the era before Medicaid and CHIP were widely available and the entirely preventable emergency cases that would turn up in emergency rooms.
"I have seen the change in my practice lifetime that giving good basic care will do," Brown said. "I am really concerned we're going to see that backslide a good bit."