In his continuing effort to cater to swing voters, George W. Bush is venturing ever further onto Democratic turf. For example, his campaign touts the governor's support for the Children's Health Insurance Program (CHIP), intended to help working families who make too much for Medicaid but too little to afford private health insurance. "When the CHIP program was first implemented," a press release reads, "Governor Bush embraced it as an opportunity to help deliver health coverage to more than 423,000 children."
Those are impressive numbers. And the need is plain in Texas, where a quarter of the residents--1.4 million of them children--lack health insurance. But Bush's actual record on CHIP is anything but supportive. As previously reported, Bush fought doggedly, but unsuccessfully, to limit the number of Texas children the program would cover. One reason was Bush's desire to keep money free for a big tax cut. But another key reason has received less attention: Bush's desire to prevent more children from getting Medicaid.
CHIP and Medicaid are inextricably linked because eligibility for one program kicks in where the other ends. Many families applying for CHIP discover that while they don't qualify for that program, they are eligible for Medicaid. This is known as the "Medicaid spillover" effect. And it's particularly important in Texas, which offers little Medicaid outreach and thus has many eligible families who aren't in the program. Normally, one would consider insuring more kids to be a positive development--unless, of course, one happens to be a conservative Republican governor running for president. Not only does a Medicaid recipient cost Texas more than a CHIP recipient does, but Medicaid is an entitlement whose numbers in Texas have been falling for years--one of Bush's proudest accomplishments as governor.
The spillover from a broad-based CHIP program threatened to reverse that trend. "The mantra among Bush staffers during the legislative process was, 'Keep the lid on any program that will expand government,'" says Democratic state representative Glen Maxey of Austin. "That translated to, 'Keep children off Medicaid at all costs.'" Says another representative, "I was told that Medicaid costs were not to go up while Bush was considering a run for the presidency."
Bush also helped pare Medicaid rolls by refusing to simplify Medicaid applications, as health care advocates had urged. While parents can apply for CHIP by phone or mail, Texas requires Medicaid applicants to appear in person, fill out a stack of forms, and repeat the process every six months. (Texas is also one of only a handful of states that still requires an asset test, which can disqualify otherwise eligible families for owning a second car or even a cemetery plot.) As a result of these multiple obstacles, roughly 600,000 children who qualify for Medicaid don't get it.
Bush dragged his feet on implementing CHIP for as long as he could, thereby putting off the uptick in Medicaid enrollment. Rather than formulate a CHIP program, Bush waited a year until the state legislature came back into session and lawmakers wrote their own. When they set to work, Bush fought to limit the program's size and cost. Though federal law allows states to extend CHIP benefits to families earning up to 200 percent of the federal poverty line, Bush initially wanted benefits held to only 133 percent. The legislature unanimously passed a bill to cover the full 200 percent, but only after heavy resistance from the governor. Though Bush now claims credit for insuring children, he was practically alone in trying to limit coverage. There was no organized legislative opposition to fully funding the program. "The only impediment was Bush's presidential campaign," says Maxey.
This record hardly squares with Bush's theme of compassionate conservatism. So it's no surprise that Bush never took a public stand to limit CHIP. In effect he wanted it both ways--no programs, but also no bad press for standing in their way. Bush's representatives made sure the message got through to legislators. "The governor didn't want any entitlements, period," says state representative Garnet Coleman, a Democrat from Houston. "To that effect, he employed a passive-aggressive style of mitigating the value of the health care legislation while he himself was removed from the process."
A bit of political horse trading finally convinced Bush to sign the bill, and the deal speaks volumes about where children's health care fell on Bush's list of priorities. According to state legislators and policy analysts with close knowledge of the negotiations, Bush finally agreed to the bill in exchange for a raft of tax breaks for Big Oil. "Bush wanted an emergency bailout of Exxon and Mobil that consisted of around $86 million in tax breaks to major oil companies," says one state representative. "Liberals went along with this in return for Bush's signature on a bill that covered kids up to 200 percent, covered state employees, and covered legal immigrants. It was the most progressive victory in the state legislature in the last 10 years. And Bush fought it all the way."
By stalling on CHIP, Bush succeeded in limiting the number of Medicaid recipients. The first child was not insured under CHIP until April 2000, long after children were being covered under the program in other states. By the end of June, only 28,312 Texas children were covered out of the 500,000 believed to be eligible. "Was a tax cut [for oil companies] more important than children's health?" wonders Coleman. "For Bush's political purposes, yes." The Bush campaign concedes that the oil company bailout was one of Bush's key legislative priorities, while denying there was any quid pro quo. The governor's representatives also claim that the delay in implementing CHIP was not a matter of foot-dragging but rather a result of the fact that the Texas legislature meets only every other year. To implement the program any more quickly Bush would have had to submit an emergency measure. In fact, he did submit such a measure in February of 1999--not for CHIP, but for his prized oil company bailout. ¤