As the presidential race moves into its final laps, the two major-party candidates continue to trade charges over George W. Bush’s record of providing health care to children during his tenure as the governor of Texas.
In televised debates and on the stump, Vice President Al Gore, the Democratic nominee, has criticized his Republican rival for leading a state with the second-highest percentage of uninsured children in the nation. Last year, 14 percent of Texas’ children under 18—or 1.4 million—were uninsured, a higher proportion than for any other state except California, where 18.3 percent of children lacked health insurance.
“There is a record here, and Texas ranks 49th out of the 50 states in ... children with health care,” the vice president said during the second presidential debate Oct. 11.
Mr. Gore also said that night that Texas ranks “dead last” in the percentage of insured residents overall, a figure he based on a U.S. Census Bureau report summarizing data from 1997 to 1999 that showed 24 percent of Texans had no health insurance. New numbers released last week showed that Texas had recently inched up to 49th place.
The vice president has tried to use those statistics as part of his overall strategy to portray his opponent as primarily interested in helping big businesses and wealthy taxpayers. By contrast, Mr. Gore says his agenda includes a plan to provide affordable insurance to all children within four years.
Bush campaign spokesmen and state officials do not dispute the state’s low health-insurance rankings, but they say Mr. Gore is taking them out of context. First of all, they point out, many of Texas’ health-coverage problems predate Mr. Bush’s tenure as governor.
“You had a century of neglect of these issues, and Governor Bush has been there since 1994,” Carole Keeton Rylander, the Texas state comptroller, said last week.
In addition, she noted, Texas shares a long border with Mexico, many of whose citizens have emigrated north. Immigrants are more than twice as likely to be uninsured than the rest of the population, Ms. Rylander said, in part because many of them tend to work for small businesses that may not offer health insurance.
The border states of Arizona, New Mexico, and California also fare poorly on national health-insurance rankings.
Ray Sullivan, a spokesman for the Bush campaign, also contends that the Clinton administration has thwarted Texas’ efforts to increase health-care coverage for children. In 1997, Gov. Bush proposed reforming the state’s Medicaid program by employing private companies to administer it. If approved, the plan would have added thousands more children to the Medicaid rolls, Mr. Sullivan said.
The U.S. Department of Health and Human Services did not approve the necessary waiver, saying the state’s plan would not have provided sufficient oversight to ensure that children would receive the aid to which they were entitled. Texas is one of several states whose plans to privatize the administration of Medicaid, the federal health-insurance program for the poor, have been denied.
Gov. Bush countered Mr. Gore’s charges during the second debate by claiming that “the percentage of uninsured in Texas has gone down, while the percentage of uninsured in American has gone up.”
In fact, according to the U.S. Census Bureau, the number of uninsured people is now on the decline nationally. In 1999, 42.5 million people, or 15.5 percent of the population, lacked health insurance, down from 44.2 million, or 16.3 percent, in 1998. The recent gains represent a reversal, however, of an upward trend in the number of uninsured people that began in 1987.
More broadly, Mr. Bush added that “the allegation that we don’t care and we’re going to give money to this interest or that interest and not for children in the state of Texas is totally absurd. ... We spend a lot of money to make sure people get health care in the state of Texas.”
Just how much money Texas devotes to providing health care for people without insurance is also a matter of dispute. In the second debate, Mr. Bush said repeatedly that “we spend $4.7 billion a year in Texas for uninsured people.”
That statement was misleading, three Democratic lawmakers from Texas wrote in a letter to Mr. Gore last week.
According to a report from the Texas comptroller’s office, $3.5 billion of the $4.7 billion comes from charity care provided by doctors, local governments, or charitable institutions, and $198 million is received from the federal government. The state’s portion, the report said, is $988 million.
“He is trying to hide his record and cover up failed leadership in Texas,” said Dag Vega, a spokesman for Mr. Gore.
But Mr. Sullivan said that Mr. Bush did not intend to take credit for private contributions. He added that Texans are getting the health care they need, but from a variety of sources.
“The person who receives the health care doesn’t care if those are local, federal, or state dollars. All they care about is getting it,” Mr. Sullivan said. “Big government,” he added, “is not always the solution.”
The two candidates have sparred over other children’s health-care issues as well.
Mr. Gore charged that when the federal government offered additional funding to states in 1997 to help insure more children through the Children’s Health Insurance Program, or CHIP, the Texas governor hesitated to take advantage of it.
According to Texas health officials, Gov. Bush initially resisted Democrats’ proposals in 1999 to expand the number of children eligible for CHIP to include all those whose families earned up to 200 percent of the poverty line, the maximum level allowed under the federal program. States have to match a portion of the federal funds.
Mr. Bush lobbied to limit the program to serve children in families with incomes up to 150 percent of the poverty level—a plan that would have lowered by 200,000 the number of children able to participate. After the legislature approved the higher level, the governor signed the measure.
Fifteen states have set eligibility levels below the 200 percent mark, according to the Health Care Financing Administration, which administers the CHIP program.
In the second debate, Mr. Gore criticized Gov. Bush for “declaring a tax cut for oil companies an emergency need” the same year he lobbied against the maximum eligibility level for CHIP. “The governor preferred to put the money toward a tax cut, a significant part of which went to wealthy interests,” the vice president said.
Gov. Bush acknowledged that the state’s CHIP program “got a late start,” but he said that was partly because the Texas legislature meets only four months every two years.
Ms. Rylander, the state comptroller, who is supporting Mr. Bush’s presidential bid, added that Texas has enrolled 116,000 children in CHIP since April, and hopes to have 400,000 children enrolled by next August. An estimated 600,000 children are eligible for the program.
Finally, Mr. Gore has noted that last month a federal district judge found serious problems with the way Texas’ Medicaid program is administered. The judge found Texas officials in violation of a 1996 consent decree stipulating that the state was failing to comply with a federal law to provide timely and adequate health care to indigent children enrolled in the program.
A Bush spokesman last month characterized the ruling as “strange” and said the governor had made numerous improvements to the state’s program.
How Much Impact?
One leading Washington political analyst said last week that Vice President Gore’s focus on Gov. Bush’s health-care record in Texas could help move undecided voters to the Democratic ticket next month.
“I think it’s a good message that could appeal to swing voters and could pull moderate Republicans away from Bush,” said Stuart Rothenberg, the editor of the Rothenberg Political Report and a columnist for Roll Call, a newspaper that covers Congress.
But he said it was hard to gauge whether health care is a big enough issue on its own to sway many voters: “If you ask voters if they care about children’s health, most are going to say yes. The question is whether they base their vote on that.”