El Paso, Texas, Stuggles to Provide Care for Children Enrolled During ‘Ambitious’ CHIP Campaign

Despite enrolling more than 23,000 of the 28,000 children eligible for Texas' CHIP program, the city of El Paso is dealing with an "unexpected problem" -- it is not prepared for the "torrent of new patients, and may never be," the New York Times reports. The city lacks a children's hospital and pediatric surgeon and has only 46 pediatricians out of a needed 100. In the meantime, an additional 5,000 city children have applied for the CHIP program, and 30,000 are waiting to be enrolled in Medicaid. Local pediatrician Dr. John Gugedahl said, "The good news is that these children do have some access to the delivery system. The bad news is that we don't have an adequate pediatric delivery system, because of chronic underfunding for so many years." Pediatricians practicing in El Paso are "feeling the strain" of dealing with so many children, and some have "complain[ed]" that CHIP reimbursement rates are too low. For example, a few years ago 60% of pediatrician Dr. Carlos Gutierrez's patient load had private insurance and 40% had Medicaid. Now, 70% of his patients have either Medicaid or CHIP coverage. As a result, Gutierrez's "receipts have gone down" as his expenses have increased," the Times reports. The Texas Medical Association has recommended that doctors limit Medicaid and CHIP patients to about half their practice. However, some pediatricians have stopped accepting new CHIP beneficiaries.

Finding Solutions
El Paso Mayor Raymond Caballero, who considers the lack of health infrastructure to be the city's "primary problem," is advocating a change in municipal contracting practices to favor companies that give their employees private coverage. The Times reports that the idea behind Caballero's move is that because reimbursement rates for private insurance are higher than those for CHIP or Medicaid, the city then will be able to recruit and retain doctors. In addition, state Sen. Eliot Shapleigh and state Rep. Norma Chavez "cajoled" state officials to increase the city's CHIP funds by 15% beginning Sept. 1. The "promise of greater financing" did "persuade" some pediatricians to accept new CHIP patients again. Sara Rosenbaum, a health law professor at George Washington University, said, "What El Paso is experiencing is a look into the future for all of us if we don't come up with a national health policy. You hear this from people around the country that even as the number of insured children is going up, many local expansion sites are struggling with the question of what do we do now" (Yardley, New York Times, 8/7).