There are few thoughts more agonizing than children suffering from health problems and going without medical care.

Yet this scenario is playing out for roughly 873,000 uninsured young Texans. For perspective, that’s about the population of greater El Paso.

A new Georgetown University report shows this state has the highest number of uninsured children in the country and underwent the steepest increase in recent years. After years of steady improvement, a combination of state and federal policies are pushing Texas backward. The number of uninsured children in Texas increased 16 percent from 2016 to 2018.

Nationally, 5.2 percent of children are uninsured. In Texas, it’s 11.2 percent.

“All the trends that we think are contributing to the growing number of uninsured children are happening in Texas,” said Joan Alker, executive director of Georgetown’s Center for Children and Families.

It starts with the state’s refusal to expand Medicaid coverage under the Affordable Care Act, which would provide federal funding for about 90 percent of the expansion’s cost. It continues with red tape and stringent eligibility requirements.

Currently, a parent with two children who makes more than $3,827 — or 18 percent of the federal poverty line — does not qualify for Medicaid in Texas, although his or her children may. However, many of these parents don’t realize their children are eligible for coverage.

If Texas chose to participate in the Medicaid expansion, parents who make up to 138 percent of the federal poverty line would qualify. Overall, that means more than 1.4 million Texans would become eligible for insurance, the majority of them Hispanic, according to the Kaiser Family Foundation.

Experts say when adults are insured, their kids are likely to be insured, too.

Texas is one of only 14 states that have opted out of the medical expansion program. In those states, children are nearly twice as likely to be uninsured, the report found.

And Texas has the most stringent income eligibility requirement of the 14 states.

Also to blame for the high rate of uninsured children is a series of “red tape” measures that make enrolling and renewing coverage more difficult. For example, Texas checks the incomes of families relying on Medicaid or Children’s Health Insurance Program not once a year, but several times. Families who have fluctuating monthly incomes that occasionally rise above the eligibility limit, or who are erroneously flagged in the system, must hurry to provide additional proof of income to the state within a tight time frame to keep their benefits.

Each year, tens of thousands of children are kicked off for this reason.

There are also concerns the Trump administration’s public charge directive and general rhetoric have created a “chilling effect” among immigrants fearful of interacting with government entities, should their or one of their family members’ immigration status be threatened. Under the public charge directive, which was blocked from going into effect by the courts, legal immigrants who rely on federal benefits such as Medicaid and food stamps could be denied a green card or other pathway to citizenship.

According to a study by the Urban Institute, 1 in 7 immigrants didn’t apply or dropped out of a public benefit last year out of fear of being barred from obtaining a green card. Experts say the threat of the directive continues to fuel fear in the immigrant community.

Illegal immigrants are largely ineligible for Medicaid and other federal public benefits, and legal residents must fulfill more eligibility requirements to receive them than a U.S. citizen.

The Trump administration has also cut advertisements and outreach for the Affordable Care Act.

“It all adds up to a situation where Texas and the Trump administration have pulled back the welcome mat for children’s coverage,” Alker said.

Children without insurance are more likely to get sick and stay that way longer. They’ll miss school. They’re less likely to graduate. They’ll make less money than their insured peers.

And their families will have a higher chance of going bankrupt or suffering from the medical debt incurred by visits to the emergency room.

But there is a prescription to help keep Texas children healthy: Expand Medicaid and reexamine the bureaucratic obstacles that make it difficult for families who are already enrolled to stay that way. Having 11.2 percent of Texas children go without health insurance is unacceptable and an invitation to tragedy.