Texas led the nation in children without health insurance as the number of its youngest uninsured jumped last year, according to a new national health care report.

An estimated 835,000 Texas children went without health insurance in 2017, an increase of about 80,000, or more than 10 percent, from 2016, according to the report by Georgetown University’s Center for Children and Families. To put those numbers into perspective, one in five of the nation’s uninsured children lived in Texas.

“Texas was already doing a bad job of making sure kids had health coverage and now Texas is doing even worse,” said Adriana Kohler, senior health policy associate at Texans Care for Children, an Austin-based children’s advocacy group.

For Kyla McKay, the struggle to hold onto health coverage feels overwhelming as she cares for her three children, two with serious medical conditions. Chaos and exhaustion are a given as the 35-year-old stay-at-home mom spins through her days. But the threat of losing her children’s health insurance is what nearly brings her to her knees.

For the past dozen years, her family has careened between being insured, being uninsured and then back again, stitching together a patchwork of coverage programs.

“We’re safe right now,” said McKay, of Pasadena. “But it feels like storm clouds are gathering.”

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McKay’s fear is not without warrant. After years of declines, the number of uninsured children rose across the nation last year, up by more than 250,000, even as the national economy strengthened and unemployment fell.

Advocates say the rise in uninsured children is happening as existing assistance programs are threatened or hobbled by administrations in Washington and Austin chip away at existing programs through budget cuts and delays as well as attempting to dismantle protections in the Affordable Care Act. At the same time, enrollment in government programs is dropping in immigrant communities as parents avoid enrolling children out of fear that under new Trump administration policies their citizenship status could be jeopardized if they take public assistance.

At one Houston assistance center, for instance, applications for government-funded health care programs for children are down 23 percent from year ago. Renewals for Children’s Medicaid, the federal health insurance for the poor, are down 28 percent.

“I have been writing this report for 8 years and this is the first year that progress has not only come to a halt but now we’re going backwards. This is a very big red flag for me,” said Joan Alker, executive director of the Georgetown center and co-author of the report.

She worries that the uptick in uninsured numbers will continue and the stakes are high. “It’s very hard for uninsured children to succeed.”

A lack of well-baby exams, routine childhood check-ups and access to care and medication when needed can worsen school success as well as a lessen a child's chance at long-term health and economic success into adulthood, advocates say.

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“This is a disturbing report for anyone who wants Texas kids to get the eyeglasses they need to read the chalkboard at school, mental health treatment they need to be healthy, early treatment to stop cancer before it spreads, and everything else that health insurance can mean for a child,” said Kohler, “Texas leaders need to make a commitment to reducing the state’s sky-high uninsured rate for kids and adults.”

Carrie Williams, press officer for the Texas Health and Human Services Commission, said in an email that the 10.7 percent child uninsured rate in 2017 was a significant improvement over 2008 when the Texas rate was just over 18 percent. She credited the improvement to a strengthening economy.

Gov. Greg Abbott’s office did not respond to a request for comment.

McKay, the Pasadena mother, said that years ago, as a young couple with two babies, they skipped health insurance for their family, taking their chances, feeling invincible. Or maybe just lucky. Her husband could get insurance through his work, but the monthly premium deducted from his paycheck devastated their already tight budget. It was more expensive than their mortgage payment. Instead they bought a cut-rate plan only good for occasional doctor visits.

In 2006, about a year after their second child, Katie, was born, McKay noticed her daughter wasn’t hitting the baby milestones such as trying to crawl. One day in day care Katie began screaming in pain, unable to open her eyes or hold up head. McKay was terrified and rushed her child to the pediatrician who brushed it off and sent them home. They went shopping for another doctor.

But they were warned by the doctors they met they better get full coverage because there would be a lot of medical bills coming. Katie underwent tests and saw specialists for years in search of a diagnosis.

At first they bought private insurance just for her. That plan went out of business. Then they tried another insurer, which rejected Katie for having a pre-existing condition. Next they tried Texas’ high risk pool program, designed for those with chronic health problems who cannot get insurance elsewhere.

The couple was turned down because McKay’s husband could get insurance through his work, even though they explained they could not afford it and it did not cover all of Katie's vast needs. Finally they landed in the Children’s Health Insurance Program. McKay’s husband had to take a pay cut to qualify.

Today, Katie is eligible for Medicaid because she is considered medically fragile. She is believed to have mitochondrial disease, a rare condition where parts of her cells fail to furnish enough energy for organ function. McKay left her job to care for and home school her daughter.

Katie's little sister, Josie, now three, was born with a heart defect and had open heart surgery at 6-months-old. She also has severe food allergies. Josie is now covered by CHIP, as is big brother, Nathan, 16.

McKay and her husband skipped coverage for years so their children could be insured. This year they they signed up for a plan for the first time through the Affordable Care Act.

She worries though that their cobbled together coverage will not last. In past years Texas lawmakers have proposed deep cuts to Medicaid for disabled children. Congress has also talked about slashing programs. “This past year has been really frightening,” she said, “Even when we have insurance it feels precarious”

jenny.deam@chron.com

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