Texas KIDS COUNT: Our Border, Our Future Frances Deviney, Ph.D. Texas KIDS COUNT Director May 15, 2009 South Texas College McAllen, TX

Our Sponsors

El Paso Hudspeth Jeff Davis Presidio Brewster Val Verde Culberson Kinney Maverick Zavala Dimmitt Webb Zapata Starr Jim Hogg Hidalgo Cameron Willacy Brooks Terrell TX Counties Along the Border with Mexico

One of Every Nine Kids Lives in Border Counties Source: Children ages 0-17, 2007 Population Estimates, Texas State Data Center; Urban designations from Texas Department of State Health Services, based on 2004 U.S. Office of Management and Budget definitions.

Hidalgo County’s Child Population Growth Skyrockets from 2000 to % 12% 2% Source: Children ages 0-17, 2007 Population Estimates, Texas State Data Center; Urban designations from Texas Department of State Health Services, based on 2004 U.S. Office of Management and Budget definitions. Urban Border includes Hidalgo County.

Over Half of Hidalgo County Children Live in an Immigrant Family; Virtually All Are Citizens Source: CPPP analysis of the citizenship and foreign-born data for 117 counties available in three-year American Community Survey Data. Border includes Hidalgo County.

Median Household Income in Urban Border Counties Lower than Even Rural Non-border Counties Source: CPPP analysis of 2007 Median Household Income from Small Area Income and Poverty Estimates & Households from Census 2000 Summary File 3. Border includes Hidalgo County.

Hidalgo Co. Experiences Purchasing Power Plateau Source: CPPP analysis using 2007 Median Household Income from Small Area Income and Poverty Estimates. Purchasing Power = Median Income adjusted for inflation to year 2000 dollars.

Although Better than in 2000, Border Unemployment Still Much Higher Than Rest of State Source: CPPP of Texas Workforce Commission unemployment and labor market data. Border includes Hidalgo County.

Child Poverty in Texas Heavily Concentrated Along the Border; Nearly One of Every Two Hidalgo County Children Live in Poverty Hidalgo County (43.9%) Source: 2007 Small Area Income and Poverty Estimates, U.S. Census Bureau

2009 Federal Poverty Guidelines Persons in familyPoverty guideline 1$10, , , , ,790 Source: U.S. Department of Health and Human Services

Kids Living on Border More Than Twice as Likely to Live in Poverty Source: Small Area Income and Poverty Estimates, U.S. Census Bureau. Border includes Hidalgo County.

Children in Immigrant Families on Border Much More Likely to Live in Poverty Source: CPPP analysis of poverty and foreign-born data for 117 counties available in three-year American Community Survey data. Border includes Hidalgo County.

Condition of Family Economic Security along the Border Lower median income than state Wages not keeping pace with inflation Unemployment higher than state and on the rise Highest child poverty concentration in state and U.S. Poverty particularly high for children in immigrant families on the border

Infant Health

One of Every Seven Texas Babies is Born in a Border County Source: Texas Department of State Health Services 2005 birth data

Infant Mortality Program Review/Planning Tool Age at Death FetalNeonatal (< 28 days old) Post Neonatal (>= 28 days old) Birthweight< 2500gMaternal Health and Prematurity >= 2500 gMaternal Care Newborn CareInfant Health and Safety Source: Adapted from presentation on March 27, 2009 by Brian Castrucci, Director of the Office of Program Decision Support at the Division of Family and Community Health Services with the Department of State Health Services.

Border Counties’ Infant Mortality Rates Lower Than Rest of State, but Show the Same Pattern Source: CPPP analysis of Texas Department of State Health Services 2005 death and birth data. Border includes Hidalgo County.

Largest Number of Hidalgo County’s Infant Mortalities Occurring within First Month with Low Birthweight Babies Source: 2005 death data, Texas Department of State Health Services

Reducing Hidalgo County’s Infant Mortality Rate Will Require Increased Attention to Maternal Health and Prematurity Age at Death FetalNeonatal (< 28 days old) Post Neonatal (>= 28 days old) Birthweight< 2500gMaternal Health and Prematurity >= 2500 gMaternal Care Newborn CareInfant Health and Safety Source: Adapted from presentation on March 27, 2009 by Brian Castrucci, Director of the Office of Program Decision Support at the Division of Family and Community Health Services with the Department of State Health Services.

Women Living in the Urban Border Counties More Likely to Have Inadequate Prenatal Care Source: Texas Department of State Health Services. Border includes Hidalgo County. Inadequate Prenatal Care = No prenatal care or care that begins after first trimester.

At Most Education Levels, Women Along the Border More Likely to Receive Inadequate Prenatal Care Source: CPPP analysis of Texas Department of State Health Services 2005 birth data. Border includes Hidalgo County. Inadequate Prenatal Care = No parental care or care that begins after first trimester.

One of Every Two Births in Hidalgo County to Mother with Less than High School Degree Source: CPPP analysis of Texas Department of State Health Services 2005 birth data.

The Percentage of Low Birthweight Babies (< 2500g) Born in Border Counties Slightly Lower than Rest of State; Even Better in Hidalgo Co. Source: CPPP analysis of Texas Department of State Health Services 2005 birth data. Urban Border data includes Hidalgo County.

Majority of Low Birthweight Births are Linked to Preterm Deliveries Source: CPPP analysis of Texas Department of State Health Services 2005 birth data. Urban Border data includes Hidalgo County.

One in Five Babies Born in Rural Border Counties is to a Teen Mom Ages Source: CPPP analysis of Texas Department of State Health Services 2005 birth data. Urban Border data includes Hidalgo County.

Of the More Than 2,700 Births to Teens in Hidalgo Co., One in Four Were to Teens Who Were Already Mothers Source: CPPP analysis of Texas Department of State Health Services 2005 birth data.

Infant Health Along the Border Infant mortality rates better than state, but still have room for improvement Largest number of infant mortalities occur with LBW babies in first month Too many pregnant women not getting adequate prenatal care LBW linked to preterm deliveries Higher rate of births to teens

Health Care Coverage and Access

Higher Child Medicaid Enrollment Along Border Percentage of Children on Medicaid Source: CPPP analysis of Texas Health and Human Services Commission data: All Children ages 0-18 enrolled in Medicaid in August 2007 as a percentage of total 2007 child population 0-18 Hidalgo County (49.6%)

The Number of Hidalgo Co. Children on Medicaid Increased After Instituting Six-Month Continuous Enrollment in 2002; Later Plateau Likely Due to Eligibility System Breakdown Beginning in 2006 Simplified Enrollment Begins Source: Texas Health and Human Services Commission

Majority of Doctors Serving Children and Families have Medicaid Clients Source: CPPP analysis of Texas Health and Human Services Commission 2007 Medicaid claim data and 2008 Physician Licensure Data

Texas Border Counties Have Fewer Doctors to Serve Children and Families Than the Rest of the State Source: CPPP analysis of Texas Department of State Health Services 2008 data. Border includes Hidalgo County.

Physician Acceptance of New Medicaid Patients in Texas, 2008 Source: Texas Medical Association based on TMA Physician Survey Prepared by TMA, 2008.

TX Border Counties Projected to Have Some of the Highest Rates of Uninsured Children in 2010 Percentage of Uninsured Children Source: Texas State Data Center, Uninsured projections for children 0-17 in Hidalgo County (23.8%)

Health Access Along the Border Although there are high participation rates in public insurance programs, also a high concentration of uninsured children Not enough doctors to meet the need; even fewer willing to take new patients without insurance or with public health insurance coverage

Texas Voice for Health Reform A project of the Center for Public Policy Priorities Made possible with generous funds from the Robert Wood Johnson Foundation McAllen, TX May 15, 2009 Kymberlie Quong Charles, Coordinator

Texas Voice for Health Reform

The Government and the American People Agree… "The status quo is the one option that is not on the table," he said. "And those who seek to block any reform at any cost will not prevail this time around." -- President Barak Obama, Christian Science Monitor, March 6, 2009 Does our health care system need complete overhaul, major reform, minor reform or no reform at all? Voter attitudes on Health System Change Reforms: Findings from a Survey of 800 Likely Voters Nationwide, Lake Research Partners, April 20, %

“The crucial and weighty step needed is the decision as a country to ensure access to health care as a public good, just as we do education, roads, military, fire, and police protection.” -- Anne Dunkelberg, Associate Director, Center for Public Policy Priorities

Texas Voice for Health Reform Principles Affordability Accessibility Quality

Affordable access to good healthcare must be available for all Americans. It should: Cover all who want it Be affordable for people at all income levels Remain available and affordable when family and economic circumstances change Establish both a responsibility for the public to contribute and an assurance of cost containment for individuals and families Eliminate health costs as the number one cause of bankruptcy in the United States.

A decent standard of comprehensive care must be established. It should: Keep people healthy and treat them when they’re ill Cover the whole person Not be lost or reduced based on pre-existing conditions or pregnancy

Additionally, in order to be effective, sustainable, equitable, and balanced with our other important priorities as a nation, national health reform should also address: Safe and high quality care Costs and Cost-Effectiveness of Healthcare Consumer Choice Eliminating barriers to and disparities in care

Get Involved Join our list Communicate with us about your healthcare priorities How do our principles fit with your priorities? Contribute to our Story Bank project Engage in citizen advocacy using our online resources

Contact Information Frances Deviney, PhD Texas KIDS COUNT Director (512) ext. 106 Kymberlie Quong Charles Texas Voice for Health Reform (512) ext. 115

Use of This Presentation The Center for Public Policy Priorities encourages you to reproduce and distribute these slides, which were developed for use in making public presentations. If you reproduce these slides, please give appropriate credit to CPPP. The data presented here may become outdated. For the most recent information or to sign up for our free Updates, visit © CPPP Center for Public Policy Priorities 900 Lydia Street Austin, TX P 512/ F 512/