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Texas KIDS COUNT:Our Border, Our Future
Frances Deviney, Ph.D. Texas KIDS COUNT Director
May 15, 2009South Texas College
McAllen, TX
Our Sponsors
El Paso
Hud
spet
h
Jeff Davis
Pre
sidi
o
BrewsterVal Verde
Culberson
Kinney
Maverick
Zavala
Dimmitt Webb
ZapataStarr
Jim Hogg
HidalgoCameron
Willacy
Brooks
Terrell
TX Counties Along the Border with Mexico
One of Every Nine Kids Lives in Border Counties
Rural Non-border 701,099 (10%)
Urban Border 710,995 (10%)
Rural Border 88,405 (1%)
Urban Non-border
5,305,704 (79%)
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 2007
81
,94
7
60
1,5
82
20
1,0
02
83
,58
7
67
3,6
42
24
4,0
82
Hidalgo County Urban Border Rural Border
2000
2007
21%
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 2005-2007 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
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 2005-2007 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
Border 51,419 (13%)
Non-border 334,118 (87%)
Source: Texas Department of State Health Services 2005 birth data
Infant Mortality Program Review/Planning Tool
Age at Death
Fetal Neonatal (< 28 days old)
Post Neonatal(>= 28 days old)
Birthweight < 2500g Maternal Health and Prematurity
>= 2500 g
Maternal Care
Newborn Care
Infant 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
2.6 2.7
3.9
1.61.9
2.3
Hidalgo County Border Non-border
Infa
nt D
eath
s pe
r 1,
000
Live
Bir
ths
Less than 28 days old 28+ days old
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
Fetal Neonatal (< 28 days old)
Post Neonatal(>= 28 days old)
Birthweight < 2500g Maternal Health and Prematurity
>= 2500 g
Maternal Care
Newborn Care
Infant 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
39.3%
34.1%
41.2%
37.4%37.5%
Border Non-border
Per
cent
age
of A
ll Li
ve B
irths
Hidalgo County Urban Rural
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
16.4%
52.2%
29.7% 21.0%
27.2%
13.9%
25.9%
29.1%
36.5%
52.5%
22.2%
20.0%
49.1%
37.7% 29.5% 21.5% 14.7%
16.0%
Less thanHigh
School
HighSchool
Graduateor GED
SomeCollege,but NoDegree
AssociateDegree
BachelorsDegree
GraduateDegree
Hidalgo County Border Non-Border
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
Less than High School (52.8%)
High School Graduate or GED
(24.0%)
Some College, but No Degree (13.2%)
Associates Degree (2.4%)
Bachelors Degree (5.8%)
Graduate Degree (1.7%)
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
1.6%
57.3%
31.4%
2.9%
25.7%
59.6%
32.6%
63.0%
11.9%
LBW to Mothers WhoSmoked
LBW & Preterm (< 37weeks gestation)
LBW to Mothers withMaternal Risk Factors
Pe
rce
nta
ge
of
All
Lo
w B
irth
we
igh
t B
irth
s (
LB
W)
Hidalgo County Border Non-border
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 13-19
16.3% 16.7%
19.9%
12.4%
17.1%
Urban Rural
Per
cen
tag
e o
f A
ll L
ive
Bir
ths
Hidalgo County Border Non-border
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
128,573(Apr '09)
128,213127,742
120,851119,864119,020
112,814
101,161
86,621
80,969
Aug '00 Aug '01 Aug '02 Aug '03 Aug '04 Aug '05 Aug '06 Aug'07 Aug '08 Apr '09
Ch
ildre
n A
ge
s 0
-18
En
rolle
d in
Me
dic
aid
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
52%
30%
42%
42%
21%
15%
38%
39%
27%
54%
20%
19%
0% 20% 40% 60% 80% 100%
Surgical
Family Medicine
Pediatrics
OB-GYN
Accept All New Limit New Accept No New
Source: Texas Medical Association based on TMA Physician Survey 2008. 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 2010.
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 PrioritiesMade possible with generous funds from the Robert Wood Johnson Foundation
McAllen, TXMay 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, 2009
69%
“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
AffordabilityAccessibility
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 email 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 InformationContact InformationFrances Deviney, PhD
Texas KIDS COUNT Director [email protected]
(512) 320-0222 ext. 106
Kymberlie Quong CharlesTexas Voice for Health Reform
[email protected](512) 320-0222 ext. 115
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