 And I'm going to take you back to 101 level and I probably won't try to, I probably won't try to go into too deep detail on every single one of these, but I want to more than anything make you aware of some of the resources that we have available for you and if you want to take a deeper dive, you can talk to me about some of these things and some of my co-workers. I do want to thank everyone for inviting us to participate in this. We're one of several organizations in Texas participating in the Kids Well Grant here in Texas so we're really happy to be able to be here today and the piece I was asked to focus on was on the health care issues for Texas kids and I also brought in a few of our sort of general indicators from other folks at my office who aren't just health care people. So the first thing I wanted to show you was this is our Texas per capita so this is per each of the 25, 26 million Texans where we rank on spending and how we compare to other states and you can see that we are not in last place on everything. There's notably a few places where we're somewhere in the middle. Our spending per Texan on K through 12 is 20 second but you'll see a very different ranking when we look at spending per student because we have so many more kids than most states do proportionally as the previous presenters have pointed out to you. So you see a really different ranking when we get there and of course most of you are probably aware that we have one of the highest uninsured rates in the country. We have the highest uninsured rate in the country for people of all ages and you can see on our Medicaid, it says Medicaid and welfare. We essentially don't spend any money on welfare in Texas. We have almost no people left getting cash assistance in Texas so almost all of that spending is strictly Medicaid and even with our socioeconomic conditions we're still 43rd in terms of how much we spend in Medicaid per Texan. This is showing you, we have here a lot of angst about Medicaid in Texas but when you actually go in and adjust for inflation our spending per Medicaid client is actually and particularly the state share of that is actually considerably less than it was a decade ago. So for example in the most recent year where we're spending in 2013 dollars about just over $3,000 per Medicaid client and state dollars compared to $3,500 per client back in 2001. So all of the increase in spending in Medicaid in Texas is because of having more uninsured people, a growing number of people who qualify for the program not because our spending per person is going up. Similarly if you adjust for inflation and this is in 2013 dollars and these last two slides of my brilliant colleague Eva DeLune Castro did so I wouldn't want to take credit for them. I couldn't make them look as good or make the numbers right if I had to. So but basically we are looking at a situation where our per student spending in inflation adjusted dollars is actually a little lower than it was back in 2002 as well. And then finally this is where I said we get to these different rankings when you instead of looking at how much you spend on education per person in Texas we look at spending per student in Texas and you can see that some of these Northeastern states are tied for first place essentially and Texas is down here at 48th according to these NEA rankings. And then again another one of Eva's slides just to sort of give you some context more broadly about some of the indicators of need in Texas that there we are I believe that this is consistent with the earlier presenters that we are the number two state in terms of children as a percentage of our population, the number one state in total residents without health insurance, 12th in child poverty, 6th in elderly poverty and these are all based on some of that same ACS data that previous presenters have used and not fabulous looking educational outcomes either the share of residents 25 or older with at least a diploma where last or at least maybe there's only one after us because this ranking may include DC I'm never 100% sure whether they do. And then just a couple of slides before I get to the health care stuff just reminding us all that one of the things that we do annoyingly at our center is remind people that you've got to be paying attention to revenue systems and how adequate they are and how equitable they are just like public school. You've got to be paying attention to revenue if you want to be paying attention to the outcomes and the investments in state government and some of the these are just examples of all of the exemptions we have which are kind of the passive you don't have to ask for it money that that people get in terms of exemptions from property taxes in Texas that are all represent money that comes you know off the plate for public schools to access and you know if we have to be willing to address these things as we look at school finance and the adequacy of funding for school children and as you know as you can imagine none of them are easy to tackle. And finally just to put the whole school finance trend in perspective just a reminder that part of what we did was a number of years back our legislature rejiggered our school finance situation and said here's what we're going to do we're going to lower your school property taxes because you're all complaining about your local property taxes being too high and we're going to replace some of that with state revenue so that your local property taxes won't have to carry as much of the burden but what really happened was they didn't set up the finance system strongly enough to generate as much revenue as they had taken out of the local plate and so basically all of these other things as the graphic is trying to show you here all of the other things that state government has to do is are now being short funded because so much of that money is having to go into fill what is at least a ten billion dollar hole every time they start to write a new state budget in Texas all because of the restructuring of that school finance system. So I'm going to just fly really quickly through some of these health care things so that we can get to your questions and discussion I want to point out this is the latest this is the census likes to keep us all confused so they have two different surveys that look at health insurance and this is the current population survey is the one that has been going back for several decades so we often use it because it has that long trend data and basically according to the most recent census data from ACS we have about 6.4 million uninsured Texans in 2012 and that was one in four basically of Texans of all ages but kids are only half as likely to be uninsured as adults in Texas so we have about 1.2 million of that 6.4 million uninsured are under the age of 19 and they are only half as likely to be uninsured their uninsured rate is about 16.4% for working age adults almost twice as many or 32% are uninsured so our big challenge moving forward particularly with health reform is our working age adults but obviously that's still an awful lot of uninsured children and the entire reason why the children's rate is so much lower is Medicaid and CHIP so basically poor and moderate income children in Texas have access to Medicaid and CHIP when they don't get coverage through their parents work but adults do not essentially and that's part of the challenge we're dealing with as we deal with the ACA Medicaid expansion question so we have actually had a significant decline in the uninsured rate for children when I first started working when Congress first authorized the creation of that CHIP program one in four Texas kids were uninsured so the kids uninsured rate has dropped by a full eight percentage points from what it was before we launched CHIP and before we made Medicaid a much friendlier program for parents to keep their children in so in 2000 we had about 2.1 I'm sorry in 2000 we had just under a million kids enrolled in Texas Medicaid and since then with the growth in children's Medicaid and the creation of the CHIP program today we're covering 3.1 million children out of both of those programs and like I said the uninsured rate is dropped from 25% to 16% and then when you look at the lower income kids in the CHIP and Medicaid pool that's under two times the poverty level their uninsured rate uninsured rate is dropped from 35% before CHIP to 21.4% in the most recent data so let's drill into who our uninsured kids are and look at it by ethnicity and and I it's been a long time since I've done this pie chart so I you know it was sort of eye-opening to me to to put the 1.2 million kids up there and see that that almost 70% of them or 830,000 roughly are Hispanic children in Texas and then you could see non-Hispanic white children African-American children Asian-American kids and then a tiny slice of other kinds of identified folks showing up so obviously this is not a surprise to anybody who works in healthcare in Texas when we're talking about access to healthcare for Texas children the the Hispanic child population is is you know facing more of a challenge than than our other ethnic groups essentially this is a picture of who had Medicaid in January of 2013 I haven't gotten an updated version of this detailed file for a while but it hasn't changed very much these numbers have crept up by a few tens of thousands probably in several categories but basically one of the things I have to educate Texans about a lot is the fact that Texas Medicaid is mostly children and that very very few adults get Medicaid in Texas and so who are the adults who get Medicaid in Texas we've got significant populations of fully disabled adults below poverty elderly folks over 65 who are below poverty who typically get both Medicare and Medicaid so Medicaid picks up the out-of-pocket cost of Medicare for them and then you have two tiny groups of poor parents today it's probably this month is probably somewhere around 225,000 parents total so on the one hand I've got 2.6 million children getting Medicaid but only around 200,000 of their parents qualify and then the maternity coverage in Medicaid is absolutely a critical piece of the program somewhere around 56 percent of Texas births are paid for by Texas Medicaid 56 percent of Texas births and that's we are on the high end but in every state the range across the states in the country is the low end might be around 44 percent so every state Medicaid pays a huge role in paying for prenatal care and deliveries in Texas we are definitely on the high end for that but that coverage you don't get a card until you have a positive pregnancy test and your card doesn't work stops working two months after the baby's born so it's only temporary coverage so we don't have very many adults getting Medicaid in Texas comparing this is from the Kaiser Family Foundation and basically they are just just showing that the the black doesn't for some reason they didn't put that in their legend but black is uninsured and you can just see that Hispanics in Texas have an even higher uninsured rate than they do nationally so so you know coverage issues are really important for Texas Hispanics and then we compare the dynamics of this Medicaid expansion decision and the roughly half the state still have not made that decision to expand Medicaid to adults under the affordable care act in Texas is one of them and in the United States of the adults the uninsured adults who stand to be affected by that Medicaid expansion they are just over a third Hispanic but in Texas they are almost two-thirds Hispanic the adults that we're looking at so this is another way of showing you this is what the coverage scheme is supposed to look like under the affordable care act as Congress passed it in 2010 and the problem we have here so we're still going to have Medicaid and chip for our kids everybody who has affordable minimally decent job based coverage is expected to keep it but the people who don't have access to that gain sliding scale access to premium assistance and then if they are above four times the poverty level which is a little over ninety four thousand for a family of four this year they and they don't have access to that job based coverage they can still buy coverage in the new marketplace they're just not going to get a subsidy for it so the problem we're left with is that when Congress wrote this bill they made the sliding scale access to help in the new marketplace start at the poverty line so when Texas decided and 24 other states decided not to expand Medicaid they are basically leaving all of these adults below the poverty line without a coverage option in 2014 so this is where we stand today and I will show you a couple more things about it so our former state demographer who's probably lived in every city and on the in Texas now but currently located in Houston used to be here in San Antonio Steve Murdock and Michael Klein at Rice did this analysis of the ACA's coverage expansions for Texas and basically the takeaway is they said with with just moderate enrollment under the ACA we would cut the uninsured population in half in Texas but unfortunately they did this analysis before the Supreme Court decision so they were not teeing it up for this Medicaid expansion decision at all but they basically concluded that the Medicaid piece of it accounts for half the gain so we leave half the coverage gains of the ACA on the table if we don't do Medicaid expansion in Texas is the concern here and I'm not going to go through all these numbers but I want to make you aware that our own Medicaid agency is estimated that if we were starting Medicaid expansion in January there would be more than six billion dollars a year in additional net federal health care funding flowing through the Texas economy every year from 2014 to 2017 and then we can take the commission's numbers and distribute it by their own data on how Medicaid spending Medicaid spending in Texas is distributed in Texas counties and we see that for example Harris County which is of course the biggest county would be getting nearly a billion dollars every year and additional health care spending if we did the Medicaid expansion you can see some of these other large cities and counties and here's the south Texas so you can see Bayer County where we are today over half a billion dollars a year in additional revenue and then look at these counties in the Valley this is I think one of the things that gets my blood pressure up the most is that the economic development potential for the Rio Grande Valley would be so huge if we did this Medicaid expansion down there we create people like Ray Perryman and like Billy Hamilton our former state deputy controller and chief revenue estimator have separately and separate studies estimated anywhere from from 300,000 to a half a million jobs would be created by this income flow of six billion dollars a year and and again the Valley would would definitely benefit from that so we are not the Lone Ranger as I said we are not the only state all of these pale blue states or states that have not done the Medicaid expansion except this was September 30th and Ohio has made the move since then so we got one more state Pennsylvania is close they might be moving soon and basically this is where we are left that in January a mom with two kids living on $18,000 in Texas won't have any help to get health care coverage but her neighbor with two kids who's earning $20,000 will she'll get such a generous subsidy that she can get full coverage on a sliding scale for less than $33 a month possibly even less than that that was a that was a you know high-end figure another way to look at it is the $18,000 mom in La Mesa is going to get is not going to have any coverage in January but her cousin over in Hobbes New Mexico will because they've done the Medicaid expansion so I just want to make you aware that you know one of the reasons I'm here is under this kids will grant I'm working with a lot of different Texas organizations and we have and there are we have many partners both formally and informally who are all trying to move this Medicaid expansion discussion forward and to to just do what we can to make sure that working poor adults in Texas do have coverage options as soon as we possibly can and I'll point you out that you can find all these links to these on our website cover Texas now is our coalition Texas well and healthy is our campaign that our partners participate in and where we've created a new website where people who are in that coverage gap can get some more information and also can get involved called Texas left me out dot org we haven't done a big media push on the ladder when there but we want to make sure that there's a place where people who are in that situation can get more information since people are signing up right now so I think that was all that I had and I'll turn it back over to one