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In-Depth: Houston ‘Safety Net’ Clinic Relieved After Congress Funds CHIP

The Children’s Health Insurance Program has now been funded, for 6 more years. But local clinics still face hurdles, to help those who fall through the cracks of America’s health care system.

Allison Lee
San José Clinic was preparing for the worst, an influx of uninsured children, if Congress didn't fund The Children's Health Insurance Program.



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For over three months, Congress let the Children's Health Insurance Program (CHIP) go unfunded. Then, the bill that allowed the government to reopen after a temporary shutdown also provided money to CHIP. Had that not happened, nearly 400,000 children and pregnant women in Texas could have lost health coverage; 9 million nationwide.

CHIP is a federal program meant to be a safety net for some of the most vulnerable people: those who make too much money to qualify for Medicaid and yet don't have access to other insurance. Houston’s San José Clinic gets those who don’t qualify. It bills itself as one of the city’s first “safety net clinics,” providing affordable healthcare for the uninsured and uninsurable.

Dr. Diana Grair is on staff at the clinic. She said she's grateful to be able to help her patients but, she warned, the clinic can only do so much.

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"It's still frustrating: when you have a patient that needs surgery, for example. I mean, I cannot help those patients," said Grair. "And for CHIP, I mean, that's even more important. Because I feel like those children that are here have no way of getting insurance, are sick or, even worse, have some sort of developmental issue. And we are not able to help with that.”

“The lack of health care is very frustrating… for children and adults,” said Dr. Diana Grair. “In some small way, we are able to help them…. At least there’s something for them to kind of hang on to.” January 2018.
Dr. Diana Grair, working at the San José Clinic in Houston.

In 2016, 48 percent of San José Clinic's patients lived at or below the poverty line: making a little over $24,000 a year, for a family of four. Only about 6 percent of the clinic's patients are children, but a lot of Grair's patients have kids who are on CHIP.

"For these kinds of families, at least when it comes to their children, having that health care coverage and having that insurance, for them, that's much more important than their own health," said Grair. "And so we need that coverage, we need that kind of care."

Teresa Vasquez, 45, is one Grair's patients. She has five children: four are on CHIP.

"Our problem is that we live day-to-day on paycheck-to-paycheck," Vasquez said, in Spanish. "The money that we make is always accounted for by existing expenses. Doctor visits are an additional expense, and CHIP is very important to all, children and adults."

Heidi Bunyan is San José Clinic's Chief Operations Officer. She said if CHIP went away, they would have had to react quickly.


But, Bunyan said, if programs like CHIP aren’t funded, it's not just that the care goes away. "That, in fact, will not happen. It might even get exacerbated, because these kids aren't being taken care of regularly. And, so, whatever diagnosis they have gets exacerbated because their parents are scared to take them anywhere. What happens at that point? I mean, it's really a huge snowball effect," she said.

Allison Lee
Heidi Bunyan, San José Clinic’s Chief Operations Officer, talks about CHIP in her office.

Funding for San José Clinic isn't unlimited. They're not funded by the government. They don't take insurance, so that usual reimbursement doesn't exist. Patients are asked to make a contribution toward the costs for their care, based on their annual income. But, Bunyan said their operations are fully funded by donations and grants. And that's difficult, since the state of Texas has the highest uninsured population in the country.

According to First Focus, an advocacy group in Washington, D.C., since CHIP was enacted in 1997 the uninsured rate for kids nationwide dropped by nearly 68 percent.

CHIP now insures 9 million children and pregnant women… at least until 2023.