In Texas and nationally, health care programs for the poor must become more effective, efficient, and accountable. The post-9/11 economic downturn increased demand for Medicaid and the Children's Health Insurance Program (CHIP) and cut tax income available to pay for them. In 2004, all 50 states imposed cost controls on the programs.  Lawmakers are rightly concerned about rising enrollment and costs in these programs. Texas physicians recognize the need to assure that Medicaid and CHIP must be more effective, efficient, and accountable. At the same time, these programs are vital to the health and well-being of the state’s poor and low-income families as well as the economic vitality of the state and local governments. 

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