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November 30, 2018

Why the uninsured rate among US children just rose for the first time in nearly a decade

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    The number of U.S. children without health insurance has increased for the first time in nearly a decade, according to a report released Tuesday by Georgetown University's Center for Children and Families.

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    About the report

    Georgetown's University's Center for Children and Families has been tracking health insurance among U.S. children since 2008, when 7.6 million children, or about 10% of all kids, were uninsured. For the latest report, Georgetown researchers analyzed data from the U.S. Census Bureau.


    According to the report, an estimated 3.9 million U.S. children ages 18 and younger—or 5% of all kids—lacked health covered in 2017. The report noted the 2017 figure is up by about 276,000 children from 2016, when the uninsured rate among children reached a historic low of 4.7%.

    According to the report, the biggest declines occurred among children who had been enrolled in Medicaid and Affordable Care Act (ACA) exchange plans. Joan Alker, co-author of the report and executive director of Georgetown's Center for Children and Families, said the percentage of children enrolled in employer-sponsored health coverage rose in 2017, but not enough to offset coverage losses in Medicaid and exchange plans.

    The report noted that the percentage of uninsured children did not significantly fall in any state, but nine states experienced statistically significant increases, including Florida, Georgia, Massachusetts, Ohio, South Carolina, South Dakota, Tennessee, Utah, and Massachusetts.

    South Dakota experienced the biggest negative change, with the percentage of uninsured kids rising from 4.7% in 2016 to 6.2% in 2017. Texas had the largest percentage of uninsured children in 2017 at 10.7%, or about 835,000 kids.

    According to the report, states that did not expand their Medicaid programs under the ACA saw the uninsured rate nearly triple among children.

    Why the downturn?

    According to NPR's "Shots," the percentage of children who were uninsured did not grow at a statistically significant rate, but the decline is still "striking" because it occurred during a time of economic growth.

    Alker explained the key to getting children enrolled in coverage is to raise awareness about coverage options among parents. But last year, Congress allowed funding for CHIP to lapse, causing some states to send warning letters to families that coverage could be frozen. That, coupled with news about GOP efforts to repeal the ACA and funding cuts for open enrollment outreach, could have led to consumer confusion, "Shots" reports.

    Alker and other children's health advocates said the decline also could be due to policies targeting immigrants that were implemented under the Republican-controlled Congress and the Trump administration.

    The report noted that about 25% of children under age 18 who live in the United States have a parent who is an immigrant, and recent policy changes could make these adults more hesitant to enroll their children in coverage. "Several policies targeting immigrant communities are likely deterring parents from enrolling their eligible children in Medicaid or CHIP despite the fact that most of these children are U.S. citizens," the report stated.

    The report authors predicted the number of children without coverage could rise if the Trump administration finalizes a proposal known as the "public charge" rule, which would make it more difficult for non-citizens to enter the United States or become permanent U.S. residents if they receive or are likely to receive any of a wide range of public benefits, including Medicaid and Supplemental Nutrition Assistance Program benefits.

    The Medicaid and CHIP Payment and Access Commission has estimated up to 4.9 million individuals could leave Medicaid if the rule is finalized, and Modern Healthcare reports that would cause uncompensated care costs to rise at pediatric hospitals (Galewitz, "Shots," NPR/Kaiser Health News, 11/29; Dickson, Modern Healthcare, 11/29).

    Health Insurance 101: Get the slide decks

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