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November 5, 2019

Why more American children are uninsured, according to 2 new analyses

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    The uninsured rate among children rose for the second year in a row in 2018 due to children losing Medicaid and CHIP coverage, according to new analyses, the New York Times' "The Upshot" reports.

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    "The Upshot" released an analysis on the topic on Oct. 22, while the Georgetown University's Center for Children and Families released a separate analysis on Oct. 30.

    Uninsured rate among children rises

    According to Georgetown's analysis of U.S. census data, the uninsured rate for those under the age of 19 increased from 4.7% in 2017 to 5.2% in 2018. Coverage losses were most significant in southern states that did not expand Medicaid programs under the Affordable Care Act and already had uninsured rates that were higher than average, the report said. The only state to see an increase in health coverage for children was North Dakota.

    Meanwhile, "The Upshot" analysis of census data found that the number of children without any kind of insurance increased by over 400,000 between 2016 and 2018.

    Some of the states that saw the largest increases in uninsured rates among children were those that created new rules to check the eligibility of families more frequently or reset lists of beneficiaries in new computer systems, the "The Upshot" reports.

    For example, in Texas, eligibility status isn't checked once a year like it is in many states. Instead, Texas enrolls children for six months and then checks their eligibility for four consecutive months. If their database shows the family's income has gone over the limit, the family is notified by mail and given 10 days to prove otherwise or lose Medicaid coverage, "The Upshot" reports. According to "The Upshot" analysis, the number of uninsured children in Texas rose by about 120,000 between 2016 and 2018.

    According to the "Upshot," requiring more paperwork and more frequent income updates from Medicaid beneficiaries has been associated with coverage losses. That is in part because Medicaid beneficiaries tend to have unstable hours and incomes, and some have literacy challenges, which can make submitting detailed renewal packages or verifying their income difficult, according to "The Upshot."

    States with large immigrant populations, such as Florida, also saw large increases in uninsured rates among children, according to "The Upshot." Doctors and patient advocates say there is a growing concern among parents that signing their children up for health insurance could increase their chances of being deported or hurt their chances of getting a green card, "The Upshot" reports.

    However, CMS Administrator Seema Verma said the decreases in Medicaid enrollment were due to a strong economy.

    Similarly, Kelli Weldon, a spokesperson for the Texas Health and Human Services Commission, cited "record-low unemployment levels" for its lower Medicaid enrollment numbers.

    According to Georgetown's analysis, the percentage of children with employer-sponsored coverage did increase from 46.7% to 47.6% between 2016 and 2018. However, that increase was offset by the increase in children dropping off both public health programs and the Affordable Care Act marketplaces.


    Joan Alker, the executive director of Georgetown's Center for Children and Families, said the Center's findings "should be a clear call for action among our political leaders if they care about children's health."

    She added, "Things will likely get worse for children before they get better. These losses came amid strong economic growth and low unemployment … should an economic downturn occur the losses would accelerate."

    Sogol Pahlavan, a pediatrician in Houston, said increases in uninsured children are going to have a noticeable effect on local communities "because somebody ultimately has to bear that cost. These kids are still here; their chronic disease isn't going away just because they're losing health coverage."

    In a letter sent to HHS Secretary Alex Azar, Senate Finance Committee Chair Ron Wyden (D-Ore.) and House Energy and Commerce Committee Chair Frank Pallone (D-N.J.) wrote, "We believe that these historic coverage loses among children are the result of overly burdensome and faulty eligibility and renewal processes, diminished resources for outreach and enrollment assistance and policies that instill fear and confusion among immigrants and mixed status families" (Goodnough/Sanger-Katz, "The Upshot," New York Times, 10/22; Haefner, Becker's Payer Issues, 10/22; Cunningham, "PowerPost," Washington Post, 10/30; Livingston, Modern Healthcare, 10/30).

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