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Must read: Uninsured rate for kids headed in the wrong direction

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On Wednesday, the Center for Children and Families released our ninth annual report [2] that tracks children’s health insurance coverage at the state and national level. This report looks at two-year trends from 2016 to 2018 analyzing American Community Survey data from the Census Bureau. We believe this is the first national report to look at this two-year time period, a time during which our nation moved from implementation of the Affordable Care Act to a time when some of our leaders moved to repeal and dismantle it. This report looks at what has happened to kids during this two-year period. In a few instances we are not yet able to look at two-year trends and include only a one-year trend (2017 to 2018), as noted in the report.

Along with this report we launched a new interactive state data hub [3] with a variety of indicators of children’s health coverage status and quality of care so please check that out too.

For many years our country has made progress improving children’s health coverage rates. This progress predated the passage of the Affordable Care Act (ACA), but the ACA was the cherry on top of the sundae for kids – and brought the uninsured rate to the lowest recorded level of 4.7% in 2016.

However, the number and rate of uninsured children started moving backwards in 2017 and this trend continued into 2018 – with over 400,000 more children uninsured in 2018 as compared to 2016. As a result, much of the gains in children’s coverage that came about as a result of the ACA have now been reversed.

The national uninsured rate for kids in 2018 was 5.2% — which means that just over four million children were uninsured in 2018.  As the Census Bureau itself said last month, and we agree, the main cause for the rise of uninsured children is the loss of public coverage – most notably the loss of Medicaid/CHIP. [Editor’s note: The rate in North Carolina was 5.3%.]

What is especially troubling about this trend is that things will likely get worse for children before they get better — for two reasons. First, this loss of coverage came during a time of strong economic growth and low unemployment when children should be gaining coverage in the employer-sponsored market but no statistically significant change in the one-year period 2017 to 2018 is seen in that regard. During that calendar year almost one million kids lost Medicaid/CHIP coverage [4]. Should an economic downturn occur, and we know that one will eventually occur, we would expect a lot more kids to become uninsured.

Second, the policy reasons behind the loss of public coverage for children are continuing in 2019 and perhaps even accelerating which suggests that these numbers will continue to go in the wrong direction when we get this year’s data next fall. These findings should be a a clear wake up call for elected leaders if they care about children’s health.

Key Findings:

Who is Losing Coverage?

In looking at the demographics of those children who are more likely to be uninsured some interesting trends emerge:

Why are fewer children insured?

As I mentioned before, Medicaid/CHIP have seen sharp declines in children’s enrollment [5]. The serious erosion of child health coverage that we are discussing today is due in large part to the Trump Administration’s actions or inactions that have made health coverage harder to access and/or have deterred families from enrolling their eligible children in Medicaid/CHIP.  Specifically, we believe there are three main culprits:

The importance of continuous coverage for children cannot be overstated and has long term consequences. Children who have Medicaid have better health outcomes even as adults, are more likely to graduate from high school and have higher earnings as adults – using fewer government benefits in the long term. While 5.2 percent sounds like a small number, the world of families affected is much larger – because families whose child is uninsured even for a few months face medical debt and even bankruptcy if a child falls on the playground and breaks a wrist or has an asthma flare up and winds up in the ER. The red flags are waving in this data and it is up to our elected officials to reverse this troubling trend.

[Editor’s Note: Thank you to the American Academy of Pediatrics, Texans Care for Kids and community-based enrollment specialists in Florida for joining us in releasing this report.]

* Families looking for information on how to enroll their children in Medicaid or CHIP call 877-KIDS-NOW or visit insurekidsnow.gov [6].]

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy. This post first appeared on the group’s Say Ahhh! Blog [7].