Senior Policy Analyst
The uninsured rate among children rose for the second straight year in 2018 to 5.2 percent, up from 2016’s historic low of 4.7 percent, a new report from Georgetown University’s Center for Children and Families (CCF) finds. This backsliding — along with the increase in the overall uninsured rate — provides more evidence that Trump Administration efforts to weaken health coverage under the Affordable Care Act (ACA) and public programs like Medicaid and the Children’s Health Insurance Program (CHIP) are taking a toll.
The children’s uninsured rate dropped steadily for much of the past decade (see chart) as states extended Medicaid and CHIP eligibility to more children and streamlined enrollment procedures. It fell even further when the ACA’s major coverage provisions took effect in 2014. Expanding coverage for adults makes it easier for whole families to gain coverage, research shows, which is a big reason why uninsured rates fell among both adults and children after 2014.
The recent increase in the children’s uninsured rate is concentrated among particular populations, CCF found:
Some 92 percent of the 2.5 million uninsured adults who are caught in the coverage gap because their state hasn’t expanded Medicaid — meaning their incomes are too high for Medicaid but too low to qualify for tax credits to buy marketplace coverage — live in the South. That helps explain why the children’s uninsured rate of 7.1 percent in that region is three points higher than the rate in the rest of the country.
Uninsurance has risen among adults and children nationally as Medicaid and CHIP enrollment have fallen. The Administration attributes the enrollment declines to an improving economy, but we didn’t find evidence to support that contention. Along with its anti-immigrant rhetoric and policies, which likely have had a “chilling” effect in discouraging eligible immigrants from enrolling in health coverage, the Administration is encouraging states to take steps that increase paperwork and make it harder for families to keep their children enrolled. Taken together, these policies likely contributed to the Medicaid and CHIP enrollment declines among children.