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off the charts

Children’s Uninsured Rate Rose for Second Straight Year in 2018

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:

  • Children from moderate-income families. The uninsured rate rose from 6.9 percent in 2017 to 7.3 percent in 2018 among children from families with incomes between 138 and 250 percent of the poverty line (about $29,000 to $53,000 for a family of three). Among children from families with incomes above 250 percent of poverty, it rose from 3.2 percent to 3.5 percent. The CCF report notes that these increases occurred against the backdrop of rising costs for employer-sponsored family coverage and a decline in the number of children in families buying marketplace plans — many of whom have incomes between 138 and 400 percent of poverty and thus are eligible for federal financial assistance to buy coverage.
  • Hispanic children. The uninsured rate among Hispanic children rose from 7.9 percent in 2017 to 8.2 percent in 2018. That’s likely due in part to the Administration’s anti-immigrant rhetoric and policies, which have deterred some lawfully present immigrants from enrolling in Medicaid or subsidized marketplace coverage even though they’re eligible.
  • Children in states that haven’t adopted the ACA’s Medicaid expansion for low-income adults. The uninsured rate among children in non-expansion states rose from 6.4 percent in 2016 to 7.3 percent in 2018. (The increase in expansion states was much smaller, from 3.5 percent to 3.8 percent.) As noted, expanding Medicaid coverage to parents boosts participation by their children who are already eligible for Medicaid and CHIP.

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.