As many readers know, this week the annual Census Bureau’s Current Population Survey numbers were released and the number of uninsured persons actually declined for the first time since 2007 – by 1.4 million. Since 2007 the number of uninsured adults has been growing – this year marks the first turnaround.
This bit of good news, in an otherwise dreary landscape with respect to stagnating poverty and growing income inequality, has been widely attributed to the Affordable Care Act. By allowing young adults the opportunity to get coverage through their parents’ plans, the ACA helped reduce the uninsurance rate — 540,000 more young adults aged 19-25 were covered in 2011 as compared to 2010. And we are heading towards a larger reduction in the uninsured rate in 2014 assuming that implementation of the law goes forward as planned.
The decline didn’t surprise me since I know personally quite a few people who have taken advantage of this provision! But I was struck by this direct connection between federal action and a tangible result for families. Often it is hard for many Americans to see what impact policymakers have on their lives.
For those of us who have been working on children’s coverage, another interesting and direct connection presented itself to me. A less publicized provision in the law is also hard at work keeping children insured. The “maintenance-of-effort” or stability provisions, which require states to maintain eligibility levels in Medicaid and the Children’s Health Insurance Program, have helped keep children’s coverage stable.
Since 2008, there has been no significant change in the number of uninsured children. In many ways this has been a victory — because Medicaid and CHIP have held the ship steady as more families lost employer-based coverage in the recession. Medicaid and CHIP have shored up children’s coverage whereas many of their parents and other adults had no such option. Children’s coverage has remained at historic high levels while coverage for adults – until this year – kept declining steadily.
Yet 8% of children still remain uninsured. In contrast, 98% of seniors in the U.S. have coverage – we must get there for kids too! So “maintaining our effort” is not enough – we must “enhance our effort” by taking full advantage of the opportunities of 2014 to make the next big historic leap. It may seem counter-intuitive to some – but the best hope for making a big dent in the number of children without insurance is to enact the Medicaid expansion for adults – which is now an optional policy choice facing states thanks to the Supreme Court ruling. Moving to a world where families are covered together – and everyone has a path to coverage – will help our nation make great progress in covering not only adults but also in reaching children who are currently eligible for Medicaid or CHIP but are not yet enrolled. These kids constitute two out of three of today’s uninsured children. So implementing the Affordable Care Act fully and successfully for families is essential to make the next big leap forward for kids and families.
Editor’s Note: The Census Bureau will provide more state-specific information when the American Community Survey is released on September 20.