ACA Help Bring Child Uninsured Rate Down to Record Low

50-State Analysis Finds Improvement Greater in Medicaid Expansion States

The rate of uninsurance among children dropped to a historic low of 6% following implementation of the Affordable Care Act in 2014, according to a new report by the Georgetown University Health Policy Institute’s Center for Children and Families. The improvement in the uninsured rate for children was widespread with 25 states recording statistically significant declines in the number of uninsured children and no state reporting a significant increase. Just under 4.4 million children remain uninsured in the United States.

Some states saw much greater improvements in children’s coverage than others. States with the sharpest declines in the rate of uninsured children were Nevada, Colorado, West Virginia, Mississippi, and Rhode Island. Nevada’s decline was considerably larger than any other state. The state with the largest number of uninsured children remaining, by a considerable margin, is Texas.

The report attributes the success mainly to the Affordable Care Act, Medicaid and the Children’s Health Insurance Program.

“The Affordable Care Act is one of the most significant domestic policy initiatives in decades, and it builds on more than a decade of success in reducing the number of uninsured children through Medicaid and CHIP,” said Joan Alker, executive director of CCF. “This national achievement in reducing the number of uninsured children is the result of many efforts made by many different policymakers and stakeholders at the state and national levels.”

States that extended Medicaid coverage to more uninsured adults saw nearly double the rate of decline in uninsured children as compared to states that didn’t accept the ACA’s Medicaid option. The improvement in children’s coverage in those states is likely due to a robust “welcome mat” effect as parents enrolled their children when they signed up for newly available coverage. Even states that did not expand Medicaid appeared to have experienced a welcome mat effect due to the ACA.

“Extending affordable health coverage to parents would make a significant difference in the lives of children in states that have not yet expanded Medicaid,” said Alker. “States choosing to extend Medicaid coverage to parents directly help children by reducing their uninsured rate, boosting families’ financial security, and enabling children to get better care from healthier parents.”

The report, based on data from the U.S. Census Bureau American Community Survey, also found disparities in insurance rates among demographic groups. Nationwide, Hispanic and school-aged children were disproportionately uninsured as well as those living on the brink of poverty or in rural areas.

To read the full report, visit

The Georgetown University Center for Children and Families (CCF) is an independent, nonpartisan policy and research center founded in 2005 with a mission to expand and improve high-quality, affordable health coverage for America’s children and families. CCF is based at the Health Policy Institute at the McCourt School of Public Policy.