Medicaid Expansion: Important Factor in Declining Uninsurance Rates for Children

Our report released last week (Children’s Health Insurance Rates in 2014: ACA Results in Significant Improvements) contained good news for people who share the belief that no child should ever be uninsured in our country – the national child uninsurance rate is now at a historic low of 6 percent. Kids haven’t quite caught up to seniors, where the universal availability of Medicare means uninsurance rates for Americans over 65 of less than one percent, but last year’s big decline is great news. My colleague Joan Alker writes how the “welcome mat” effect of the Affordable Care Act with more parents newly eligible for coverage results in more kids finding out they can get covered as well through existing Medicaid and CHIP programs. Joan also points out that this effect was greater in states that chose to accept the available federal money and expand their Medicaid programs to cover more adults, including parents.

There is certainly a correlation here between Medicaid expansion states and states that saw the biggest declines in the numbers of uninsured children. The Northeast and West have lower rates of uninsured kids coupled with state Medicaid expansions while the South and Midwest where states have not yet expanded coverage (with some notable exceptions in states like Louisiana and Alabama) generally have higher rates of uninsured children. The four states that have not expanded Medicaid where the vast majority of adults live who would get covered through a Medicaid expansion are Texas, Florida, North Carolina and Georgia. Unsurprisingly, three of these states have uninsured rates for children higher than the national average.

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Medicaid Expansion Progress Map (1)

Of course this doesn’t automatically mean Medicaid expansion decisions are the cause of the decline in child uninsurance rates however. For example, some states with much lower rates of uninsured children like Alabama or Louisiana have yet to accept federal Medicaid dollars to expand coverage. The reality of policy implementation, as always, is more complex. State decisions and action on outreach under the Affordable Care Act affected how many parents signed up for marketplace coverage and when more parents came to the marketplace to find out about health coverage more parents found out their children were already eligible for coverage too. This could be one explanation in North Carolina where a robust enrollment initiative seen as a national model resulted in high numbers of eligible adults, including parents, obtaining marketplace health coverage.

In addition, now that we are at such average low numbers of uninsured children, progress is more difficult in states that have already been addressing the issue. And don’t forget that overall a slowly improving economy means that there are fewer uninsured families nationwide.

Nevertheless, I think our report is correct in pointing out that a state’s decision to accept federal dollars set aside for it to expand Medicaid to adults, including parents and families with younger children, is a important positive factor that contributes to more children gaining health care coverage. Look no farther than this final chart from CCF’s report showing states that expanded Medicaid saw nearly double the rate of decline in uninsured children as non-expansion states.

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Every parent in our country without exception should have the peace of mind of knowing that if a child needs a flu shot, a checkup or even an ambulance they can make the appointment or phone call without worrying how they will possibly pay the bill. Our report shows we are approaching that day but we still have a little farther to go. Extending Medicaid coverage to more adults, including parents, is an important tool to help us achieve this worthy goal.

Adam Searing is an Associate Professor of the Practice at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.