My favorite study from our wonderful colleagues at the Urban Institute has just been released, and it underscores that the sharp reduction in the uninsured rate for children was closely linked to the ACA. The study, like others before it (including our own) documents the decline in the number of uninsured children to historic lows in 2014 – the first year of implementation of the Affordable Care Act. But what is unique about Urban’s work is their model, which estimates the participation rate of children in Medicaid and CHIP.
The participation rate is a measure which considers what percent of kids that are eligible for Medicaid and CHIP are actually enrolled. Medicare, by comparison, has a participation rate close to 100% which is why virtually no seniors are uninsured. Because Medicaid and CHIP are means tested and rules are complex and vary from state-to-state, the current structure makes it hard to achieve close to universal participation. But as means tested programs go, children’s coverage has made enormous progress and Urban’s study finds that the participation rate for kids rose from 88.7% in 2013 to 91% in 2014 – a sharp increase. This is likely the primary reason that substantial reductions in the number of uninsured children occurred in 2014. Since 2008 the Medicaid/CHIP participation rate rose by nearly 10%.
As the authors point out, coverage expansions (especially for parents) and outreach efforts associated with the ACA as well as other changes affecting kids in particular (removing barriers to enrollment, more outreach etc.) were expected to reduce the uninsured rate for kids. As readers of SayAhhh! are well aware, one of the main reasons we at CCF believe that Medicaid expansion is a kid’s issue is because when parents are covered kids are more likely to be covered as well. The Urban study finds that this is borne out with higher participation rates (92.9%) in states that have expanded Medicaid v. 89% in states that did not expand Medicaid in 2014. The 10 states with the largest participation gains all expanded Medicaid.
Other interesting findings include:
- The majority of uninsured children continue to be eligible for Medicaid/CHIP but are not enrolled (EBU’s for short) although that number has declined somewhat given the success of the welcome mat: (62% down from 65% in 2013)
- As of 2014, 32 states have participation rates over 90% — only three states (UT, AK, WY) are below 85%.
- The South continues to be the region with the highest uninsured rates despite some strong participation rates in many states. Florida, Texas and Georgia all have participation rates below 90% — so with so many children living in those states that is no doubt why the South continues to lag.