I previously wrote about the growing gap between the rate of uninsured adults living in non-expansion states and expansion states. Next, I am analyzing the rate of uninsured children using the same data source, the National Health Interview Survey (NHIS). We are anxiously waiting for the release of the American Community Survey in the fall to complete our annual report on uninsured children and to have a better sense of the coverage trends for children. Until then, the NHIS is one of the few sources currently available to analyze 2017 health coverage data.
The 2017 NHIS provides evidence that the progress the nation made covering uninsured children is stalling. The Census Bureau’s report on health coverage, which analyzes data from the Current Population Survey, found that the rate of uninsured children had no significant change between 2015 and 2016. There is a similar trend in the NHIS between 2015 and 2017. This signals a change in the trends, as the NHIS showed significant declines in the rate of uninsured children between 2010 and 2015 across all income groups. Our research also shows significant declines in the rate of uninsured children from 8.6% in 2009 to 4.5% in 2016. The declines were widely attributed to the policies enacted under the Affordable Care Act and previous efforts through Medicaid and CHIP.
However, the progress appears to have stopped after 2015. Between 2015 and 2017, the rate of uninsured children increased from 4.5% in 2015 to 5.0% in 2017, but the change was not significant. During this time period, however, the rate of uninsured poor children increased significantly from 4.4% to 6.0%. The spike is troubling because these are some of the most vulnerable children. It is unclear what is driving the increase.
Rate of uninsured children by income
| 2015 | 2017 | Change | |
| Poor (<100% FPL) | 4.4% | 6.0% | Significant |
| Near poor (100-199% FPL) | 6.7% | 7.5% | Not significant |
| Not poor (200%+) | 3.3% | 3.8% | Not significant |
There is also evidence that children in non-expansion states are lagging behind children in expansion states. Research shows that increasing health coverage for parents also increases the number of children with health coverage. A Health Affairs study found that there was an estimated “welcome mat” effect of 710,000 children gaining public coverage when their parents enrolled in Medicaid between 2013 and 2015.
Data from the NHIS show that there is a growing gap in the rate of uninsured children in non-expansion and expansion states. The rate of uninsured children in non-expansion states increased significantly from 5.5% in 2015 to 7.3% in 2017. In expansion states, the rate of uninsured children did not have a significant change.
Rate of uninsured children by Medicaid expansion status
| 2015 | 2017 | Change | |
| Expansion states | 3.8% | 3.5% | Not significant |
| Non-expansion states | 5.5% | 7.3% | Significant |
As we frequently emphasize, there was historic progress in efforts to reduce the rate of uninsured children over the last decade. Health insurance is important for children because research shows that the uninsured are less likely to access health care and more likely to struggle with economic insecurity. In addition, coverage reductions lead to significant harms to health, particularly for those with lower incomes and chronic health conditions. There are indications that this historic progress may be at risk.
