New Report Shows Progress on Children’s Health Coverage Reversed Course

[Editor’s Note: For the most recent Georgetown University Center for Children and Families report on children’s health coverage and an interactive version of the report with state-by-state data, click here.]

For the past eight years, CCF has published a report tracking health coverage rates for children across the country. This year, for the first time since we began writing this report, the number and rate of uninsured children in the United States went up.

For many years, that rate has been declining thanks to bipartisan efforts to extend coverage through Medicaid and the Children’s Health Insurance Program (CHIP). But in 2017, approximately 276,000 more children became uninsured, leading to a total of 3.9 million uninsured children nationwide. The rate for children age 18 and under went up from 4.7 percent in 2016 to 5 percent in 2017, according to our analysis of U.S. Census Bureau’s American Community Survey data.

While this may not seem like a huge change, both of these increases are unprecedented in the past decade. Even more troubling, the number of uninsured children increased during a time of economic strength – in fact, at a time when one would expect the uninsured rate to go down, as more children were covered by employer-sponsored insurance in 2017.

However, coverage for children from public sources, Medicaid and CHIP, and in the individual market – inside and outside the Marketplace – decreased during this time period. That caused the number of uninsured children to go up – despite the strong economy.

Having health insurance is important for children because it improves their access to needed preventive and primary care such as well-child visits, immunizations, and prescription drugs. Insured children are also less likely to miss school, and they are more likely to have better economic and educational outcomes when they grow up. Think of a child with asthma who needs doctor visits and medications to keep her allergies and asthma under control – and without that help will wind up in the ER and missing school. Kids need health care to succeed.

I’ve written this report for eight years in a row now, and I found it even more notable that no state, except for the District of Columbia, saw any measurable progress in reducing the number of uninsured children in 2017. Never before have we seen such uniformity in state behavior. This finding underscores that even states with the best of intentions were not able to overcome the negative national currents that are affecting children’s health coverage.

These findings are a stark warning that our nation’s progress in covering children is at risk.

Among our other findings:

  • While no state saw meaningful movement in the right direction, nine states had the worst possible outcome and saw statistically significant increases in their rate of uninsured children. These states are (in order of magnitude) South Dakota, Utah, Texas, Georgia, South Carolina, Florida, Ohio, Tennessee, and Massachusetts.
  • Three quarters of the children who lost coverage in 2017 live in states that have not expanded Medicaid coverage to parents and other adults. Three big states that jump out in this vein are Texas, Florida and Georgia – all of whom saw sizable increases in their child uninsured rate.
  • Texas, for example, saw its rate of uninsured children jump from 9.8 percent in 2016 to 10.7 percent in 2017 – the highest uninsured rate of any state in the country. One in five uninsured U.S. children live in Texas.

Why do we think this is happening? We can’t know for sure, but here are some of our best guesses:

The majority of uninsured children are already eligible for Medicaid or CHIP but are not currently enrolled. The name of the game here is to make sure that families are aware that their child has a path to coverage and that these kids get enrolled and stay enrolled. For these families, 2017 was a year of constant news about the President and Congress wanting to take coverage away – first with the attempt to repeal the Affordable Care Act and make drastic cuts to Medicaid, all of which continued with a last gasp effort in September 2017.

Then on September 30, funding for CHIP expired and, in an unprecedented delay, Congress did not extend funding until early 2018 – again with families hearing that their state might have to close its CHIP program. At the same time, the Trump Administration began efforts to sabotage the ACA’s Marketplace including cuts to advertising, outreach and enrollment funding for navigators – who were playing an important role connecting families with public coverage, with the repeal efforts raising insurer uncertainty and driving up  premiums.

The Trump Administration also began a series of actions hostile toward immigrant families. One quarter of children living in the United States has a parent who is an immigrant. For these “mixed status” families, there is likely a heightened fear of interacting with the government and this may be deterring them from signing their eligible children up for government sponsored health coverage.

As a result, the “welcome mat” for coverage has been pulled back and we see the results – more uninsured children.

With an improving economy and low unemployment rate, the fact that our nation is going backwards on children’s health coverage is very troubling. Without serious efforts to get back on track, the decline in coverage is likely to continue in 2018 and may in fact get worse for America’s children.


Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.