Last year saw the nation’s first increase in the number of uninsured children in nearly a decade, and young children were not immune to this troubling trend. Just as the rate of uninsured children increased on a statistically significant basis for all children under age 19 between 2016 and 2017, so it increased significantly for children under age 6, too, from 3.8 percent of all young children in 2016 to 4.2 percent in 2017.

No state made progress in reducing its rate of uninsured young children, and five states—Florida, Kentucky, Montana, New York and Tennessee —saw statistically significant increases in the number of young children without health coverage. See your state in our new fact sheet here.

These coverage losses are particularly troubling given the need for stable health care during the early years. Medicaid provides critical access to preventive care and routine screenings that can identify delays early and set a child on the course to healthy lifelong development. Without that coverage, small problems can grow into bigger ones and limit a child’s ability to be successful in school and life.

While every state is unique and we are still unpacking exactly why uninsured rates either stagnated or went up, there’s no question that the constant attacks on health coverage and the Affordable Care Act (ACA) in 2017 created a national climate of uncertainty and confusion around coverage. Between the ACA repeal bills through the fall of 2017 and the five-month delay of the CHIP funding, many parents may have assumed coverage would no longer be available for themselves or their children. And when parents dropped off, it may have created a reverse of the “welcome mat effect,” where children lost coverage as a result of their parents losing coverage.

At the same time, the Trump Administration began an intimidation campaign against immigrant families, which created a culture of fear surrounding the use of public programs, including Medicaid and CHIP. Anecdotally, we know this resulted in many people choosing not to renew their coverage. The Trump Administration also took steps to sabotage the marketplaces, including cutting funding for navigators and outreach.  

Given that these trends continued during 2018—see the proposed “public charge” rule and last week’s decision upending the ACA in the Texas v. Azar case for the latest examples—there’s no reason to think we won’t see more coverage losses when new data sets are released next year. So how can we get back on the right track?

• Expand Medicaid to adults (without barriers). There is an overwhelming body of research confirming that when parents have stable health coverage, their children are more likely to be covered too. Expanding Medicaid coverage to adults up to 138 percent of poverty in the remaining 14 non-expansion states would undoubtedly mean more children will be covered. The work doesn’t stop with expansion, however. Even now, about one in four eligible parents is not enrolled, so more needs to be done to reach eligible parents and get them covered.
  
• Continuous eligibility for children. Adopting this policy means that a child who enrolls in Medicaid or CHIP can stay on for at least 12 months, even if their family’s size or income fluctuates throughout the year. This increases the likelihood that a child will receive consistent, regular care over the course of the year, which is essential in early childhood when there are many screenings and well visits needed to ensure children are developing as they should. It also supports quality improvement, since children enrolled for less than 12 consecutive months are often excluded from quality measurement, which tells us what services they are receiving and when. Congress could mandate that all states adopt 12-month continuous eligibility in Medicaid, or the remaining 27 states that don’t have it for children in Medicaid (see chart here) could adopt it.

There are more recommendations for improving Medicaid for young children here. But as this data set shows, we can’t take coverage for granted. This increase in the rate of uninsured children turns back the decade-long bipartisan success story of expanding coverage for all children, particularly in the early years. Now is the time to recommit to the goal of ensuring that all children get the care they need to succeed.