Why are There More Uninsured Kids and What Can We Do About It?

Yesterday the Census Bureau released one of its annual surveys (the Current Population Survey or CPS), which looks at health insurance status. This year, in an unusual move, the Bureau actually released a mini special report focusing on children. While we await more data at the end of the month from the American Community Survey (which provides more in depth state numbers that we analyze for our annual state-by-state children’s coverage report), what did yesterday’s data tell us?

As we expected, the data show bad news – the number of uninsured children is on the rise. In fact, the data confirmed exactly what we have been saying for some time – the relatively strong economy is not enough to compensate for large declines in Medicaid/CHIP and more children are becoming uninsured.

As the Census Bureau demographers write:

“While the percentage of children with private health insurance coverage did not statistically change, the percentage with public coverage fell by 1.3 percentage points.”

As a result, 4.3 million kids were uninsured in 2018 – a statistically significant increase of 425,000. The kids uninsured rate went from 5.0% in 2017 to 5.5% in 2018. These kids losing public coverage are not all moving to employer sponsored insurance and remaining covered as some have argued. This is especially troubling given that the economy is in relatively good shape. What will happen when a recession hits?

What do we know about the kids who have higher uninsurance rates?

We will have a lot more information when we get more data at the end of the month, but here are a few toplines:

  • Hispanic children saw a large jump of 1 percentage point – from 7.7% to 8.7%. White children were the other racial category to see a statistically significant increase. This is clear evidence of a chilling effect of the Administration’s ongoing campaign of hostility and intimidation directed at immigrant families and the recent issuance of the public charge rule will only make this worse. Many of these kids are citizens who are clearly eligible but have immigrant parents who fear enrolling them in government assistance. Stay tuned for a blog from our colleague Kelly Whitener who will dive into this terrible situation further.
  • Young children (age 0-5) saw a large increase as well with their uninsured rate jumping from 4.5% to 5.3%. When children don’t have health coverage, their health care needs are less likely to be met and this is especially troubling when they are in this critical time period. A child’s brain develops rapidly in the earliest years of life, building a foundation for future educational and economic success. And every parent knows, the pediatrician’s office is your best friend during those early years.
  • Children in the South are the worst off regionally and saw the highest rates of uninsured jumping from 6.5% as a region to 7.7%. This is no surprise given states like Texas, Florida and Georgia have some of the highest rates of uninsured children in the country. But we will have to wait for the ACS data to look at the state specific changes for children. 

Why is this happening?

We will dive deeper into this question in our annual report, but we continue to point to three main causes:

  1. The chilling effect which is causing immigrant and mixed-status families to not enroll or even withdraw their children from Medicaid/CHIP.
  2. Cuts in outreach and enrollment funds by the Trump Administration related to their undermining of the ACA. Also, however, outreach grants for CHIP were delayed significantly by the unprecedented delay in CHIP funding at the end of 2017 – as a result a critical back to school period was missed.
  3. CMS is not only ignoring this problem, but making behind the scenes efforts to urge states to tighten up eligibility and verification procedures (i.e. adding red tape) which are resulting in eligible children losing coverage. This is contributing to Medicaid and CHIP enrollment declines.

Here’s a heartbreaking story from a family in Idaho with a severely disabled child who lost Medicaid coverage due to red tape. The story was shared with us by our friends at Idaho Voices for Children:

Elizabeth has a 4 year old son, Paul, who had a stroke when he was about a year old. He was on “Katie Beckett” Medicaid until July 31st. Paul was scheduled to have surgery on the 20th of August and the surgical center had called the state to get pre-authorization for the surgery and was told the Medicaid coverage had ended on July 31st. They called Elizabeth and told her so she immediately called the state. She was told that her case had closed for failure to do re-evaluation paperwork. They said they mailed her a notification beginning of June and beginning of July. The only thing she had received was a letter on July 16th saying that there were changes being made to Medicaid but said nothing about re-evaluation or even had Paul’s name on it. She received a letter August 6th saying the coverage had ended. No letter for re-evaluation was received.

In the meantime, Paul has been receiving services at Seattle Children’s hospital and they have been on the waitlist for a year to see a particular specialist. They didn’t want to lose their spot so they paid out-of-pocket to see this specialist. They had to apply for financial assistance through the hospital to help with services Medicaid should have covered. Paul’s mom had to cancel his surgery. He goes to physical, occupational, and speech therapy weekly and she had had to cancel all of his appointments for the period they went without coverage. Elizabeth was finally able to get Paul’s Medicaid coverage restored after nearly a month of going without coverage.

What can be done about it?

There are many things to be done, and Part 2 of this blog from Tricia Brooks will review some ideas in the coming days. And stay tuned for another paper in our long running series The Future of Children’s Health Coverage on how to cover all kids. But in the meantime, there is no doubt that a commitment from the top is needed to turn this situation around. The bipartisan commitment to ensure that kids have health coverage must be restored and the welcome mat should be rolled out again before more children wind up uninsured.

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.