Our annual report on the state of children’s coverage is out. It’s a deep dive into a disturbing trend – children across the country are losing affordable health coverage, rolling back gains started with the Affordable Care Act. 

One main cause of this drop in coverage is easily fixed.  The 14 states that haven’t expanded Medicaid should do so immediately. I wrote recently how many states are seeing new bipartisan interest in Medicaid expansion as the benefits are becoming so hard to ignore. We really are creating two Americas of health: A group of largely Southern and a few Midwestern states v. the rest of America. And this latest trend – more uninsured kids – is further evidence how state decisions to refuse Medicaid expansion are contributing to this divide.

Here are the Medicaid expansion highlights:

1. Half of America’s uninsured children reside in six states. Texas and Florida together have the highest percentage of uninsured kids by far with California, Georgia, Arizona and Ohio rounding out the list. Texas and Florida also have not accepted the federal money available to expand Medicaid. Of all the 14 states that haven’t expanded, a change in just these two states would have a huge positive impact on both parent and child coverage.
2. Uninsured children are more likely to live in the South by an order of magnitude. In fact, over half of all uninsured children live in the South. Not unrelated: The South is the region containing the most states still refusing Medicaid expansion.
3. Finally, the rate of uninsured children grew three times as fast from 2016 to 2018 in states that refused the Medicaid expansion compared to states that have expanded Medicaid. In addition, the uninsured rate for kids is almost twice as high in non-expansion states as it is in states that have extended affordable coverage.

It’s simple – Medicaid expansion, although the coverage is aimed at parents and other adults, has a huge protective effect on children’s coverage as well. Why? When parents sign up for their own health coverage, they often realize they can enroll their children too. In addition, states that expand are building a more comprehensive system of coverage where the expectation is that most people have a pathway to getting insured.

We need to fix the problems that are resulting in so many children losing health coverage.  One policy choice the 14 remaining “non-expansion” states can implement quickly that will have a huge impact on the health and well-being of children and families – accept federal funding to expand affordable health coverage through Medicaid.