Early Childhood Investments Less Effective if Young Children Remain Uninsured

Today, we are releasing a companion report to our annual 50-state look at uninsured children with a focus on young children under age 6. Unfortunately, the U-turn we’ve seen in health coverage for children of all ages also extends to the nation’s infants, toddlers, and preschool-aged children. After a decade-plus of downward progress, since 2016 the rate of uninsured children grew back up to 4.3 percent in 2018, back to more than 1 million young children lacking insurance.

The younger the child, the more frequent their preventive checkups, to make sure their development is on track and to address any delays or concerns as early as possible. The American Academy of Pediatrics recommends at least 15 well child visits before age 6—a period of incredibly fast and consequential development, including rapid brain development, that occurs well before children enter kindergarten.

Any new parent knows these visits are more frequent in the weeks, months, and years following birth. And as the parent of a 9- and  3-year-old, I value our family’s health insurance when unexpected bumps or fevers require an unplanned trip to our pediatrician.

States have worked hard to invest in PreK to aid school readiness for many years now. And we’ve seen recent progress in preschool, child care, and supports for infants and their families, such as home visiting. All of these are incredibly important investments to support young children during this rich period of development.

Not to mention the work that even more states have done for young children through Medicaid, such as advancing early childhood social and emotional health, using pediatric check-ups to support families as well as their children, and other two-generation strategies that use Medicaid coverage as a means to connect families to the range of resources to help them—and their children— thrive. This report serves as a sobering reminder that we can’t take our nation’s health coverage progress for granted.  States championing PreK and other early childhood initiatives are undercutting their investments if children can’t get their health needs met.

Where are the states with the biggest increase in young, uninsured children? Thirteen states had significant increases in the rate and/or number of uninsured children under age 6: Alabama, Florida, Georgia, Illinois, Kansas, Kentucky, Missouri, New York, Ohio, Tennessee, Texas, Washington and West Virginia. (By the way, it’s no coincidence that many of these states haven’t expanded Medicaid to parents and other adults—the report also unpacks that connection, so be on the lookout for co-author Maggie Clark’s upcoming blog devoted to this topic). Only Minnesota had a significant decrease in the number (but not rate) of uninsured children. All remaining states stalled in their progress, which is concerning to see during a period of economic strength where you would expect more children—not fewer— to be covered.

We’ve shown here and in earlier reports that much of this increase in children’s uninsurance can be traced to dramatic decreases in Medicaid and CHIP enrollment, even though most uninsured children are eligible for public coverage. Enrollment drops have been fueled by policies and political action in Congress and the Trump Administration starting in 2017 that created confusion among families, encouraged states to add red tape and other conditions to enrollment, and instilled fear among immigrant communities that made families less likely to sign up even their eligible, citizen children for available coverage.

It’s past time to address this troubling trend. Let’s extend the strong, bipartisan commitment we regularly see for early education to include health coverage (again). All children—especially our youngest—deserve to get the care they need, when they need it.

Elisabeth Wright Burak is a Senior Fellow at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.