The Rate of Uninsured Infants and Toddlers is Growing. Don’t Let COVID-19 Pandemic Make Things Worse

Three+ weeks into my at-home work existence with a fellow teleworking spouse, a 3rd grader and a preschooler and I’ve found a new base level of stress, despite yoga, workouts, mediation and ALL of the deep breaths. It’s hard. And yet our family is among the luckiest of Americans. We are safe and healthy. We have stable housing, health insurance, and food to eat. Our jobs allow for remote work. We can socially distance with plenty of music, TV, and games.

But the families in the crosshairs of the COVID-19 pandemic were already struggling, already living on the brink. Families struggling to pay for child care, food and rent, and now filing for unemployment. Parents without health insurance who don’t seek care for fear of bankruptcy. Families dealing with cycles of addiction or substance abuse. Families caring for children with special health care needs who already struggle to get by and have the added stress of protecting their child from the virus itself. Parents taking risks by going into work as a grocery store cashier, emergency child care worker, health care provider or other essential employee. Children isolated with parents struggling with undiagnosed mental health conditions, and children with those conditions themselves.

Today I’m thinking about families with infants and toddlers that have fewer resources to help them most effectively support children’s healthy development.  Add another stressor to the list:  infants and toddlers without health insurance. Children under age three. Just as our earlier analyses of coverage trends, our new fact sheet shows the national the rate of uninsured infants and toddlers began to reverse in 2016, going back above 4% in 2018. Seven states (Georgia, Illinois, Kentucky, Ohio, Texas, Washington, and Wisconsin) showed statistically significant increases from 2016 to 2018, driving the national rise.

Why does this matter? Even a few months of uninsurance adds more mental and financial stress to a low-income family’s plate. Child development experts talk about the dangers of prolonged, or toxic stress on brain development, which can—if not addressed early—be more difficult to overcome as a child ages, increasing their risk for a host of physical and mental health challenges over their lifetime. To be clear, I’m not talking about the healthy stress that protects us each day, or even the so-called “tolerable” stress that is incredibly difficult to overcome but relatively universal over the course of life– a death of a family member or a natural disaster, not unlike the global pandemic we all face now.

It is this toxic stress – strong, prolonged and/or frequent – that more young children could face now, right when their brains are developing rapidly. Faced with rising unemployment and risk of infection, more and more families are plagued with new worries and challenges. Some caregivers may need new tools or supports—like mental health services, social supports, or parenting help—to be the responsive caregivers they want and need to be for their young children. Postpartum depression, substance abuse, and other ailments can escalate for any family under the stress we’re seeing now, highlighting the importance of parents’ health to children’s coverage and healthy development  and the greater challenges facing parents in those remaining 14 state where lawmakers actively choose each day to maintain a coverage gap.

Supporting young children through trauma isn’t just a good idea – experience shows it matters. It’s hard to think beyond treatment of what ails us today when the health system is bursting at the seams in a growing number of places. But without some forethought around prevention and health promotion for children and their families right now, we will pay for the absence of supports in the health, education, employment, and child welfare systems for years to come.

The first step is making sure every child from birth on has access to health insurance. Medicaid and CHIP are available sources of coverage for most uninsured children. We can’t let this pandemic leave their futures behind.

Check out the new fact sheet here.

ZERO TO THREE created the Think Babies™ campaign to make the potential of every baby a national priority. Funding partners for Think Babies™ include the Robert Wood Johnson Foundation, which supports the campaign’s public education aspects, and the Perigee Fund, which supports the campaign’s public education and advocacy aspects. Learn more at

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