Census Data Show Largest Annual Increase in Number of Uninsured Children in More Than a Decade

Despite the strength of the pre-pandemic economy in 2019, the number of uninsured children grew at an alarming rate according to newly released data from the Census Bureau’s American Community Survey (ACS). The ACS data released today documents the largest annual increase in the number of uninsured kids from 2018 to 2019 since the survey began asking about health insurance in 2008. The child uninsured rate increased from 5.2% in 2018 to 5.7% in 2019.

 As readers of SayAhhh! know, for many years the rate of uninsured children had been declining – reaching a historic low in 2016 at 4.7%. However, during the Trump Administration, that progress has started to reverse, and the new data find that the uninsured rate for children increased a full percentage point in three years. That rate translates to 726,000 more kids becoming uninsured during the Trump presidency prior to the state of the COVID-19 pandemic and the associated recession.

What makes this such bad news is that this data is all pre-pandemic, so the reality today for families is likely considerably worse as so many parents have lost their jobs and their health insurance in 2020. Just how many more children have become uninsured? We don’t know, but this new data underscore how the country was already headed more rapidly in the wrong direction before the crises of 2020 hit.

We will be unpacking the state specific changes in our upcoming annual report, but here are a few toplines about which kids are losing coverage.

Coverage losses were widespread across the country, income levels, regions, and race/ethnic groups with only Asian/Pacific Islander children not experiencing an increase in their uninsured rate in 2019. There are two important and clear trends to note:

  • While White and Black children experienced losses of coverage, Latino children saw the largest jump in their already high uninsured rate – 1 percentage point – from 8.2% to 9.2%.  This is clear evidence of a chilling effect of the Administration’s ongoing campaign of hostility and intimidation directed at immigrant and mixed-status families including its dangerous “public charge” rule. Many of the children losing coverage are citizens who are clearly eligible but have immigrant parents who fear any interactions with government. Stay tuned for a blog from our colleague Kelly Whitener who will dive into this terrible situation further.
  • Children in the South are the worst off and that region saw the highest rates of growth in the child uninsured rate jumping from 7.1% to 7.7%. This is no surprise given states like Texas and Florida have some of the highest rates of uninsured children in the country (12.7% and 7.6% respectively).

 Why is this happening?

The loss of public coverage is a key contributor to these pre-pandemic trends as we have explained before. In particular:

  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, delayed funding of CHIP and release of outreach grants; and ongoing efforts to undermine the Affordable Care Act.
  3. Federal and state policymakers making it harder to enroll in coverage. CMS has urged states to add more red-tape and tighten up eligibility and verification procedures causing eligible children to lose Medicaid and CHIP coverage.

Some but not all of these trends are hopefully being mitigated by the current Medicaid disenrollment freeze enacted by the Families First Act, which extends through the duration of the COVID-19 public health emergency. However the disenrollment freeze does not extend to separate state CHIP programs, does nothing to address the “chilling effect” and, of course, does not address newly uninsured children whose parents have lost their employer-sponsored insurance in 2020 and may not know that they are eligible for public insurance. No substantial national efforts have been made by the Trump Administration to inform families of their child’s public coverage options.

Finally, the failure by some states to accept the ACA Medicaid expansion has hurt kids. The child uninsured rate in non-expansion states grew from 7.3% to 8.1% compared to an increase from 3.8% to 4.2% in expansion states.  When parents are covered, kids are more likely to be covered too.

Leaders at the state and national levels have policy options available to them to reverse this alarming trend. Continuous, affordable and comprehensive health coverage is essential for children to grow and thrive. A growing number of uninsured children will have long term consequences for them and for our society – and will exacerbate the extraordinary number of challenges kids face today. Today’s news is sobering indeed.

U.S. Census Bureau Graphic
U.S. Census Bureau Graphic


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.