Child Uninsured Rate Declined During the Pandemic Thanks to Medicaid

New data from the American Community Survey (ACS) released today by the U.S. Census Bureau suggests that the continuous coverage provision of the Families First Coronavirus Response Act (which prohibits states from disenrolling anyone involuntarily from Medicaid during the duration of the federal COVID-19 public health emergency), has resulted in the child uninsured rate stabilizing and slightly improving in 2021.

Overall, the child uninsured rate in the U.S. in 2021 was 5.4 percent as compared to 5.7 percent in 2019 – a small but significant decline. This equates to an estimated 4.2 million uninsured children in the U.S. in 2021 as compared to 4.4 million in 2019. (Because of the pandemic, ACS health insurance data was not available for 2020.) I expect that when we get the data for 2022 the number of uninsured children will continue to go down.

This silver lining for children in a bleak pandemic was expected given the increase in child Medicaid enrollment nationwide. Census data shows a statistically significant 1.6 percentage point increase in the share of children covered by Medicaid alone or in combination. But it is well known that these data tend to undercount Medicaid – and recent enrollment data from the federal Centers for Medicare and Medicaid Services finds that more than half of the nation’s children (40.625 million) are enrolled in Medicaid or CHIP and that child Medicaid/CHIP enrollment increased by 5.6 million between February 2020 and May 2022.

This is the first comprehensive look at the pandemic period from ACS since 2020 data was not released. We can’t wait to dig in and explore these trends more deeply in our annual report on children’s health insurance trends which we expect to release in mid-November.

My hunch is that states that have large numbers of uninsured children and are prone to using administrative barriers to keeping eligible children out of Medicaid/CHIP or dropping them at renewal will see some of the largest improvements in their child uninsured rates. Looking at you Texas, Georgia, Florida.

We will have to dig more deeply into the data but from a quick look at Texas (which has the greatest number of uninsured children in the country) this seems borne out. Today’s data find that the Texas child uninsured rate declined almost a full percentage point from 12.7 percent in 2019 to 11.8 percent in 2021, driven by an increase in the share of children covered by Medicaid alone or in combination from 36.4 percent in 2019 to 38.4 percent in 2021.

Of course, as readers of SayAhhh! know, the risks to children are very high when the Medicaid continuous coverage provision lifts. We have estimated in previous work that as many as 6.7 million children could experience a gap in coverage when the PHE ends – which is currently slated to be in place at least until January 2023. It’s important to emphasize that 3 out of 4 children projected to lose coverage when the continuous coverage provision is phased out will still be eligible for Medicaid or CHIP, according to a recent federal government report. (Children of color face the greatest risk of losing coverage due to procedural errors.) Children who are uninsured are less likely to get needed care, and any period of uninsurance exposes families to large medical bills. As any parent knows, a fall on the playground or on the soccer field leading to a broken bone that is treated in the emergency room can undermine families’ financial security for months and years if they don’t have good insurance.

Today’s data release and what lies ahead underscore the importance of policy choices that political leaders make at the federal and state levels and whether they value children’s health and wellbeing.

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.