Today the U.S. Census Bureau released the Current Population Survey (CPS) for 2024 which examines income, health insurance and other trends. Overall, the uninsured rate was unchanged at 8%; the child uninsured rate was 6.1%. – a slight increase that was not statistically significant. Later this week we will get state by state data from the Census Bureau’s American Community Survey (ACS), which will be much more illuminating with respect to how children fared during the Medicaid unwinding – as I previewed there were enormous differences in state performance.
As expected, the percentage of children relying on Medicaid as a coverage source went down significantly by 2.2 percentage points. This was not surprising given that the Medicaid unwinding, which we carefully tracked, led to a net decline of 5.53 million children enrolled in Medicaid. If anything, this decline seems low given the raw numbers. Medicaid and CHIP are combined in Census surveys so there is no real way to tease out how many children moved from Medicaid to CHIP from this data.
Overall, there was no statistically significant increase in employer-sponsored insurance but there was a statistically significant increase in “direct coverage” which includes the individual market, primarily the federal and state Marketplaces.
Administrative data show that Marketplace enrollment among children has increased dramatically in recent years, likely driven by enactment of the enhanced Marketplace tax credits under the American Rescue Plan Act in 2021. For example, this year, the number of children under age 18 who enrolled in Marketplace plans during open enrollment equaled 2.57 million, an increase of 1.55 million (or by more than 2.5 times) since 2020. Between 2023 and 2024, the number of children enrolling in Marketplace plans during open enrollment increased by about 611,000.
Greater individual market coverage, including in the Marketplaces, helped offset the loss of Medicaid coverage due to unwinding between 2023 and 2024, which was likely a key factor behind why there was no statistically significant increase in the child uninsured rate in CPS data. But it is likely that there would have been significant increases in the child uninsured rate if the enhanced premium tax credits had not been available. These enhanced Marketplace credits, however, are scheduled to expire at the end of this year.
And that is just one of the storm clouds gathering for children and families. The CPS data shows that children of Hispanic origin continue to have the highest uninsured rate at 10%. The extreme anti-immigrant agenda, including the unprecedented sharing of personal Medicaid data by the Trump Administration with ICE, is likely having a chilling effect on the willingness of mixed-status families with an immigrant parent to enroll their children in public coverage this year.1 This is another reason that we fear that the number of uninsured children is rising already.
In the wee hours of Wednesday night/Thursday morning, the Census Bureau will release the ACS, which has more robust data than the CPS providing an opportunity to make state-by-state comparisons. Georgetown CCF will be holding a webinar on Friday, September 12th at 1pm ET to share our rapid analysis of child coverage trends from the ACS, and we will look into our crystal ball to see what lies ahead. You can register for the webinar here.
- A federal court order has blocked sharing of Medicaid data with ICE in 20 states that filed suit. ↩︎