Children’s Uninsured Rate Climbs to Highest Point in Over a Decade

Children’s Uninsured Rate Climbs to Highest Point in Over a Decade

The rate of uninsured children in the U.S. grew to its highest level in over a decade in 2019, according to a new study published by researchers at Georgetown University’s Center for Children and Families.

It hit 5.7% in 2019, versus 4.7% in 2016.

“Over the three-year period of the Trump administration, we see 726,000 more children without health insurance,” said co-author Joan Alker, executive director of the Center for Children and Families at the Georgetown University McCourt School of Public Policy, during a webinar on October 9.

Among those without coverage were approximately 178,000 infants, toddlers, and pre-schoolers under the age of 6, she added.

And from 2018-2019, the nation saw the biggest 1-year loss in children’s coverage, as 320,000 children lost insurance, the report noted.

For years, children’s uninsurance rates were a “good news story,” said Alker.

Even before the Affordable Care Act (ACA) was implemented in 2014, decades of bipartisan work in Congress to expand Medicaid and establish the Children’s Health Insurance Program (CHIP) helped to drive down the rate of uninsured children, she said.

But as new Medicaid enrollment began to taper off in 2017, the number of uninsured children began to rise, erasing much of the ACA-driven coverage expansion.

Alker blamed the rise in uninsurance among children on the Trump administration and its allies in Congress who she said have tried to undermine the ACA in many ways, including:

  • Cutting outreach and enrollment funding, as well as funding for community navigators who can help individuals identify a health plan
  • Creating more “red tape” around enrollment and renewal of health plans
  • Imposing a “public charge” rule on legal immigrant families

The latter combined with the Trump administration’s “unremitting hostility” towards immigrants and families of mixed status have stoked fears of families being deported and caused families to avoid enrolling in public benefits, including Medicaid and CHIP, she said.

“What’s so troubling is that this data is pre-pandemic,” Alker noted. These rates reflect a period when unemployment was “extremely low,” she said.

The report broke down the coverage losses by state and found that Texas, with 243,000 children losing coverage from 2016 to 2019, had the highest increase nationwide, followed by Florida, which saw 55,000 children lose coverage during the same period.

Together the two states account for 41% of the increase in uninsured children.

In all, 26 states saw significant increases in the numbers of insured children; New York was the only state to see a “significant improvement” in the number of uninsured children, and the remaining states saw “no significant change,” the report noted.

As for the rate of uninsured children, which is a better comparator state-to-state than the number of uninsured children because it helps to account for a state’s relative size, South Dakota topped the list with a rate increase of 3.1%, and Texas and Utah followed, at 2.9% and 2.3%, respectively.

The report also found that a disproportionate share of uninsured children live in the South (52.7%); 20.8% live in the West, 17.4% live in the Midwest, and 9.1% live in the Northeast. Of note, the South accounts for 39% of the total child population in the U.S.

As for the racial breakdown of these uninsured children, “losses have been most pronounced for white children, multi-racial children, and for Latino children who can be of any race,” Alker said.

Rates for American Indian and Alaska Natives, who she noted have had the highest children’s uninsured rates of any racial group for years, rose from 12.9% in 2018 to 13.8% in 2019.

Laura Guerra-Cardus, MD, the deputy director of the Texas office of the Children’s Defense Fund and a webinar presenter, brought home the point that regular access to healthcare is “essential.”

“Children require vaccines to keep themselves and those around them safe,” she said. Healthcare access also helps to identify developmental problems related to speech, hearing, and vision; genetic disorders; and possible trauma.

Importantly, regular access to healthcare in childhood helps clinicians to identify entirely treatable illnesses that could have devastating consequences later in life, Guerra-Cardus said.

Finally, Alker, Guerra-Cardus, and other experts involved in the webinar pointed out that the number of uninsured children in 2020 will likely be much higher, given the pandemic and recent rise in unemployment.

The report noted that the “best available estimates” suggest that 2.9 million people under age 65 will lose insurance by the end of 2020, including 300,000 children. This is “on top of any increase that may have otherwise occurred in 2020 pre-pandemic,” according to the report.

“Children, especially those in communities of color face a host of challenges associated with economic, educational, and heath impacts of the COVID-19 pandemic,” the authors wrote. “The United States must renew its commitment to ensuring that all children have high quality, affordable, and comprehensive health coverage.”

Data presented in the report come from the U.S. Census Bureau’s annual American Community Survey.

  • Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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