Suffer the children

After years of steady decline, the number of U.S. children without health insurance rose by 276,000 in 2017, according to a Georgetown University report released last Thursday (Nov. 29).

While not a big jump statistically—the share of uninsured kids rose to 5 percent in 2017 from 4.7 percent a year earlier—it is striking because the uninsured rate typically remains stable or drops during times of economic growth. In September, the U.S. unemployment rate hit its lowest level since 1969.

“The nation is going backwards on insuring kids, and it is likely to get worse,” said Joan Alker, co-author of the study and executive director of Georgetown’s Center for Children and Families.

Alker and other child health advocates place the blame for this change on the Trump administration and the Republican-controlled Congress, saying their policies and actions cast a pall on enrollment.

The number of children without coverage rose to 3.9 million in 2017 from about 3.6 million a year earlier, according to Census data analyzed by Georgetown.

In California, 301,000 children went without insurance in 2017, up slightly from 300,000 the year before. More than half of all California children are covered by Medi-Cal, the state’s Medicaid program. The Golden State is among six states, plus the District of Columbia, that allow all income-eligible children to join their Medicaid programs, regardless of immigration status.

More than 250,000 undocumented immigrant children are enrolled in California.

Because nearly all low-income children are eligible for Medicaid or the federal Children’s Health Insurance Program, known as CHIP, the challenge is making sure parents are aware of the programs, getting them enrolled and keeping them signed up as long as they are eligible, Alker said.

Congress let the CHIP program funding lapse for several months in 2017, putting states in a position of having to warn consumers that they would soon have to freeze enrollment. Congress restored federal funding in early 2018.

In addition, low-income families were bombarded by news reports last year of Congress threatening to repeal the health law that expanded coverage to millions. In the past two years, the Trump administration has slashed funding to Affordable Care Act navigators to help people sign up for coverage through the federal health insurance exchange (healthcare.gov).

Alker also pointed to the Trump administration’s September proposal, known as the “public charge” rule, which could make it harder for legal immigrants to get green cards if they have received certain kinds of public assistance—including Medicaid, SNAP (aka food stamps) and housing subsidies. Green cards allow them to live and work permanently in the United States.

OLE Health, a large health provider based in Napa Valley that serves many immigrants, said it has seen patients disenroll from Medicaid in the past year. CEO Alicia Hardy said many have dropped coverage over fears the help could jeopardize their immigration status.

“They are afraid of being deported,” she said.

All those events could have deterred families from getting their kids covered.

“The welcome mat has been pulled back, and as a result we see more uninsured children,” Alker said.

The overall uninsured rate for people of all ages—which plummeted from 2013 to 2016 following the ACA’s implementation—remained unchanged at 8.8 percent last year. The share of children with employer-sponsored coverage rose modestly in 2017, but not by enough to make up for the drop in children enrolling in Medicaid or getting coverage from ACA insurance exchanges, Alker said.

While no states made any significant gains in lowering children’s uninsured rate, nine states experienced significant increases. The biggest occurred in South Dakota (up from 4.7 percent to 6.2 percent), Utah (up from 6 percent to 7.3 percent) and Texas (from 9.8 percent to 10.7 percent).

More than two-fifths of the country’s uninsured children live in four states: California, Florida, Georgia and Texas, according the report.

About 835,000 uninsured kids live in Texas—by far the highest number of any state. Florida had 325,000 uninsured children last year, as its uninsured rate for that age group rose 0.7 of a percentage point to 7.3 percent.

Other states with significant increases were Ohio, Massachusetts, South Carolina and Tennessee.

The uninsured rates for children increased at nearly triple the rates in states that did not expand Medicaid under the ACA, according to the report. Studies have shown that children whose parents are insured are more likely to have coverage.

The uninsured rate among Hispanic children was 7.8 percent, compared with 4.9 percent among whites and 4.6 percent among blacks overall.

Georgetown has been tracking these figures since 2008, when 7.6 million children—or about 10 percent of kids—lacked health coverage.

Alker said the easiest way to change the trend would be for more states to expand Medicaid under the health law. Fourteen states have yet to do so. Though the expansion largely affects adults, as parents enroll, their children are likely to follow.