Report: Even before the pandemic, the number of uninsured children rose, wiping out gains made under ACA 


October 21, 2020

The number of children without health coverage in the U.S. increased by about 726,000 between 2016 and 2019, bringing the total to more than 4 million uninsured children and reversing years of national progress, a new report finds. 

The report, issued earlier this month by the Georgetown University Center for Children and Families, concludes that many of the gains in coverage made as a result of the Affordable Care Act’s major expansions, implemented in 2014, have now been eliminated. After reaching a historic low of 4.7 percent in 2016, the child uninsured rate began to increase in 2017, the year that President Trump was sworn into office, and as of 2019 jumped back up to 5.7 percent. 

The report found that the number of uninsured children has increased every year during the Trump era, with the largest increase coming between 2018 and 2019 when, despite a continued strong economy, the number of children without health insurance rose by 320,000 — the largest annual jump in more than a decade. 

The report warns that the situation now could be much worse – but how much worse is something we don’t yet know. 

“Moreover, since this data was collected prior to the pandemic, the number of uninsured children is likely considerably higher in 2020, as families have lost their jobs and employer-sponsored insurance, though it is impossible to know yet by precisely how much,” the report states. 

The study found both geographic and racial disparities in the number of uninsured children. Shockingly, one-third of the total increase in the number of children without coverage from 2016 to 2019 live in Texas – 243,000 in all. Florida had the next biggest loss, adding about 55,000 children to the uninsured count during the three-year period. Twenty-nine states experienced an adverse change for children from 2016 to 2019 while only one state – New York – actually saw a significant decrease in uninsured children. 

 The report found that losses in coverage were widespread across income, age and race/ethnicity, but were largest among white and especially Latinx and American Indian/Alaska Native children. (The uninsured rate for white children rose from 4.9 percent in 2017 to 5.6 percent in 2019. Over the same two year span, the uninsured rate for American Indian and Alaska Native children rose from 12.9 percent to 13.8 percent; for Latinx children, who may be of any race, the increase was from 7.9 percent to 9.2 percent.) 

“For decades, children’s health coverage had been a national success story, but the data show that during the years of the Trump Administration the trend went in the wrong direction,” said Georgetown University Center for Children and Families Executive Director Joan Alker. “What’s worse, the numbers of children losing coverage accelerated from 2018 to 2019 during a time when unemployment was very low. The situation is likely worse today.” 

The report attributed the loss in coverage to several factors: efforts to repeal the Affordable Care Act and cut Medicaid; cuts to enrollment outreach and advertising; inadequate oversight over state Medicaid programs that have created more red tape barriers; and the creation of a climate of fear and confusion for immigrant families that discourages them from enrolling eligible children in Medicaid or the Children’s Health Insurance Program (CHIP). 

A group of organizations that advocate for children – including the Children’s Defense Fund, Family Voices, and First Focus on Children – joined Georgetown University Center for Children and Families in calling for immediate action from Congress and the Trump Administration. 

“The COVID-19 pandemic, which has had a disproportionate impact on communities of color, only exacerbates the impact on children and families who lack access to affordable, comprehensive, and high-quality health coverage,” the children’s advocates said in a statement welcoming the report. “We know that children without health coverage could also suffer long-term harm, ending up in poorer health, with less educational attainment and less financial security in adulthood.” 

The groups added that even before the pandemic, “the Administration’s actions – such as the public charge rule, which has reduced families’ willingness to enroll their children in Medicaid and the Children’s Health Insurance Program (CHIP), and other problematic policy changes that impeded access to Medicaid, CHIP, and private insurance – are contributors to this erosion of children’s coverage. The ongoing pandemic and subsequent economic recession lead us to believe coverage losses for children will only continue to get worse.” 

The advocates noted that Congress earlier this year “took the first step to protect children and families by providing greater financial support for Medicaid in the Families First Coronavirus Response Act, along with its continuous coverage protections ensuring that children, pregnant women, and families won’t lose Medicaid coverage due to red tape during the pandemic.” 

“We call on Congress and the Administration to advance policies that ensure all children and families have health care coverage, not policies that stand in the way of making that possible,” the advocates concluded. “Our children’s futures depend on our ability to act now.” 

You can read the Georgetown University Center for Children and Families here. 

Affordable Care Act
Children's health care