Gains in health coverage for children have been steady since 2008, but they picked up steam after 2013.
While the overall uninsured rate has dipped to a record low of 8.6%, the rate among children was even lower at 4.8% in 2015, according to a new report from the Georgetown University Health Policy Institute.
Between 2013 and 2015, about 1.3 million children gained coverage, mostly through Medicaid and the Children’s Health Insurance Program (CHIP) as coverage expanded under the Affordable Care Act (ACA). Employer-sponsored coverage for children remained stable during this period, according to the report, authored by Joan Alker, MPhil, and Alisa Chester, MA. The authors found that gains in coverage spanned a variety of ethnic and income groups, and that 41 states made progress.
Since 2008, raw numbers of uninsured children have continued to fall despite the recession. The number of uninsured children was 6.9 million in 2015, and that total declined slightly each year through 2013, before falling faster after 2013. The number of uninsured children was 5.2 million in 2013, 4.4 million in 2014, and 3.5 million in 2015.
The largest pockets of children who remain uninsured are Native American/Alaskan Native and Hispanic children, as well as those with incomes between 100% and 200% of the federal poverty level. The report calls these children the “near poor,” and uninsured rates here for children are 6.8%. Overrepresented among the uninsured are older children and those in the South, where many states did not expand Medicaid and families may be in the “coverage gap.”
Many reports have suggested that Hispanic children eligible for CHIP coverage lack it because while the children were born in the United States, their parents may be in the country illegally and are reluctant to sign them up for a government program. In 2015, 7.5% of Hispanic children were uninsured, compared with 3.5% white, non-Hispanic.
Uninsured rates for children have been declining for 30 years. The first wave came after Medicaid was extended to all children below the poverty level in the 1980s, and the second wave came after the creation of CHIP in 1997. Health coverage rates for children had stagnated, the report said, before the ACA was fully implemented over the course of 2014 and 2015.
The report finds a direct connection between improved coverage for parents and increased coverage for children. “Research has shown that extending new coverage to parents results in more children obtaining coverage,” the authors write.
States with the highest numbers of remaining uninsured children are: Texas, with 682,000 or 19.3% of all uninsured children; California, with 302,000 or 8.5%; Florida, with 284,000; Georgia, with 166,000; Arizona, with 134,000; Ohio, with 115,000; and Pennsylvania, with 111,000. The data were based on 2014, and Pennsylvania has since converted to conventional Medicaid expansion.