Decline in Public Health Coverage for Kids Helps Drive Rising Uninsured Rate

The first significant increase this decade in the number of Americans without health insurance partly springs from a continuing decline in the number of children in Medicaid and the related Children’s Health Insurance Program (CHIP).

The U.S. Census Bureau on Tuesday released a survey showing that in 2018, 27.5 million people did not have health insurance at any point during the year, up from 25.6 million in 2017. The uninsured rate rose to 8.5%, up from 7.9%. The percentage of people with public health coverage decreased by 0.4 percentage points. The percentage of people with private insurance also declined by 0.4 points.

Late last month, the Centers for Medicare and Medicaid Services announced that child enrollment in Medicaid and CHIP, both health programs for the poor, dropped by more than a million children between December 2017 and May of this year. Nationwide, the number of children enrolled in those programs fell from 37.7 million to 36.7 million, a 2.7% decrease, according to an analysis of CMS data by Georgetown University’s Center for Children and Families.

The CMS data shows wide variation between states, but 36 states plus the District of Columbia experienced declines in Medicaid and CHIP enrollment. Child enrollment in public health plans fell by 13.6% in Missouri and by 9.6% in Idaho. During the same period, however, enrollment was up by more than 6% in Alaska and Virginia.

Earlier this year, some health policy experts speculated that an improved economy had allowed more families to leave public health insurance plans and enroll in commercial insurance. But the data released by the Census Bureau today suggests otherwise.

According to the census, the nationwide rate of children under 19 enrolled in private insurance did increase slightly, from 61.6% in 2017 to 61.8% in 2018. But the percentage of children with public coverage declined from 37% to 35.7%. Overall, the uninsured rate among children climbed from 5% in 2017 to 5.5% in 2018.

Joan Alker, executive director of the Georgetown center, laid the blame for the declining child enrollment on actions taken by the Trump administration to undermine former President Barack Obama’s signature Affordable Care Act, which lowered the uninsured rate.

The administration has taken steps to restrict Medicaid for immigrants, and it has supported some states’ efforts to limit Medicaid eligibility and impose work requirements.

“This serious erosion of child health coverage is likely due in large part to the Trump administration’s actions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP,” Alker said. “It’s time to renew the bipartisan efforts that resulted in the child uninsured rate reaching historic lows in recent years.”

Neither the U.S. Department of Health and Human Services or CMS responded to requests for comment.

But Chris Pope, a health policy fellow at the Manhattan Institute, a free-market think tank based in New York, dismissed the declines in enrollment and insurance coverage as slight. Pope attributed the declines to a better economy, arguing it was enabling some people to exit public health insurance plans who could not afford private insurance.

“The premiums are still high and the value low,” he said.