Title:Insuring kids health

Georgetown’s Center for Children and Families studies health coverage in the U.S.

On the surface, the last 10 years of data show a promising reduction in rates of uninsured children in the United States, down from 9.7% in 2008 to 5.7% in 2019. But the broad figures mask some setbacks in recent years and a closer look is needed to truly understand child health coverage trends, says Kelly Whitener, associate professor with Georgetown’s Center for Children and Families at the McCourt School of Public Policy’s Health Policy Institute.

Whitener notes that “coverage rates depend on state residency— some do a better job covering kids than others.” For example in 2019, just 1.5% of children in Massachusetts were uninsured, while in Wyoming the number was 10.6%. There are major inequities by race and ethnicity, as well, with the biggest gaps for American Indian and Hispanic/Latinx children. Although 5.7% of all children were uninsured in 2019, 13.8% of American Indian and 9.2% of Latinx children were without coverage, she says.

“American Indian coverage is complicated by the role of the Indian Health Service, which is really important for Indigenous American health,” Whitener notes. “It is valued by the tribes I’ve worked with, for many reasons including clinics which are culturally appropriate. But they are inadequately funded.”

Meanwhile, Congressional debate in 2017 about the future of the Affordable Care Act led many to believe that Medicaid and the Children’s Health Insurance Program (CHIP) were no longer available, causing a drop in enrollment, says Whitener. Then some states and the Trump administration added bureaucratic hurdles and rule changes that led to a chilling effect for immigrant families that compounded the problem.

Medicaid and CHIP together are the largest and most important sources of health coverage for children—covering more than 38 million kids. Whitener says it’s critical that state and federal policymakers focus on connecting more children with the health coverage they need to support their healthy development. Health care providers have an opportunity to advocate for their Medicaid and CHIP patients by supporting streamlined eligibility and enrollment processes to make sure children get and stay covered. “Research shows that having health coverage as a child has lifelong, positive impacts such as improved health, improved educational outcomes, and higher paying jobs in adulthood,” she says.

Other strategies to help cover more children include filling eligibility gaps related to immigration status and for families with moderate incomes who can’t afford policies offered by their employer; streamlining policies to make it easier for those who are currently eligible to enroll and stay covered; expanding outreach and education campaigns; and covering more parents and caretakers.

For more information, check out ccf.georgetown.edu.

This sidebar originally appeared in Children’s Health Equity Through Community Care.