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How are children getting their health insurance?

Health Care Reform and Policy
by Heather Robinson
How are children getting their health insurance?
How are children getting their health insurance?

Lawmakers at both the state and federal levels have been trying to find ways to ensure more Americans are covered by health insurance. Whether that's through public programs or private coverage, there's a clear need to ensure everyone has access to the most affordable high-quality care. That is especially true of children, but it seems that - by and large - individual states may be falling behind in that duty.

The national uninsurance rate for children 17 years old or younger came in at 5.2% in 2018, up from 5% a year earlier, according to the latest data from the Centers for Disease Control and Prevention's National Health Interview Survey. There was also an increase in the share of kids covered through public health insurance, which stood at 41.7%, up three basis points from 2017.

Of course, some states were far more successful than others in delivering coverage to children overall, such as Georgia, where the uninsurance rate fell six basis points to 6.2%, though that number is obviously above the national average. New York, meanwhile, had the lowest estimated uninsurance rate of the 17 states examined, at just 1.6%, but that was up from 1.2% the previous year. In Virginia, enrollment in public plans increased sharply, which may explain why the state's child uninsurance rate plunged from 9.2% to just 2.9%, though the CDC cautioned the latter number was a projection and may be unreliable.

Child uninsurance rates are on the rise.Child uninsurance rates are on the rise.

A big impact
While a small increase in the national uninsurance rate may sound relatively innocuous - perhaps the result of standard industry churn - this amounted to about 828,000 more kids going uncovered by Medicaid and the Children's Health Insurance Program alone last year (a 2.2% decline), according to a Georgetown University study. That marked only the second drop in enrollment since the turn of the century, and the decline was double that of the only other one, in 2007.

As recently as 2016, the nation saw an all-time record low for child uninsurance rates at just 4.7%, and it stayed unchanged in 2017. More troubling may be that the study found enrollment for 2018 dipped in 38 states. Researchers believe it's likely the newer trend could lead to even more difficulty in getting kids covered in the future.

Separate CDC data from 2017 also suggests it's not just uninsured kids who may bear the brunt of the negative effects; other children who have health insurance could be put at greater risk as well. The reason why is - for all the controversy surrounding vaccinations and whether children should be allowed to go without - lack of health insurance or access to care is a huge indicator of likelihood of being unvaccinated among babies 19-35 months old.

For just about every common vaccine infants normally receive, babies with private or public insurance typically have vaccination rates at or above 90% for multiple doses where possible, the CDC reported. Among babies without insurance coverage, that number was typically well under 80%. Likewise, 89% of kids living below the poverty line had at least one dose of the MMR vaccine, versus 93% for kids outside that demographic group.

What's being done?
In Florida, where the child uninsurance rate rose five basis points from 2017 to 2018, to 8.1% (well above the national average), lawmakers recently put more funding into the state's budget for its children's health insurance program, the Florida Healthy Kids Corporation. As a result of the additional money needed to keep the organization going, about 146,000 kids without insurance in the Sunshine State will receive reduced-cost coverage starting in 2020; parents will pay about $3,000 less for deductibles on medical care, and $1,500 less for prescriptions.

Likewise, in California, where about 302,500 kids were dropped from federal or state-funded health insurance programs, officials recognize the problem and say they are moving to address it. Many different solutions are now being considered to deal with the problem, especially at a time when funding for both appears to be in short supply. However, officials also seem to believe at least some of that decline in enrollment came because the state's economy is doing better and more people who used to rely on those programs are now covered by private insurance.

The CDC's data - which shows a slight decline in private enrollment from 2017 to 2018 - does not necessarily bear that out, as there was a minor increase in uninsurance (3.1% to 3.5%), and enrollment in public coverage also took a step back. Included in the solutions that could bring uninsurance back down are the reinstitution of the individual mandate at the state level, after it was removed federally as part of sweeping tax reform. Lawmakers are also trying to introduce legislation that would help bring coverage costs down, and further, to make it easier and safer for undocumented immigrants to enroll in coverage.

It seems states broadly recognize it's vital to ensure kids get a fair chance to receive affordable health care, and that there are clear implications and risks if that isn't happening. Broadly speaking, CHIP and programs like it remain extremely popular, and thus it's likely more work will be done to address the issue of child uninsurance going forward.

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