Number of Children Without Health Insurance Increasing Across U.S.

Charlie Plain | May 3, 2019

The national rate of uninsured children increased from 4.7 percent in 2016 to 5.0 percent in 2017, ending a run of nationwide gains in children’s coverage that lasted from 2008 through 2016 and bringing the total number of uninsured children nationwide to nearly 4 million. This is according to a new annual report on children’s health insurance coverage from the State Health Access Data Assistance Center (SHADAC) at the School of Public Health.

The increase of nearly 270,000 uninsured children was accompanied by a significant decline in public health coverage, such as Medicaid.

Elizabeth Lukanen wearing glasses.
Lead author Elizabeth Lukanen.

“This analysis is concerning because research has shown that uninsured children have fewer visits to see physicians and to address chronic conditions as well as use fewer preventive health care services compared to insured children,” says the report’s lead author and SHADAC Deputy Director Elizabeth Lukanen.

Data for the report was gathered from the American Community Survey (ACS), a yearly questionnaire from the United States Census Bureau asking Americans about their jobs, housing, health insurance, and other topics. SHADAC researchers used the newest ACS data to calculate changes in health insurance coverage from 2016 to 2017 for children nationwide and at the state level both overall and among demographic groups. They also determined variations in 2017 coverage rates within and across states.

Key National Findings

  • The increase in uninsurance was driven by decreases in both Medicaid coverage (-0.7 points) and individual coverage (-0.4 points), which outweighed simultaneous gains in employer-sponsored insurance (ESI) coverage (0.7 points).
  • The 2017 national increase in uninsurance was significant across all demographic groups.
  • State changes in children’s health insurance coverage from 2016 to 2017 reflected the national picture of increases in uninsurance and ESI coverage, along with decreases in Medicaid and individual coverage.
  • State-level disparities in uninsured rates among children were substantial in 2017, with uninsurance varying widely within and across states both among children as a whole and by income, race/ethnicity, and parental education. At the state level, increases in uninsurance were particularly prevalent among nonwhite children.

In Minnesota

  • In 2017, Minnesota had a lower rate of uninsurance among all children at 3.4 percent compared to the national rate of 5.0 percent.
  • About 66 percent of insured children in Minnesota were were covered by ESI in 2017, and about 26 percent were enrolled in Medicaid.
  • There were considerable disparities in uninsurance among different subgroups of children within Minnesota in 2017. For example, 2.5 percent of Minnesota’s white children were uninsured compared to 7.2 percent of Hispanic children. Similar patterns were seen by income, where 6.2 percent of low-income children were uninsured compared to 1.2 percent of higher-income children.

“While our study does not determine the cause of the changes in children’s coverage, the increase in children’s uninsurance between 2016 and 2017 could potentially be related to a number of policy developments,” says Lukanen. “For example, it’s quite possible that a reduction in outreach and enrollment funding for the Affordable Care Act and confusion about its repeal caused fewer parents to explore health insurance for themselves, and therefore, they did not obtain coverage for their children.”

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