After falling steadily for at least eight years, the number of children without health insurance rose nationwide for the second year in a row in 2018, according to a new report released on Wednesday.
Nationwide, 5.2% of children were without health insurance in 2018, according to the report, produced by the Georgetown University Center for Children and Families. The number of children without coverage grew by 400,000 from 2016 to 2018, to a total of more than 4 million.
The report blames the shift on the Trump administration’s weakening of the Affordable Care Act and on policies undermining Medicaid, the health insurance program for the poor.
In addition, the report’s authors say, a pervasive “climate of fear” generated by the administration’s attacks on immigration has contributed to even higher rates of Latinx children lacking health insurance than children in other racial or ethnic groups.
In Wisconsin, the picture was somewhat better. Just 3.8% of the state’s children lack health coverage, a state-by-state database accompanying the report shows.
Out of 50 states and the District of Columbia, Wisconsin ranks 21st in coverage for children. And the state was not among 15 that the report singled out as having a statistically significant increase in the number of uninsured children.
Does that mean Wisconsin is off the hook?
“No, it does not,” said William Parke-Sutherland, health policy engagement coordinator for Kids Forward, which works closely with the Georgetown center and received an advance copy of the report. Madison-based Kids Forward is a non-partisan policy advocate for Wisconsin families and children.
Falling behind neighbors
“This is a nationwide trend that we’re seeing, and it’s pretty disturbing,” Parke-Sutherland said. The number of uninsured children in 2018 “is the highest level of uninsured kids since the ACA’s major coverage initiatives took effect in 2014. So we are part of that.”
Nationally as well as in Wisconsin, “we saw basically stagnation when we should have seen growth in health coverage,” he said. “This is taking place at a time of economic growth, a time of low unemployment. We would have expected to see coverage for children increasing as well as coverage in general increasing. If we were to fall on hard economic times we might see some significant decreases” in coverage.
“We used to be a leader in insurance coverage for kids,” he added. “Now we are behind all of our bordering states” — Minnesota, Iowa, Michigan, and Illinois.
If Wisconsin were to catch up with Iowa, where just 2.7% of children lack health coverage, “we’d have about 15,000 fewer kids uninsured, so it’s pretty significant.”
All of those adjacent states have accepted federal support to expand Medicaid under the ACA, while Wisconsin has not. Gov. Tony Evers included the Medicaid expansion in his original state budget, but the Republican-led legislature eliminated that provision. Evers is now backing a stand-alone bill to expand Medicaid, and Marquette University Law School polls have shown strong support.
Reversing a trend
The Georgetown Center for Children and Families report is based on an analysis of U.S. census data.
Nationally, 9.7% of children lacked health insurance in 2008. The number fell over the next five years to 7.5%, largely due to expansions of Medicaid and the federal Children’s Health Insurance Program (CHIP). When the ACA took effect, the number of children without insurance declined further, reaching 4.7% by 2016.
In 2017 it rose to 5%, and in 2018 rose again to 5.2%.
“The ACA primarily improved children’s coverage rates by increasing the likelihood that eligible children would be enrolled in Medicaid/CHIP when their parents obtained coverage, simplifying eligibility and enrollment procedures, funding new outreach and enrollment efforts, and establishing the individual mandate,” the report states. “Some children benefited from newly available subsidized coverage in the ACA Marketplaces as well.”
Congressional attempts to abolish the ACA and cut Medicaid, as well as its repeal of the ACA’s individual mandate penalty and a months-long delay before Congress authorized extending CHIP, all helped discourage poor families from enrolling in available insurance programs, the report’s authors write.
In addition, the Trump administration cut funding for outreach under the ACA, further undermining the program, and has reversed a trend of streamlining access to Medicaid. “These factors have contributed to a diminishing infrastructure to support families in need of coverage and an ‘unwelcoming’ climate that is less focused on ensuring that eligible children are enrolled and remain enrolled,” the report states.
By race or ethnic group, the lack of insurance for children is highest among Native Americans (13.2% in 2018, up from 12.9% in 2017) and Hispanic children (8.2% in 2018, up from 7.9% in 2017).
With regard to the latter, the Trump administration “has ramped up its rhetoric and policies targeting immigrant communities with a campaign of fear and hostility,” the report observes. “These policies are now clearly deterring parents from enrolling their eligible children in Medicaid or CHIP — despite the fact that most of these children are U.S. citizens.”
What the state can do
Parke-Sutherland said these developments have affected Wisconsin as well.
“This is really a nationwide trend, and this is going to require bipartisan, nationwide solutions at the federal level,” he said of the overall increase in children without insurance.
Nonetheless, he added, there are steps Wisconsin can take on its own to help alleviate the problem.
The majority of children who are uninsured are eligible under Medicaid or CHIP but not enrolled, Parke-Sutherland said. The new study “underscores the reason to keep Medicaid a vibrant, strong, and well-funded program, and encourage full participation in it.”
Pointing to the statistic showing that the single group most lacking in health insurance were Native Americans, he suggested that the state could help more of its Native American population enroll in Medicaid or BadgerCare, as it’s called in Wisconsin.
The state also could act to make sure children have continuous Medicaid coverage for the entire year, even when parents’ income fluctuates enough to make them ineligible for some of that time, he added.