US must get back on track for kids

Today’s political noise is reaching such deafening levels that a silent and troubling trend is going unseen, unheard, and most importantly, un-acted upon. New research shows that the U.S. has slipped backward on children’s health coverage and the number of uninsured children is now at the highest level since 2014 when the Affordable Care Act’s (ACA) major coverage expansions took effect. 

After years of progress on children’s health coverage, a new report by the Georgetown University Center for Children and Families shows that more than 400,000 children have joined the ranks of the uninsured between 2016 and 2018. 

These coverage losses are widespread, with 15 states showing statistically significant increases in the number and/or rate of uninsured children. In states that haven’t yet expanded Medicaid, kids are more than twice as likely to be uninsured as those who live in states that expanded.

Southern states have an extremely large proportion of uninsured kids relative to the child population — more than one in five uninsured kids live in Texas alone.

The losses are concentrated in families with low and moderate incomes, earning roughly $29,000 to $53,000 annually for a family of three. And we know from recent Census data that these families are not merely switching to coverage through a job, despite the continued strong economy.  Imagine how quickly the number of uninsured children may rise when the economy sours.

These numbers are alarming. We know what happens to children who don’t have health insurance. We hear about the impact every day from pediatricians across the country that sees this firsthand — and who know what happens when children don’t get the check-ups and doctor-recommended screenings they need.

What’s especially troubling is that reductions in the child uninsured rate have been a national, bipartisan success story for many years, even before the passage of the Affordable Care Act. Thanks to Medicaid expansions for kids that started decades ago, and the passage and implementation of the Children’s Health Insurance Program (CHIP) in 1997, the country has been moving in the right direction for decades.

The Affordable Care Act built on these years of progress and reduced the number of uninsured kids to its lowest level recorded. But now that trend is reversing. 

Pediatricians and other community-based health providers are seeing parents who are hesitant to enroll their child in government assistance because of the Trump administration’s harmful policies towards immigrant families. One in four children lives in an immigrant family and 9 in 10 of them are U.S. citizens.

Fear of deportation or the inability to get a green card have led many parents to decide not to enroll their children in health insurance or other programs for which they are eligible. The implications of these tactics of fear are huge for the future of our country.

But immigrant families are not the only ones affected. Today, more and more pediatricians see parents who learn their child is uninsured when they seek care. These children have lost coverage to more subtle policies which amount to more red tape and confusion for families who are seeking to enroll or renew their child’s Medicaid coverage.

Another likely contributing factor is the last few years of efforts to repeal the Affordable Care Act and Congress’ unprecedented delay in extending CHIP. At the same time that families were getting repeated messages that coverage might be going away, federal funding for outreach and community-based enrollment assistance was cut, or in the case of CHIP, outreach grants were delayed and a critical back to school period was missed entirely.

Research is clear that when kids have health coverage, they are more likely to enter school ready to learn, graduate, and become healthier and more productive adults. The majority of uninsured kids are eligible for Medicaid or CHIP but are not currently enrolled.  So, this is a problem our country can fix. 

But to do so will require the political will and bipartisan leadership — at both the state and federal levels on both sides of the aisle. It’s time for a renewed bipartisan commitment to ensuring that children get the health care they need to grow up healthy and succeed in life. Their future depends on it.

Joan Alker is the executive director of the Georgetown University Center for Children and Families. Kyle Yasuda, M.D. is president of the American Academy of Pediatrics.