A remarkable public health achievement has taken place with too little fanfare: the steady, year-over-year strides made over most of the last decade in ensuring that children have health care coverage.
In 2008, 7.6 percent of children under the age of 19 were uninsured nationally. That number dropped each subsequent year, hitting a historic low of 4.7 percent in 2016.
Unfortunately, a troubling new report shows that this admirable trend has come to a halt. In 2017, the latest year for which data are available, the uninsured rate for this age group rose to 5 percent, according to the Georgetown University Health Policy Institute’s Center for Children and Families. Given the coverage headwinds detailed in the report, the uninsured rate could climb even higher when the 2018 information is tallied.
The Georgetown center is home to respected researchers and relied on data from the U.S. Census Bureau’s American Community Survey. The uptick detected is credible and concerning. The annual percentage change translates to an additional 276,000 uninsured children, bringing the total nationally to 3.9 million. Moving in the wrong direction has consequences that go far beyond public health metrics.
Ensuring that children can see a medical provider as they grow plays a key role in propelling them toward a prosperous future — helping them go to class, stay in school, get a job and become contributing members of their communities. As the Georgetown report puts it, “Kids need health care to succeed.” Everyone has a stake in making sure the next generation is healthy enough to do just that.
That the uninsured rate climbed during the strong economy of recent years is disturbing. The timing underscores the role that politics had in reversing this positive trend. Congressional delays in funding the Children’s Health Insurance Program in late 2017, for example, along with efforts to undercut the Affordable Care Act (ACA) contributed to families’ being “unaware of their options or deterred from seeking coverage.” The researchers summed it up well, describing all of this as rolling out an “unwelcome mat” to public health care programs that cover kids and their families, or that provide assistance, as the ACA does, to buy private insurance.
No state, even traditional health care leaders like Minnesota, was immune to the halt in progress. Other than the District of Columbia, no state meaningfully reduced its children’s uninsured rate in 2017, according to the report. Minnesota’s rate didn’t improve, but it didn’t get worse, either, remaining at 3.4 percent. But its neighbor South Dakota had the largest magnitude of change of any state. Its percentage of uninsured children rose from 4.7 percent in 2016 to 6.2 percent in 2017.
The states seeing large increases had this in common: They have failed to expand eligibility for Medicaid, the public medical assistance program for the poor and disabled, as the 2010 Affordable Care Act allowed them to do. Uninsured rates in these states “increased at almost triple the rate … than in states that have expanded Medicaid.” (Minnesota was one of the first states to do this, under Gov. Mark Dayton’s leadership.)
Another common theme in states with high rates of uninsured children: They often are home to many American Indians or Alaska Natives. North Dakota is one of these states, and its leaders must take action.
Minnesota’s uninsured rate of 3.4 percent is deceptively impressive. The state ranks only 17th when it comes to top states for children’s coverage, according to the Georgetown report. The District of Columbia was on top, at 1.2 percent, and Massachusetts was second, at 1.5 percent. Iowa cracked the report’s top 10, coming in seventh with a 3.1 percent uninsured rate in 2017.
At a minimum, Minnesota should be in the top 10 of this critical public health ranking. The Georgetown report notes that the majority of uninsured children are already eligible for public medical assistance programs. A game plan to ensure that kids are enrolled in these programs would get the state’s newly appointed health care leaders off to a smart start.