Looking for Some Good ACA News? Health Reform, Medicaid and CHIP Drive Sharpest Decline in Child Uninsured Rate on Record

Looking for Some Good ACA News? Health Reform, Medicaid and CHIP Drive Sharpest Decline in Child Uninsured Rate on Record
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The U.S. just reached an important milestone that will help more children grow to reach their full potential. Following the sharpest two-year decline in child uninsured rates on record, the U.S. made history with 95 percent of children covered by health insurance. The only age group with a better rate of health coverage are seniors who hover around 99 percent coverage rates thanks to the success of Medicare. The improvements for children were driven by the Affordable Care Act, Medicaid and the Children’s Health Insurance Program (CHIP).

For the past six years, my colleagues and I here at Georgetown University’s Center for Children and Families have reported on state-by-state and national trends in children’s health coverage. This year, we found that the nation’s uninsured rate among children fell by a third (from 7.1 percent to 4.8 percent) from 2013 to 2015 as health reform’s major coverage provisions took effect. That constitutes the largest two-year drop in the child uninsured rate on record, driven by continued enrollment growth in Medicaid and CHIP and further coverage gains achieved by health reform. 

Forty-one states successfully reduced their child uninsured rates during that time frame – far more than our previous reports have found. Children in all demographic groups studied including age, income, race and ethnicity saw an improvement in their uninsured rates. Latino children saw significant drops though they continue to be disproportionately represented in the uninsured population.

This is truly a remarkable achievement and a testament to what can be achieved when national and state leaders work together to confront intolerable problems such as children going without health coverage. The positive trend in children’s health coverage started with the expansion of Medicaid to poor children over two decades ago, the creation of the Children’s Health Insurance Program (CHIP) in 1997, and subsequent improvements to both programs. The Affordable Care Act, which maintained and enhanced Medicaid and CHIP coverage for children, accelerated this positive trend. A key feature of the ACA for kids was the “maintenance of effort” provision that ensured that states were not able to roll back their Medicaid and CHIP coverage for children.

Another key benefit of the ACA for children is what we call the “welcome mat” effect, which undoubtedly contributed to the sharp reduction in uninsured children. As more parents became eligible for and signed up for affordable coverage, they learned their children were eligible too and the whole family was able to get covered. A forthcoming report will examine whether this effect is stronger in states that expanded Medicaid than those who didn’t.

A majority of Americans are not aware of this historic achievement. A recent PerryUndem poll found that about half of voters think the number of uninsured children has increased in the last five years. In reality, the number of uninsured children actually declined by 40 percent in the past five years and has been almost cut in half since 2008. Yet, this good news for children has gone largely unnoticed by the American public. 

Studies indicate that when children have health coverage, they are more likely to graduate from high school and attend college. As compared to uninsured children, those with public coverage are much more likely to access needed care and even remain healthier as adults.

The next Congress and President will face major policy decisions that will impact whether or not the U.S. will preserve these gains and keep the momentum going for children. The future of children’s health coverage depends to a large extent upon the strength of Medicaid, CHIP and the Affordable Care Act. With CHIP funding up for renewal next year, Congress and the next President will have an opportunity to build on or imperil this success.


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