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Three years of declining health coverage for children

October 12, 2020

Topics: Quote of the Day

By Joan Alker, Alexandra Corcoran
Georgetown University, Health Policy Institute, Center for Children and Families, October 8, 2020


For many years, the United States was on a positive trajectory in reducing the number and rate of uninsured children; in 2016, the nation attained a historic low of 3.6 million uninsured children. This progress occurred as a result of expansions of public coverage—primarily Medicaid and the Children’s Health Insurance Program (CHIP)—and was accelerated by the implementation of the Affordable Care Act’s (ACA) major coverage expansions in 2014. As employer-sponsored insurance became increasingly unaffordable for dependents, public coverage ameliorated the impacts of private coverage losses for children. However, the number of uninsured children began to increase in 2017 as Medicaid enrollment began to decline and reached 4.4 million in 2019. This represents an increase of 726,000 children during this three-year period. The rate of uninsured children rose a full percentage point from 4.7 percent to 5.7 percent. Much of the gain in coverage that children made as a consequence of the ACA’s major coverage expansions has now been eliminated. Moreover, the most recent year of data (2018 to 2019) shows the biggest one-year loss in children’s coverage during this time period, with 320,000 more children becoming uninsured. These coverage losses occurred in a healthy economy with the lowest unemployment rate in decades prior to the economic shocks and job loss associated with the COVID-19 pandemic.

Key Findings

  • After reaching a historic low of 4.7 percent in 2016, the child uninsured rate began to increase in 2017, and as of 2019 jumped back up to 5.7 percent. This increase of a full percentage point translates to approximately 726,000 more children without health insurance since the beginning of the Trump Administration when the number of uninsured children began to rise. Much of the gain in coverage that children made as a consequence of the Affordable Care Act’s major coverage expansions implemented in 2014 has now been eliminated.
  • The number of uninsured children increased every year during the Trump Administration. The largest increase was observed between 2018 and 2019 when, despite a continued strong economy, the number of children without health insurance rose by 320,000. This increase in the number of uninsured children was the largest annual jump seen in more than a decade. Moreover, since this data was collected prior to the pandemic, the number of uninsured children is likely considerably higher in 2020, as families have lost their jobs and employer-sponsored insurance, though it is impossible to know yet by precisely how much.
  • One-third of the total increase in the number of uninsured children from 2016 to 2019 live in Texas. The state saw by far the greatest coverage loss over the period with an estimated 243,000 more children living without health coverage. Florida has the next biggest loss, adding about 55,000 children to the uninsured count over the three-year period. As a consequence, 41 percent of children’s coverage losses during the Trump Administration occurred in Texas and Florida. Twenty-nine states experienced an adverse change for children from 2016 to 2019. The only state that bucked national trends and significantly reduced its number of uninsured children during this three-year time period was New York.
  • These coverage losses were widespread across income, age, and race/ethnicity, but were largest among White and especially Latino children (who can be of any race).


Full report:


By Don McCanne, M.D.

There is a special place for children in the hearts of Americans. For the last half century an extra effort has been made to provide health care coverage for children, especially through the Medicaid and CHIP programs, but also through private plans through the ACA exchanges and employer-sponsored plans that also cover dependents.

However, the reluctance to support a universal national health program inevitably left many children without coverage. American style of health care reform – incremental patches – did have some effect in reducing but not eliminating the number of children uninsured, but this has changed during the last three years – not coincidentally the years of the Trump administration. An additional 726,000 children are now without health insurance (totaling 4.4 million in 2019), and that does not include more recent losses in coverage due to job loss during the Covid pandemic, due to the threat of the public charge rule against immigrants who are here legally, and due to increased administrative barriers to enrollment in the public programs. Apparently not all Americans hold in esteem children who represent the future of our nation. But it really is disconcerting to see some of our public stewards struggle to take health care away from children.

Think again about a single payer system of improved Medicare for All… health care… for everyone… for life… health care that is affordable for each of us. Imagine an America where each year we wouldn’t find ourselves compelled to count up the number of children uninsured due to the failure of our politicians to ensure health care for everyone who needs it. Yes, the uninsured children… think of them and what that represents, and then extrapolate that to the rest of us.

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About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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