The number of children without insurance rose for the first time in a decade, and the trend may be spurred in part by the Trump administration’s rhetoric on immigration, according to a new report.
Researchers at the Georgetown University Health Policy Institute’s Center for Children and Families found 3.9 million children were uninsured in 2017, an increase of about 276,000 from 2016. That represents a 5% increase in the number of kids without coverage, up from a “historic low” 4.7% increase the year before.
The report acknowledges that an uptick of under 1% may not seem like much, but it’s statistically significant, and it’s the first time since 2008 that the rate increased. No state or the District of Columbia recorded a significant decrease in the number of children without insurance in 2017.
Edwin Park, a research professor at the Georgetown McCourt School of Public Policy who contributed to the research, told FierceHealthcare that the reversal is a “highly troubling sign” and if current trends hold, 2018’s numbers may be even worse.
The trend is especially worrying, he said, as the economy is faring well, which typically boost access to insurance through employment.
“Usually when you have a strongly growing economy, more people end up in higher paying, higher quality jobs that offer health insurance," Park said.
Latest @GeorgetownCCF children's health coverage finds first increase in children's uninsurance rate b/t 2016-2017 after decade of declines despite strong economy. ACA repeal bills, CHIP delay, marketplace sabotage & anti-immigrant hostility likely causes. https://t.co/mkQbLR2TzZ pic.twitter.com/KSQvap0o0o— Edwin Park (@EdwinCPark) November 29, 2018
The researchers point to increasing anti-immigrant rhetoric as a factor in the decline in coverage, as a quarter of American children have at least one parent who’s an immigrant. By “taking away the welcome mat” to immigrants, families may be afraid to enroll or go to the doctor.
“Immigrant families have lower participation in public programs like Medicaid and CHIP than non-immigrant families, and that’s always been the case,” Park said. “I think the concern is a lot of the attention and hostility against immigrants...could affect the ability to adjust. You could see eligible children not enrolling in Medicaid and CHIP because of the concerns of their parents.”
Other factors likely contributing to the decline are the confusion around the stalled Affordable Care Act repeal in Congress and the successful rollback of the law’s individual mandate, both of which could make some families feel like they are at risk for losing coverage anyway.
The delayed extension of the Children’s Health Insurance Program created similar uncertainty, according to the report.
Medicaid expansion also plays a key role, the Georgetown researchers found. Three-quarters of the children that lost insurance coverage in 2017 reside in states that did not expand the program. Texas, a non-expansion state, has the highest rate of uninsured children in the country, with 1 in 5 kids without coverage living there.
Park said that state-level changes to Medicaid, such as work requirements, also factor into the equation. If parents are culled from the rolls for noncompliance with these requirements, it’s unlikely that their children will remain covered, too.
“If the parents are falling off, eventually their kids are probably going to fall off as well,” he said.
To reverse these declines, states should take steps to shore up their Medicaid programs and insurance marketplaces and should consider rolling out mandate penalties themselves to replace the federal levy. The Trump administration has also significantly scaled back investment in outreach and navigators for enrollment, so providing education and pathways to coverage will also likely to fall to states, Park said.