For the first time in a decade, the number of children without health insurance in the United States has risen — and Texas again has the largest share.
A Georgetown University Center for Children and Families report released Thursday found that more than one in five uninsured children in the U.S. live in Texas — about 835,000 as of 2017. The state saw an increase of about 83,000 uninsured children from 2016 to 2017.
Researchers are most vexed that the report marks the first time since the data was collected in 2008 that the nationwide number — as well as the rate — of uninsured children increased, after a decade of decline. The national rate increased from a historic low of 4.7 percent in 2016 to 5 percent in 2017. Texas’ rate of uninsured children in 2017 was at 10.7 percent, up slightly from the previous year and still more than double the national average.
“The absence of significant progress across the country suggests that even states with the best intentions were unable to withstand strong national currents to protect children from losing health coverage,” researchers wrote.
Texas has had the highest number of uninsured kids two years in a row. Estimates for comparable numbers of uninsured children by state before 2016 were not immediately available from researchers or the U.S. Census. That's because the Census in 2017 changed the definition for children in its American Community Survey data. Previously, children were defined as 17 and under, but now the federal agency counts them as 18 and under.
The new rates are "a big red flag,” said Joan Alker, the center's executive director. She said she wasn’t expecting an improvement — “the best outcome would be stagnation” — but she was surprised by the results.
The increase in the number of uninsured children comes from a combination of factors, Alker said. She pointed out that Texas has the highest uninsured rate among adults in the country, meaning children are less likely to have coverage if their parents don’t. It’s also a challenge for Texas families to receive Medicaid, the joint federal-state health insurance program for the poor and disabled, since some low-income families make too much money to qualify. Alker also said jobs in common Texas industries including the agriculture and service sectors are less likely to offer insurance coverage.
In addition, Texas has a high proportion of Hispanic children, who are also less likely to be insured. The report found a pattern where states doing poorly with child uninsured rates often have larger populations of Hispanic children or Native American/Alaska Native children.
“[The report] will raise alarm bells and it should,” Alker said. “We know kids who are uninsured don’t do as well in school, don’t have as good outcomes educationally or economically, so this is an issue that policymakers really need to pay attention to.”
There are several national factors that affect the rate of uninsured children.
For one, the anti-Affordable Care Act talk from the Trump administration, Congress and Texas lawmakers. Texas is leading the charge in a federal lawsuit that will determine whether the law is constitutional after Congress ended the mandate for individuals to have health insurance. In addition, expanding Medicaid through the 2010 health law has been a nonstarter in the GOP-dominated Texas Legislature. An estimated 1.1 million low-income Texans would be eligible for coverage under a Medicaid expansion, according to the Kaiser Family Foundation. Experts have said adding more adults to Medicaid would decrease the uninsured rate but Republican legislators have said the future costs to Texas are not worth it. The center's report found that nationwide, three-quarters of the children who lost coverage between 2016 and 2017 live in states that have not expanded Medicaid coverage to parents and other low-income adults.
There’s also the rhetoric around immigration, which may have discouraged some families from seeking coverage for themselves and their children, known as the "unwelcome mat" effect, according to experts. In addition, there was mass confusion last year when families feared their kids would lose coverage under the Children's Health Insurance Program after Congress failed to renew funding in time. While the funding was ultimately renewed, public health experts fear parents may have allowed the CHIP coverage to expire and haven’t renewed.
Thousands of uninsured children are often eligible for health insurance under Medicaid, CHIP or Healthcare.gov, the federal website where people can buy coverage, but families may be unaware of their options.
The steady decrease of federal funding available for navigators, who help people sign up for health insurance, hasn’t helped either. In Texas, that funding went down by 85 percent over two years to just $1.4 million in 2018. Only two community organizations statewide — Change Happens, a clinic based in Houston and MHP Salud, a community health group in the Rio Grande Valley, Laredo and El Paso — received funding for the navigator program. Public health advocates have expressed fear that underrepresented communities are not being reached.
Adriana Kohler, a senior health policy analyst with Texans Care for Children, an advocacy group, said state lawmakers “have to recognize we have a problem and start working on it.” Some solutions, she said, include expanding Medicaid and allowing children to stay on Medicaid for a full year without filing income verification paperwork every six months, a policy that often has children losing coverage.
“Texas was already doing a bad job in making sure children have health insurance and now it’s even worse,” Kohler said. “It’s not just about the number or percentage increase — this is disturbing for Texas families and communities who want children to get well child check-ups and everything else that health insurance means for a child.”