The number of children without health insurance in the United States rose for the first time in at least a decade, according to a report by the Georgetown University McCourt School of Public Policy’s Center for Children and Families released Nov. 21.

The study estimated that the number of children without insurance in the United States rose by 276,000 in 2017, bringing the total number to 3.9 million. The number of uninsured children rose for the first time since 2008 last year, according to the report, which analyzes data the U.S. Census Bureau releases annually.

The report found that three-quarters of children who lost coverage live in states that did not expand Medicaid services available under the Affordable Care Act, a policy signed by former President Barack Obama in 2010 that expanded Medicaid eligibility and offered cost assistance for the uninsured through health insurance marketplaces.

The report found that the number of uninsured children rose in all 50 states because of loss in coverage or possible decreases in signups. Washington, D.C., saw the only increase in children with health insurance in 2017, after the number decreased in 2016. The percentage of children without health insurance in D.C. decreased from 3.1 percent to 1.2 percent. In a list of all 50 states and D.C., the city jumped from 13th to first in the number of children with insurance.

GU HEALTH POLICY INSTITUTE | In 2017, the number of children without health insurance in the United States increased for the first time since 2008, according to a Nov. 21 report released by the Georgetown University McCourt School of Public Policy’s Center for Children and Families.

The discrepancy between the growing U.S. economy and the increase in number of uninsured children is concerning, said Olivia Pham, CCF research associate and co-author of the study.

“I think that it is really alarming, especially when we’re in a time when we have a strong economy,” Pham said. “Why are we seeing this increase in uninsured kids?”

The report suggests recent federal policy changes may have influenced the uptick in uninsured children. While the majority of children from low-income families are eligible for Medicaid or the federal Children’s Health Insurance Program, doubt regarding the programs’ futures may discourage enrollment, according to the Urban Institute, a think tank in D.C.

Congress did not fully fund CHIP for over three months in 2017, prompting some states to freeze enrollment in the program.

Additional efforts in 2017 to repeal the Affordable Care Act and its individual mandate, which required almost all U.S. citizens and permanent residents to have health insurance, could have also affected the number of families with health insurance, the study says.

The report found one in four uninsured children has at least one parent with immigrant status. The rhetoric of President Donald Trump’s administration on immigration policy also may have contributed to fewer sign-ups, according to Pham.

In September, the White House proposed adding Medicaid to a list of public services that could prevent legal immigrants from receiving green cards if they had applied for public assistance.

“That kind of policy takes away the welcome mat from Medicaid and CHIP,” Pham said. “It has the potential to discourage families from applying for coverage and may give them fear about applying for Medicaid and CHIP when it could endanger other members of the family or their status.”

The report also documented a pattern of uninsured children in states with high percentages of Native American and Alaskan Native populations. Indian Health Services, a division within the Department of Health and Human Services, provides health programs to Native Americans in the continental United States and Alaska.

However, these populations still have high levels of uninsured children because the IHS does not provide insurance coverage, Pham said.

“The IHS is a provider of health services, but they are not a source of health coverage,” Pham said. “That is still important, because there are not IHS facilities everywhere, and kids can’t always access an IHS immediately when they need care.”

The study found Texas had the most uninsured children in the country in 2017, while South Dakota witnessed the largest increase in uninsured children from 2016 to 2017. Both states are among the 14 that have not authorized an expansion of Medicaid for low-income families.

In order to limit the increase of uninsured children, policy changes must be implemented, Pham said.

“I think the big concern with this report is that this upward trend in uninsured children continues,” Pham said. “If there are not changes in policy, if people don’t feel like it’s safe to access services, we’re going to see more and more children uninsured.”

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