Backsliding continues on children’s health care coverage
The share of U.S. children without health insurance grew to 5.8% in 2023, with children of all races and in most regions of the country experiencing a decline in coverage.
More than 4.4 million U.S. children do not have health insurance, according to new figures from the U.S. Census Bureau, representing a half-point increase in the children’s uninsured rate since 2022.
“After making enormous progress in cutting the uninsured rate for children, we have been backtracking since 2017,” said First Focus on Children President Bruce Lesley. “The American Rescue Plan Act helped children stay insured, but they are once again losing ground. Children were the only group to lose coverage in 2022 and now, in 2023, they continue to fall behind. Children’s bodies and brains develop faster than at any other time in life and the loss of coverage as kids follows them into adulthood. Every child in this country should have access to high-quality, affordable health care.”
The 2023 uninsured rate for children increased among every ethnic group, but Hispanic children experienced the highest loss of coverage, with an increase of 0.8 percentage points to 9.4% of all Hispanic children. Asian children had an uninsured rate of 4.2%, white children had an uninsured rate of 4.4%, and Black children had an uninsured rate of 4.8%.
Since the so-called Medicaid “unwinding” began in 2023, 5.7 million children have been disenrolled from the program, most of them due to administrative issues.
The new Census figures also show that children in states that have not expanded Medicaid are uninsured at roughly twice the rate of those in Medicaid expansion states.
In 2022, more than 4 million children — or 5.4% of all U.S. children — did not have health insurance, according to the U.S. Census Bureau, and children were the only group to lose coverage that year. The 0.4 percentage point increase from the previous year came despite an extension of pandemic-era policies that prevented states from removing children from public health care programs such as Medicaid and the Children’s Health Insurance Program (CHIP). In 2021, the number of U.S. children without health insurance declined for the first time in at least four years, aided by government policies that helped maintain their access to medical care.
First Focus on Children has long advocated for continuous eligibility in Medicaid and the Children’s Health Insurance Plan (CHIP) for children from birth through age 5. Early childhood continuous coverage would guarantee children in these programs uninterrupted coverage from birth until age 6 even if their household’s circumstances change, preventing gaps in coverage and periods of uninsurance due to income fluctuations or missed paperwork. First Focus Campaign for Children supports Rep. Joe Neguse’s (D-CO) Save Children’s Coverage Act (H.R. 1316), which would allow states to implement continuous eligibility for children through age 5 without a cumbersome administrative burden.
First Focus Campaign for Children also supports the Children’s Health Insurance Program Permanency (CHIPP) Act, which was reintroduced in the 118th Congress by California Democrat Rep. Nanette Barragán. The CHIPP Act (H.R. 4771) would permanently fund CHIP and related programs that support the development of child health quality measures, as well as outreach and enrollment efforts.
For more than 25 years, CHIP has ensured high-quality, affordable, pediatric-appropriate health care for children in families whose parents earn too much to qualify for Medicaid but too little to purchase private health insurance on their own. CHIP helped reduce the number of uninsured children by more than 68%, from an uninsurance rate of nearly 15% in 1997 to less than 5% in 2016. CHIP, together with Medicaid, plays a particularly important role for children of color: In 2021, more than half of Black, American Indian or Alaska Native, and Hispanic children relied on Medicaid and CHIP as their source of health coverage.