Even as Republicans boast of a strong economy and low unemployment, the United States has taken unprecedented steps backward in health insurance coverage for kids — and once again, Texas is among the worst offenders. For the first time in the decade that this data has been tracked, the number of uninsured children in the United States actually increased in 2017, according to a new report, which points to the federal government’s sabotage of the Affordable Care Act as a likely primary factor. And the decline in coverage is on track to continue, researchers say.
In the new data, the Lone Star State ranks where it typically does on matters of health care coverage: at the bottom. Home to more than 20 percent of all uninsured kids in the country, Texas has the highest number and rate of kids without health coverage, according to the annual Georgetown University report, based on U.S. Census data. After several years of slow but steady progress, Texas saw one of the country’s largest spikes in its rate of uninsured children, which increased from 9.8 percent in 2016 to 10.7 percent last year — more than double the national rate. The increase extends across race, ethnicity and income level. About 80,000 fewer Texas kids were insured in 2017 than the year before.
“This is a stark warning that national progress in covering kids is at risk,” said Joan Alker, lead author of the report and executive director of the Georgetown University Health Policy Institute Center for Children and Families. Particularly troubling, she said, is the uniform lack of progress across all states in 2017, especially at a time of economic growth. The rate of uninsured kids remained stagnant or rose even in states such as California and Maryland — which, unlike Texas, have tried to increase coverage and resist federal attacks on the ACA.
The Trump administration and conservative lawmakers’ attempts to sabotage the health care law are likely the primary driver, Alker said. Votes in Congress to repeal the ACA last year, though ultimately unsuccessful, brewed confusion over whether the law still exists and coverage is still available. (It does, and it is.) When Congress allowed funding for the bipartisan Children’s Health Insurance Program (CHIP) to lapse for a shocking four months last winter, parents in some states were told that their kids’ coverage could soon end.
Meanwhile, the Trump administration has shortened the insurance sign-up period, which runs until December 15 in Texas, and slashed funding for outreach and enrollment assistance. And Texas Attorney General Ken Paxton is leading a lawsuit against the ACA that could kick millions of people off their health insurance, putting coverage for kids with pre-existing conditions at risk.
Another factor noted in the study is anti-immigrant sentiment from the federal government. One-quarter of Texas kids live with at least one parent who is not a citizen. Trump’s intimidation of these families is likely deterring many from seeking government benefits, including enrolling kids in Medicaid or CHIP that they’re eligible for, Alker said. While the uninsured rate among Hispanic kids nationwide remained consistent in 2017, it jumped from 13.5 to 14.4 percent in Texas, where health care workers say they’ve seen a spike in fearful immigrant families deciding not to seek care.
“Texas has always done a bad job making sure kids have health coverage; now it’s doing even worse,” said Adriana Kohler, a senior health policy associate with the advocacy group Texans Care for Children. “That’s why this is so important, and so disturbing.”
Kohler suggests two straightforward ways Texas could insure more children. First, by allowing kids to stay on Medicaid for a full year, rather than requiring renewals every six months that she says add bureaucratic red tape and cause kids to “fall through the cracks.” Second, and most importantly, Texas should expand coverage for adults, Kohler said, noting that if parents have insurance, their kids are more likely to be covered. “This all goes back to fact that state leaders have not taken action to address the high uninsured rate overall,” she said, which remains the highest in the country and also increased last year.
Yet Republican state leaders in Texas rejected the ACA’s Medicaid expansion, which Alker calls the “No. 1 surefire way” to “turn this around.” Driven by opposition to Obama’s health care law, Texas has repeatedly declined billions in federal funds that would’ve expanded health coverage to about 1 million poor Texans. Three-quarters of the kids who lost coverage last year live in the 14 holdout states that haven’t expanded Medicaid. Expanding coverage for those low-income adults would in turn boost enrollment of eligible kids, Alker said. “If Texas expanded Medicaid in 2017, I think we probably would see different numbers.”