“We're making progress in reducing the number of uninsured kids,” said report author Julie Sonier, deputy director for SHADAC. “Particularly, we're making progress among groups of kids that historically have been far more likely to be uninsured than other kids.”
Disparities based on race and income level, which has served as a barrier to coverage for many within the most vulnerable populations for years, appears to have narrowed among children during the study period, according to the report. The percentage of uninsured children in households with incomes below 138% of the federal poverty level fell from 15.5% in 2008 to 10.4% in 2012.
Also, children in low-income households were 4.5 times more likely to be uninsured than children in higher-income households in 2012, a decline from 2008 when they were 5.3 times more likely.
The uninsured rate among Hispanic children dropped sharply from 18% in 2008 to 13% in 2012. Overall, the uninsured rate among non-white children fell from 9.6% in 2008 to 7.1% in 2012.
Perhaps less encouraging was the kind of coverage children obtained over the past several years, as the percentage of children with private insurance declined from 64% in 2008 to 59% in 2012. Overall, declines in private insurance were offset by a rise in the number of children obtaining health coverage through public aid programs such as Medicaid and the Children's Health Insurance Program, up from 26% in 2008 to 34% in 2012. Huge shifts from private to public health insurance were found in states including Montana, whose rate of children with private insurance dropped from 65% in 2008 to 53% in 2012 only to see the rate of children with public coverage swell from 19% in 2008 to 35% by 2012.
“Many states have been working really hard over the past several years to streamline the enrollment process for those programs, particularly with a focus on kids,” Sonier said.
Though no states were found to have seen an increase in the number of uninsured children between 2008 and 2012, the analysis found that coverage varied greatly throughout the country. While substantial declines occurred in Oregon, Florida, Delaware, Mississippi, South Dakota and Idaho—all of whose rates fell by more than 5 percentage points—the rate remained above 10% in as many as eight states, with Nevada having the highest at 17%.
A number of children were likely to gain coverage as a result of the Patient Protection and Affordable Care Act, Sonier said, despite that the vast majority of the provisions within the health law were aimed at adults.
One way is through the availability of premium tax credits provided for those purchasing private insurance through the health insurance exchanges. For children eligible but not already enrolled into either Medicaid or CHIP, Sonier expected some could gain coverage as their parents become eligible and sign up for public coverage through the ACA.
About 7 million children ages 18 and younger were uninsured in the U.S. in 2012, according to the Kaiser Commission on Medicaid and the Uninsured.
Follow Steven Ross Johnson on Twitter: @MHsjohnson