Joan Alker, executive director of the Center for Children and Families, said during a call with news media Tuesday that the decline in coverage is "due in large part to the Trump administration's actions or inactions that have made health coverage harder to access or have deterred families from enrolling their eligible children in Medicaid or (the Children's Health Insurance Program)."
The increase in uninsured kids can be explained in part by Trump administration actions and rhetoric that have led immigrant families to keep from enrolling eligible kids in government programs for fear of being deported, separated from their children, or having trouble in the future adjusting their status, she said.
Though it was recently blocked from taking effect by federal judges in two states, the Trump administration's public charge rule, finalized in August, would have penalize legal immigrants for using government benefits like Medicaid.
Some states have also made it harder for families to enroll in or renew their kids' coverage by requiring more paperwork and more frequent income checks, Alker explained.
"After many years of clear bipartisan leadership to get kids covered and national attention on the value of coverage, the discussion in 2017 about repealing the Affordable Care Act, cutting Medicaid and delaying funding for CHIP has had repercussions. It has caused a lot of confusion about whether or not families could get coverage for their kids," she said.
According to the report, the loss of coverage was widespread across the nation, with 15 states experiencing a statistically significant increase in either the number or the rate of uninsured children between 2016 and 2018.
States that had the most significant increases in the number of uninsured by percent change over the two-year period include West Virginia, Tennessee, Idaho, Alabama and Ohio.
Of all states, Texas had the largest rate of uninsured children at 11.2% in 2018.
States that have not expanded Medicaid under the ACA were more likely to have higher rates of uninsured children, according to the report. Uninsured children from families with incomes between 138% and 250% of the federal poverty level saw the sharpest increase in the uninsured rates.
There's evidence that children with Medicaid coverage have better health outcomes and are more likely to graduate from high school, earn higher income as adults, and use fewer government benefits in the long-term, Alker said, adding that families whose children are uninsured even for a short period risk medical debt and bankruptcy if an accident occurs.