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Massachusetts health care — wonky, with a healthy dose of reality

Uninsured Children on the Rise Across the Nation – Massachusetts (Mostly) Holding Strong

Uninsured Children on the Rise Across the Nation – Massachusetts (Mostly) Holding Strong

December 2, 2019

Massachusetts is known for its dedication to expanding access to health care, especially for the most vulnerable populations, including children. As a state, Massachusetts has led the cause by developing health coverage systems which were used as models for the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA). The Georgetown University Health Policy Institute Center for Children and Families (Georgetown CCF) recently released their annual report about the child uninsurance rate. This year’s report, The Number of Uninsured Children is On the Rise, compares health insurance data from the US Census Bureau’s American Community Survey from 2016 through 2018.

While children’s health coverage rates had been improving for many years prior to 2014, due in large part to the creation of programs like CHIP, the ACA further decreased the rates and number of children without insurance to their lowest levels in 2016. These programs allowed for an increase in coverage eligibility and simplification in the enrollment process. However, since 2016, children’s participation rates in Medicaid and CHIP have decreased for the first time since 2008, when participation began to be measured.

Although the state continues to lead with the lowest uninsured rate for children in the US, the uninsurance rate for the Commonwealth’s children increased by 0.2%, comparing 2016 and 2018. Our blog post on last year’s Georgetown CCF report on uninsured children highlights an increase in the child uninsurance rate even in Massachusetts – from 1% to 1.5% from 2016 to 2017. Looking at this year’s report, it appears the uninsurance rate for children in the state has actually decreased from 1.5% to 1.2% between 2017 to 2018. However, compared to 2016, the actual number of uninsured children continues to be slightly higher.

To put this in context, Massachusetts continues to lead the nation in health coverage for children. The Georgetown CCF report highlights other states where state and federal policy decisions have led to an increase in uninsured children, with no progress in moving the needle in this respect. Almost half (49.6%) of uninsured children in the US reside in just six states – Texas, Florida, California, Georgia, Arizona, and Ohio. Of these states, Texas, Florida, and Georgia have not expanded Medicaid for parents or childless adults, and there are still several other states that are “holdouts” in this regard – which can impact health coverage for children as well. The report shows one state – North Dakota – has made some progress in decreasing the child uninsurance rate.

Many factors can lead to the continued downward trend of health coverage for children during the past couple of years. The report cites the decrease in public health coverage as a major factor in the increase in uninsured children. Current federal policymakers have had a different approach when it comes to access to care. Attempts from Congress to repeal the ACA and the administration in chipping away at certain ACA protections, the repeal of the individual mandate penalty in 2017 and funding cuts for ACA outreach and enrollment have all brought a reduction in infrastructure and focus on ensuring enrollment in health coverage. Even the delayed budget extension for CHIP led to confusion among families who rely on the program about whether the benefits would continue. Researchers at Georgetown CCF believe that the increase in negative immigration rhetoric and policies on the federal level have also deterred families from enrolling their children in public benefits, including health insurance, such as parents disenrolling their eligible children despite their legal immigration status.

In Massachusetts, Health Care For All and stakeholders in the health care community are dedicated to protecting and improving access to health coverage. We also know that having health insurance does not necessarily translate into having access to care. Some health insurance comes with high costs and some safety-net programs, even for children, have caps on services and leave gaps in coverage of necessary care. That is why HCFA and the Children’s Health Access Coalition is advocating for a bill which would ensure that low-income immigrant children in our state have equitable access to coverage. An act to ensure equitable health coverage for children (H. 162/ S. 677) better known as Cover All Kids, seeks to expand comprehensive MassHealth coverage to low-income children who would otherwise be eligible except for their immigration status. This bill would help more than 30,000 children and young people in our state obtain the coverage they need, to live, learn, and thrive. If your child or the children you serve are facing barriers to accessing because they depend on the Children’s Medical Security Plan (CMSP), MassHealth Limited, or the Health Safety Net (HSN), share your story today and together we can a difference! Now is the time for Massachusetts to Cover All Kids.