The Number of Uninsured Children Started Declining Even Before Obamacare

A new report shows the rate of uninsured children declined significantly in most states between 2008 and 2012. The Affordable Care Act calls for new investments that could help bring those rates down lower.
by | April 15, 2014 AT 4:30 PM
An emergency room physician tends to a child in Alabama.
From 2008 to 2012, the percentage of children without health insurance fell from 9.7 percent to 7.5 percent, according to a report. David Kidd/Governing

Most states significantly lowered their percentage of uninsured children during the Great Recession and the years that followed, more than compensating for losses in private coverage with gains through Medicaid and the Children’s Health Insurance Program, according to a new report. The Affordable Care Act calls for new spending in 2016 that would potentially spell more good news, but that will require Congressional authorization.

From 2008 to 2012, the percentage of children without health insurance fell from 9.7 percent to 7.5 percent, according to a report from the State Health Access Data Assistance Center of Minnesota, which was funded by the Robert Wood Johnson Foundation. No states showed an increase in the rate of uninsured children over that time, and in 35 states the gains were “statistically significant.” And while disparities in insurance rates based on household income remain, a child living at or below 138 percent of the federal poverty level is now only 4.5 times more likely to be uninsured than a non-poor child, as opposed to 5.3 times more likely in 2008.

Both CHIP and Medicaid provide health insurance for poor children, but CHIP came about more recently and covers children with higher family incomes. Signed into law in 1997, the program insures nearly eight million children at the state level through federal matching funds, which are distributed at higher rates than Medicaid. When Congress reauthorized CHIP in 2009 the program included $90 million in outreach funding and investments to improve enrollment.

Those efforts, along with increases to eligibility levels in some states, helped eliminate gaps between higher-income and lower-income children, said Julie Sonier, deputy director of the State Health Access Data Assistance Center. “They, more than other income groups across the U.S, are more likely to be eligible for public programs, and there were efforts among states to streamline administrative processes as well as efforts to improve the state’s retention of kids to be eligible,” she said.

The largest overall declines were in Oregon, where the rate of uninsured fell by 6.4 percent, in Florida at 6.1 percent and in Delaware and Mississippi, both of which declined by 5.2 percent. But Sonier said her group’s research didn’t focus on common factors among states that experienced the largest declines.


A major shift between 2008 and 2012 was the decline in private insurance and the uptick in public health programs. During that period private insurance fell from covering 64.5 percent of the child population to 59 percent, and public sources of coverage rose from about 26 percent to 33.6 percent.

The decline in private sources of coverage has been ongoing for 20 years, as employers increasingly eliminate coverage for dependants, said Tricia Brooks, a senior fellow at the Center for Children and Families at Georgetown University. CHIP deserves much of the credit for improving the rate of coverage despite that trend in private employer coverage, and the Affordable Care Act provides a prominent role for the program, she noted. States are required to maintain at least their current eligibility levels until 2019, and starting 2016 the federal matching rate will increase 23 percent, to 93 percent. But that’s assuming Congress authorizes the spending when funding for the program runs out in early 2016. The Affordable Care Act also calls for another $40 million in outreach efforts targeting the uninsured.

Brooks said CHIP has traditionally enjoyed support from both parties but acknowledged times have changed. “Granted, the politics of health reform are very different now than when CHIP was enacted or reauthorized, but it has had very strong bipartisan support,” she said.