The share of children with health coverage in the United States fell for the third consecutive year in 2019, according to census data, after decades of increases.
The decline occurred during a period of economic growth — before the coronavirus pandemic caused broad job losses that might have cost many more Americans their health insurance.
A report Friday by the Georgetown Center for Children and Families found that the ranks of uninsured children grew the most in Texas and Florida, and that Latino children were disproportionately affected. Nationally, the number of children without health insurance rose by 320,000 last year alone, to a total of nearly 4.4 million children, the report found.
“What’s so troubling about this data is we were making so much progress as a country,” said Joan Alker, the center’s executive director and an author of the report. “And now that progress is clearly reversing.”
The picture since the start of the pandemic is less clear. Many families have lost jobs that came with health coverage, which could increase the number of children without insurance. But national enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) has also swelled, aided by temporary policies to prevent families from losing coverage during the emergency. More current estimates for the uninsured rates among children will take time.
In recent years, falling enrollment in Medicaid and CHIP drove the overall changes, according to the report. Although those programs for low- and middle-income children are primarily managed by state governments, Trump administration policies could be playing a role: The administration has encouraged states to check eligibility more often, which advocacy groups say has caused many families to lose coverage because of paperwork errors and missed deadlines.
And the administration’s policies on immigrant families have caused some to end enrollment for their children even though they are eligible citizens, according to child welfare groups in several states with the largest drops. In particular, the “public charge” rule makes it harder for immigrants to be approved for green cards if they have received public benefits or are deemed likely to receive them in the future.
“They were coming to me saying: ‘Please close my case. I don’t want to get into any trouble,’” said Graciela Camarena, outreach program director in the Rio Grande Valley for the Texas branch of the Children’s Defense Fund, a group that helps enroll children in health coverage. Ms. Camarena said most clients would not be affected by the public charge policy if they signed up their children, but news of the rule had produced widespread concern.
The public charge policy was completed last summer but has been put into effect unevenly. For months, its enforcement was paused in several states by a court order. More recently, its implementation has been softened because of the public health emergency related to the coronavirus. Nevertheless, Latino children saw a disproportionate drop in coverage through 2019, according to the Georgetown report, an indication that their families were reacting to the policy.