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Even as the Economy Grew, More Children Lost Health Insurance

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 best medicine for a COVID-19 economy? More education and training

Reading the tea leaves of a U.S. economy reshaped by COVID-19 has sent economic analysts and prognosticators into overdrive. Many see a move away from big cities and into simpler, socially distanced life in small towns. If this happens at scale, it could be a boon to heretofore “left-behind” places in the Midwest and other regions.

Others predict significant drops in demand for jobs with low education and training requirements, driven by automation and the growth of technology needed to operate socially distanced offices, warehouses, manufacturing facilities and even restaurants. A recently released analysis by the Federal Reserve Bank of Philadelphia lends support to this idea.

Policymakers can adopt policies to help improve wages and opportunities in jobs with fewer credentialing requirements, for example by helping smaller manufacturers and boosting the minimum wage. But policy also needs to directly address the need for more workers with higher skills due both to the pandemic and longer-run economic trends. In many of the new and growing jobs, these higher skill requirements can best be met by providing workers with more extensive and affordable post-secondary opportunities.

As one of us argued earlier this year in the New York Times, some industries will benefit from the COVID-19-related economic crisis, but those most likely to do so – in fields such as health care, medical devices and communications – require workers with associate degrees or short-term certifications of the sort available at community colleges. A society that moves fast to retrain its work force for these new opportunities will recover more quickly than one that does not.

Deep recessions like the one we are currently in accelerate existing trends towards automation and change the skills demanded by employers. Again, this poses a particular challenge for manufacturing-reliant regions that have been hard-hit by the coronavirus and were already home to an aging workforce lagging in rates of postsecondary education.

The U.S. needs a nationwide program that offers tuition-free education to adult workers, much like the GI Bill for returning servicemen and women after World War II. As Congress continues to debate its financial response to the COVID-19-induced recession, it is worth noting that such a program would require a relatively small investment, costing barely $5 billion over four years even if the take-up rate is very high.

In Michigan, the Futures for Frontliners program, created with federal money by Gov. Gretchen WhitmerGretchen WhitmerThe best medicine for a COVID-19 economy? More education and training Biden leads Trump by 8 points in Michigan: poll The Hill’s Campaign Report: Debate fallout l Trump clarifies remarks on Proud Boys l Down to the wire in South Carolina MORE, will cover community college tuition and fees for essential workers without college degrees. It represents one possible model, and the enthusiastic early response suggests that such initiatives would be welcomed.

The worry about diverging economic opportunities for differentially educated people and places is nothing new. The gap in earnings based on education was widening even before the pandemic and is