September 27, 2022

Rate of Kids Without Health Insurance Decreased Nationwide and in 21 States in 2021, Inequities Persist

According to the U.S. Census Bureau’s new American Community Survey data on the KIDS COUNT Data Center, the rate of children under age 19 without health insurance dropped to 5% in 2021. That’s an estimated 4,165,000 million kids nationwide — down from 6% in 2019. Twenty-one states also saw declines.

Since the COVID-19 pandemic hit, Congress has passed multiple relief measures that bolstered the insurance safety net for children and families, including:

  • increased state funding to ensure that Medicaid enrollees did not lose coverage during the pandemic;
  • reduced costs for purchasing coverage through the Affordable Care Act (ACA) health insurance marketplace; and
  • expanded federal and state measures, such as the Children’s Health Insurance Program (CHIP), to improve access to insurance.

What Are Medicaid and CHIP?

Census Bureau analysis indicates that increased enrollment in Medicaid and CHIP was behind the reduced U.S. rate of uninsured children in 2021, but what do these programs entail?

  • Medicaid is a large public health insurance program for children and adults who meet a low-income eligibility threshold. Under the ACA, states can expand Medicaid eligibility to more low-income families. In 2021, 36 states and Washington, D.C. had expanded their Medicaid eligibility requirements.
  • CHIP is another public insurance program for children in families whose incomes are too high to qualify for Medicaid but likely too low to afford private insurance.
  • While kids and young adults can be covered under a parent’s or guardian’s insurance plan up to age 26, only children under age 19 can qualify for Medicaid or CHIP.

One-in-Three Children Rely on Public Insurance

Nationwide, about one-third of kids (34%) received public health insurance in 2021, while nearly half (48%) were covered through employer-based insurance. Far fewer children had other types of coverage, including a mixture of public and private insurance (5%), a plan purchased directly from an insurance company (5%) or other private insurance (2%).

At the state level, the share of kids with public insurance ranged from 13% in Utah to more than half (51%) in New Mexico in 2021.

Why Insuring Children Matters

Kids with insurance are more likely to access timely medical care for health needs. They have improved physical, mental and behavioral health outcomes compared to those without coverage. Poor health during childhood can affect virtually every area of a child’s life, including school performance, and can have lasting consequences on health, well-being and financial security into adulthood.

Children eligible for public insurance are especially likely to see the benefits of health coverage, including increased economic stability for their families. For instance, when a family receives Medicaid, they can use more of their income on other basic needs like food and housing. Medicaid has also been linked to reduced medical debt and bankruptcies, and it is considered one of the nation’s leading anti-poverty programs.

Insuring parents helps children, too. It increases the likelihood of parental health and strengthens parents’ ability to care for their children.

Children’s Risk of Being Uninsured Varies by State

Many factors, such as state policies and practices and local economic conditions, influence the wide variation in access to coverage across the country. In 2021, the lowest uninsured rates for children were in the Northeast states of Massachusetts (1%), Vermont (2%) and Connecticut (2%). The highest rate was in Texas, with 12% — or 930,000 kids — lacking insurance.

However, Texas was among the 21 states that improved in 2021, with its rate of uninsured children declining by one percentage point, from 13% in 2019. The other 20 states that made gains in 2021 also saw declines of one to two percentage points. Despite this progress, rates of uninsured children increased in seven states and Washington, D.C. in 2021, each by one or two percentage points as well.

Inequities Persist, Particularly for American Indian Children

The rate of uninsured American Indian children has been more than twice the national rate in all four years of data available on the KIDS COUNT Data Center, although the percentage for American Indian children fell in 2021, from 14% in 2019 to 12%. The uninsured rate for Latino children (9% in 2021) has also remained higher than the national level for four years. Among kids of two or more races, the rate increased from 4% in 2019 to 6% in 2021. Figures have been fairly steady for Black (5% in 2021), white (4%) and Asian and Pacific Islander (4%) children.

In addition, immigrant children, particularly those who are undocumented, are at increased risk of being uninsured compared to their peers with U.S. citizenship.

Addressing Inequities and Barriers to Health Insurance

Although pandemic-era policies helped many children and families access and keep coverage during this national health crisis, approximately 4 million kids still lack health insurance, and concerning disparities in access to coverage remain. Concerted action is also needed just to maintain the gains of 2021, as the federal mandate for states to ensure continuous Medicaid coverage is slated to end when the pandemic is over. States, too, can take action to keep eligible families enrolled in Medicaid or help them enroll in other plans.

Policymakers and leaders in multiple sectors must continue working toward systemic change to address the long-standing inequities and barriers that contribute to the disproportionately high uninsured rates among American Indian children. Additionally, leaders can reduce immigration-related barriers to enrollment in Medicaid and the ACA health insurance marketplace.

More Child and Family Health Resources

See all health insurance data on the KIDS COUNT Data Center, including these newly updated indicators:

Additional resources:

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