Are Trump’s policies causing kids in Miami to lose their health insurance?

Oct. 30--A national spike in children going without health insurance is especially bad in Florida and Miami-Dade County, partly because of a "chilling effect" for immigrant families who hesitate to enroll their children in public assistance programs because they worry about deportation, a new report found.

That's one of three factors likely driving the rise in children without insurance in Miami-Dade, where 7% of children were uninsured in 2018, according to the report by the Georgetown University Center for Children and Families released Wednesday.

About 41,500 kids are uninsured in Miami-Dade, which ranks ninth in the country for total number of uninsured children by county, according to the report.

Overall in Florida, the report showed an 18% spike in uninsured children from 2016 to 2018, the seventh-highest increase in rate of uninsured children in the country during that time.

The annual report measures the levels of uninsured children in two-year increments, and this year's report is the first in which both years had data reflecting the potential influence of President Donald Trump's immigration and healthcare policies.

"When we did this report last year and just looked at 2016 and 2017, we didn't see such a big jump in Latino children becoming uninsured," said Joan Alker, the executive director of the Center for Children and Families and lead author of the report. "Now we clearly see that in our report. ... The chilling effect is absolutely here now."

Often, that chilling effect is taking hold even though the children are U.S. citizens, because their parents aren't -- and the parents are concerned about their ability to stay in the country with their kids, the report said.

The rise in uninsured rates represents a marked two-year backslide after nearly a decade of progress.

Anne Swerlick, a senior policy analyst with the Florida Policy Institute, a nonprofit that advocates for expanding health insurance coverage, said it took a lot of hard work to get the rate of uninsured children in Florida down to about 6.6% in 2016, which was still above the national average of 4.7% at the time.

The rate has risen each of the two years since: 7.3% in 2017 and 7.6% in 2018, according to the Georgetown report. The rate was as high as 17% in 2008.

"What's striking to me is how quickly we are backsliding," Swerlick said. "Up until 2016, we were on track to really make a dent in the rate of uninsured kids in the state. ... It's scary how quickly it seems to be happening."

Aside from fears surrounding immigration policies, two other factors driving the spike in uninsured kids include congressional policy battles around Medicaid and the Affordable Care Act as well as bureaucratic "red tape" on the state level making it more difficult for parents to manage insurance plans for their children, Georgetown researchers found.

In Florida, Medicaid eligibility for children extends to those whose parents earn up to 215% of the federal poverty level, compared to the national average of 255%, the report said. But parents cannot earn more than about 32 percent of the federal poverty level to qualify. Adults without dependent children are categorically exempt from Medicaid in Florida.

Parents' statuses affect the rate of health insurance among children because parents who have health insurance are more likely to secure insurance for their kids, researchers said.

The report found that states that have not expanded Medicaid under the Affordable Care Act -- including Florida -- are seeing increases in the rate of uninsured children three times as large as states that did expand the program.

Alison Yager, director of policy advocacy for the Miami-based Florida Health Justice Project, said about 20 percent of people under the age of 65 in Miami-Dade County have no health insurance, which she said makes it more likely that their children won't have health insurance.

"We know that the further you are from that system, the harder it is to connect to it," Yager said.

Kids going without health insurance can also lead to a ripple effect in Miami-Dade County, where the taxpayer-supported Jackson Health System treats the majority of uninsured and under-insured patients.

As for a potential "chilling effect" from the Trump administration's immigration policies, Yager said health policy experts have known for many years that immigrants are uncomfortable with accessing public benefits out of fear that becoming entangled in any kind of government system would lead to problems for them and their family members.

"We're living in a moment where immigrants are being scapegoated routinely and the fear about making oneself known and visible is that much greater," she said.

At the federal level, the report cited efforts by the Trump administration to repeal the Affordable Care Act and make deep cuts to Medicaid as contributing to the backslide on child uninsured rates. It also cited Congress' delay in extending the Children's Health Insurance Program.

The "red tape" problem, meanwhile, is in large part attributable to policy decisions by the Florida Legislature in how the state administers children's health insurance programs, Swerlick said. There are several different groups that serve different populations of children, Swerlick said, including Florida Healthy Kids, MediKids and Children's Medical Services.

"It's just overwhelming for families to figure out how to navigate each of these different components," Swerlick said.

The people relying on the programs are often low-wage workers, so their income can fluctuate month to month, she added.

Swerlick said that fluctuation then causes children to be bounced between different programs that have varying income-eligibility requirements, and that's often when children lose health insurance.

Lanre Falusi, a pediatrician and national spokesperson for the American Academy of Pediatrics, said the findings of the report were "deeply concerning."

"For children who are uninsured, I worry about the critical services they are missing out on and what it will mean for their short- and long-term health," Falusi said. "Our federal leaders must advance policies that ensure children can get the health care they need to grow up healthy and thrive."

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