More Iowa children under private insurance, research shows

Gazette (Cedar Rapids, IA)

May 28-- May 28--More of Iowa's children are moving out of Medicaid for their health insurance coverage and into private insurance, according to new research.

A report by the State Health Access Data Assistance Center, or SHADAC, shows fewer children living in Iowa are uninsured, and new data from 2017 indicates their parents may be getting health care coverage from employer-based insurance plans.

Researchers of the report also attributed Iowa's historic support of health coverage to be a major contributing factor, leading Iowa's uninsured rate to be below the national average.

"Iowa especially is pretty good. It has a pretty low rate compared to the nation," said Elizabeth Lukanen, SHADAC deputy director.

More than 20,500 Iowa children, or about 2.7 percent, were uninsured in 2017, according to the SHADAC report, which was created using data from the American Community Survey conducted by the U.S. Census Bureau.

This is a slight uptick from 2016, when 2.2 percent were uninsured.

However, the data shows Iowa's uninsurance rate among children has been declining steadily for a number of years, said Lukanen. In 2011, 4.7 percent of children were uninsured.

SHADAC found the highest uninsured rates were among children who were either low income or their parents had a high school education or less. There also were higher uninsured rates among children of color compared to their white counterparts.

The report shows that Medicaid coverage declined between 2016 and 2017 nearly 3 percent, from nearly 30 percent to 27 percent in 2017.

Lukanen said this drop would be concerning, if not for the corresponding increase in private insurance -- ticking up from about 68 percent in 2016 to 70 percent in 2017.

"I think it might be some of these kids are no longer eligible for Medicaid because their parents are getting jobs," Lukanen said. "We'll be interested in looking at the uninsured rate for 2018 to see if this slight uptick in uninsurance is real, but I think it's more likely that they're shifting from Medicaid to private coverage at this point."

Nationwide, about 3.9 million children did not have health insurance in 2017, or about 5 percent, according to SHADAC. This reverses "an almost decadelong decline of uninsurance," Lukanen said.

There was a major policy shift on the federal level between 2016 and 2017, with the election of President Donald Trump, and along with that, his criticisms of the Affordable Care Act, the previous administration's health care insurance initiative.

The Trump administration's reduction of ACA outreach and defunding of navigators -- professionals federally funded to help individuals sign up for insurance through the individual market -- may have contributed to the increase in uninsured children, Lukanen said.

Lukanen attributed Iowa's low uninsured rate to the state's "strong history" of supporting public health insurance options.

Iowa "has a very generous eligibility thresholds for children, so it covers kids of much higher incomes than other states, and the state in general has been very supportive of the Affordable Care Act and legislation to get kids covered," Lukanen said.

"One of the things we've seen strong evidence is when parents get coverage, their kids get coverage."

Lukanen compared Iowa to Texas, which had the highest rates of uninsured children in 2017 at nearly 11 percent.

While Texas also had an increase in the number of children on employer-based health plans, it wasn't enough to offset the decline in public health options, she said.

Texas historically has not been supportive of the ACA, she said.

"If you have politicians saying the ACA is bad, we don't want it, then you're probably just less likely to support it yourself and much less likely to get coverage under that plan," Lukanen said.

"If I as a parent don't think I should be subject to the mandate, I'll never find out my kid is eligible."

Measuring uninsurance rates among children is a key indicator to their future economic outcomes, Lukanen said. Research has shown if children don't have health insurance, they are less likely to go to the doctor's office for care and therefore are more likely to miss school.

--Comments: (319) 368-8536; michaela.ramm@thegazette.com

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