Number of uninsured kids rising in state

Dec. 10--BOSTON -- The number of children without health insurance is rising in Massachusetts for the first time in years, according to a report that blames divisive national politics for the reversal.

An estimated 20,000 children in the state didn't have health insurance in 2017, an increase of about 5,000 children from the prior year, according to a new report from Georgetown University's Center for Children and Families. The surge knocked the state off its No. 1 ranking for the smallest portion of uninsured children.

In fact, Massachusetts was one of nine states -- including Texas, Georgia, South Carolina, Florida, and Tennessee -- that saw substantial increases in the number of uninsured kids.

Nationally, an estimated 3.9 million children did not have health insurance in 2017, according to the Georgetown researchers, an increase of 276,000 from the previous year.

"It's a troubling sign," said Edwin Park, a research professor at the Georgetown McCourt School of Public Policy who contributed to the study. "We've made significant progress in the last decade covering all kids, and now we're moving in the opposite direction."

Health care advocates blame President Donald Trump and a Republican-controlled Congress, in part, saying divisive policies have cast a pall over enrollment in health plans.

They cite efforts to repeal the Affordable Care Act, make drastic cuts to Medicaid and the Children's Health Insurance Program, as well as tightening immigration laws.

"Immigrant families have lower participation in public programs like Medicaid and CHIP than non-immigrant families, and that's always been the case," said Park. "But when you roll back the welcome mat by creating an environment that is hostile to immigrants, that can reverse the historic progress we have made in enrolling all eligible children."

Unusual increase

Researchers noted the uninsured rate typically remains stable or drops amid economic prosperity, which is why the increases now are so troubling.

In September, the national unemployment rate was 3.7 percent -- its lowest level since 1969, according to the U.S. Labor Department.

"Usually, when the economy is doing well and people are working, health coverage increases," Park said. "But clearly we're not seeing that."

The number of children with employer-sponsored health coverage rose slightly in 2017, but not by enough to make up for the drop in children enrolling in government-backed plans.

Overall, the uninsured rate for people of all ages -- which declined from 2013 to 2016, following the federal health law's implementation -- remained unchanged at 8.8 percent last year.

Roughly 17 percent of Americans were uninsured in 2010, the year the Affordable Care Act was enacted.

Among children, uninsured rates grew at nearly triple the pace in states that did not expand Medicaid under the Affordable Care Act, according to the report.

In Texas, for example, 835,000 children were uninsured in 2017 -- a 10.7 percent increase over 2016 and the highest rate in the nation. One in five uninsured U.S. children live in Texas.

Despite the increase in Massachusetts, the state still has among the lowest number of uninsured children in the country, relatively speaking.

In 2017, the portion of children without health insurance went from 1 percent to 1.5 percent, well below the national average of 4.6 percent, according to the Georgetown researchers.

Massachusetts's first-in-the-nation health care law, signed by Gov. Mitt Romney in 2006, mandates health insurance for adults older than 18, but it doesn't require children to be covered.

A 2016 study by the Blue Cross/Blue Shield of Massachusetts Foundation found 95.7 percent of working-age adults in the Bay State are insured.

'Chilling effect'

Suzanne Curry, a senior policy manager with the Boston-based advocacy group Health Care for All, agrees that national rhetoric surrounding health care and immigration is a factor driving up the rate of uninsured children.

"A lot of families might be scared of the implications of receiving a public benefit, even when they are eligible," she said. "It has a chilling effect."

Health coverage is important for children because it improves access to preventive and primary care, such as well-child visits, immunizations and prescription drugs, Curry said.

"Prevention is really important, especially when it comes to kids," she said.

Curry cited the Trump administration's proposed "public charge" rule as another factor that could lead to fewer children getting health insurance. The rule would make it harder for legal immigrants to get permanent resident cards if they have received public assistance such as Medicaid, food stamps or housing subsidies.

"If that rule goes through, it will only exacerbate the rising numbers of uninsured kids," Curry said. "We're hoping the Trump administration will reconsider it."

Christian M. Wade covers the Massachusetts Statehouse for the North of Boston Media Group's newspapers and websites. Email him at cwade@cnhi.com

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