Tarrant County: Home to 62,600 uninsured children, 5th highest in U.S., report says

Oct. 30--AUSTIN -- After years of decline, the number of uninsured children is at the highest level since the Affordable Care Act's major provisions went into effect in 2014. And the largest share comes from Texas, with Tarrant County ranked fifth nationwide, according to a report released Wednesday.

The number of children without health insurance increased by 400,000 nationwide between 2016-18, the nonpartisan Georgetown University Center for Children and Families found, causing advocates to fear that years of progress is in jeopardy. Over 4 million children lacked health insurance last year in the U.S., and more than one in five were in Texas, according to the report.

Five Texas counties ranked among the top 10 with the highest number of uninsured children last year. Harris and Dallas counties ranked first and second, and Tarrant, following Los Angeles County, was fifth, where roughly 62,600 children were uninsured in 2018, a rate of 10.8%. Harris is the nation's third-largest county, Dallas is eighth and Tarrant 15th.

In Texas, 11.2% of children don't have health insurance -- more than double the national average of 5.2%.

"What we're seeing is this is a problem for kids of all backgrounds in communities throughout the Lone Star State," said Adriana Kohler, a senior health policy associate with Texans Care for Children, a nonprofit that advocates for improving children's well-being. "There isn't a community that's immune to this issue."

Recently released Census Bureau data showed that Texas' uninsured rate increased for the second year in a row. And Texas isn't the only state seeing higher rates of uninsured, with Wednesday's report noting 14 other states saw statistically significant increases in the number or rate of uninsured children. North Dakota was the only state that saw an improvement in that area over the two-year period.

"The decline in health coverage occurred at a time when children should have been gaining coverage in the private market and is a red flag for policymakers as even more children would likely lose coverage in an economic downturn," Joan Alker, one of the report's lead authors and the executive director and co-founder of the Center for Children and Families, said in a news release.

The report points to various actions taken under the Trump Administration for the trend's reversal nationwide, citing attempts to repeal the Affordable Care Act, a climate of fear for immigrant families and more.

The report cited the administration's proposed "public charge" rule as a reason for a chilling effect among enrollment in mixed status or immigrant families. While temporarily blocked by federal judges, the rule would have allowed immigration officials to take into account whether an immigrant uses public benefits when determining whether he or she should be approved for a green card.

The majority of uninsured children are eligible for Medicaid or the Children's Health Insurance Program but many are not enrolled, the report notes. In Texas, 88.1% of uninsured children who were eligible participated in Medicaid or CHIP in 2017 -- lower than the participation rates of neighboring states like Louisiana (96.5%) or New Mexico (95.4%).

"Most cases these children are citizens but the parent is an immigrant and they're worried about being deported, separated from their children or having trouble in the future adjusting their status," Alker said.

Marivi Wright, a community outreach coordinator for the Players Center for Child Health at Wolfson Children's Hospital in Jacksonville, Florida, said she encounters parents' worry of the unknown firsthand when helping Hispanic and Latino families apply for benefits through Medicaid and CHIP.

"Lately what we see is a lot of fear among our families," Wright said. "The fear that they have is what is making them decide not to enroll their kids in any of the benefits."

Nationwide, the uninsured rate increased for Hispanic children from 7.9% in 2017 to 8.2% in 2018. That rate was even higher in Texas where 14.8% of Hispanic children lacked insurance in 2018. White children also saw a statistically significant increase nationwide from 4.9% in 2017 to 5.2% in 2018.

The report also noted a "disturbing trend" that the number of uninsured children under 6 increased between 2016 and 2018, with the rate jumping from 3.8% to 4.3%. In Texas, the rate for children under 6 was at 8.3% in 2018.

Alker said that was "especially troubling" because usually the younger a child is, the more likely he or she is to have coverage.

"Children are not just little adults. They have unique health needs that require unique care. And if a child does not have health insurance coverage, it could mean missing a life-saving vaccine or skipping a well-child checkup," said Lanre Falusi, a pediatrician at the Children's National Hospital in Washington, D.C. and national spokeswoman for the American Academy of Pediatrics.

Families are often required to repeatedly prove their Medicaid eligibility, and Kohler said in Texas, lawmakers have an opportunity to get rid of some of the red tape that surrounds the process.

Southern states were home to a little over half of the uninsured children in the country -- the largest share of any region -- even though only 39% of the nation's children live in those states.

Of those, Texas, Oklahoma, Florida and Georgia, all had uninsured rates significantly higher than the national average.

And the rate of uninsured children also grew three times as fast from 2016 to 2018 in states that haven't expanded Medicaid, compared to those that have.

While state lawmakers passed laws this past legislative session that aim to create a temporary high-risk health insurance pool, provide relief from surprise medical bills, and more, they failed to expand Medicaid under the Affordable Care Act.

Texas is one of 14 states that has yet to do so, and it's leading a lawsuit that has the potential to shake up the nation's healthcare system by striking the ACA in its entirety. Ending the act, often referred to as Obamacare, would eliminate protections for those with pre-existing conditions, such as pregnancy, arthritis and diabetes. The case is likely headed to the U.S. Supreme Court.

The report also comes just days before the start of open enrollment on the ACA's exchange, which begins Friday. From Nov. 1 to Dec. 15, you can enroll in health insurance plans for 2020 on HealthCare.gov.

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