By now, the evidence seems pretty clear that Obamacare has reduced the ranks of the uninsured across virtually every demographic since the start of the law's coverage expansion in January. Except for one, apparently: kids.
The good news is that children under 18 have had a pretty low uninsured rate over the past few years, around 7 percent, thanks to previous coverage expansions of Medicaid and the Children's Health Insurance Program. But the children's uninsured rate has hardly budged in the first six months of 2014, even as the uninsured rate for adults dropped 4 percentage points over the past year, according to the new Urban Institute Health Reform Monitoring Survey. The researchers say this is the first measure of the Affordable Care Act's effects on children's coverage.
It's not that kids were overlooked by the ACA, but its main coverage features, like the Medicaid expansion, mostly benefit adults. And kids make up just 6 percent of enrollees on the new health insurance exchanges offering subsidized private coverage to low- and middle-income individuals and families.
But researchers at the Urban Institute and the Georgetown University Center for Children and Families see some factors that could lower the children's uninsured rate in the future. Medicaid enrollment is increasing even in states that haven't expanded coverage, which could bring more children into the program. The health-care law also moves some low-income kids off of CHIP eligibility, where insurance premiums could be prohibitive for some families, and into Medicaid. About 55 percent of still-uninsured kids, the researchers estimate, are eligible for public coverage through Medicaid or CHIP.
There are still some major looming policy decisions that could shift the uninsured rate either way. The report points out that some of the states with the highest rates of uninsured children, like Florida and Texas, haven't expanded Medicaid coverage to parents — and past research shows expanding public health insurance to parents makes it more likely their kids will get insured.
Meanwhile, Congress must figure out whether or how to fund the popular CHIP program, now nearly 20 years old, beyond the 2015 fiscal year. This is the first time lawmakers will decide CHIP's fate since Obamacare's coverage expansion took effect, and advocates are worried that lawmakers will limit or altogether cut the generous kids coverage program. The latter option, congressional Medicaid advisers warned this summer, would probably send the uninsured rate in the wrong direction.