Report on ACA’s impact for uninsured kids


The first look at how much the Affordable Care Act is impacting the care of kids.

The rate of uninsured children in the United States took a sharp drop last year, declining from 7.1% to 6%-a historic low, says a new report on census data.1

The decrease is attributed in great part to the implementation of the Affordable Care Act (ACA), says the Georgetown University Center for Children and Families, which looked at numbers from the American Community Survey from the Census Bureau.

Earlier in the year, estimates from the National Health Interview Survey showed the uninsured rate for children aged younger than 18 years had dropped from 6.5% to 5.5%, a slight difference from this report’s numbers.

According to the Georgetown study, the number of uninsured children in the United States fell from 6.9 million in 2008 to 4.4 million in 2014.

The center says the numbers show that the eligibility expansions are only part of the story because 68% of uninsured children in 2012 actually were already eligible for Medicare or the Children’s Health Insurance Program (CHIP), but not enrolled. It says reducing barriers to coverage and enhanced outreach and retention efforts are essential.

A Kaiser Family Foundation report said recently that of the 32.3 million nonelderly uninsured at the beginning of this year, 10% were children who were eligible for Medicaid or CHIP.

Income still makes a huge difference, the Georgetown University report shows. For children below 100% of the federal poverty line, the uninsured rate was 7.3%. For those below 200% of the poverty line, the rate is actually higher at about 9%. However, for those with families above 300% of the poverty line, the rate was 3%.

Despite the fact that the rates of uninsured children fell in many different groups and areas across the nation, there are still some major differences. The states with the lowest rates, ranging from 1.5% to 3.1%, were Hawaii, Massachusetts, Vermont, West Virginia, and the District of Columbia. Those with the highest rates, ranging from 9.4% to 11.4%, were Alaska, Arizona, Nevada, Texas, and Utah.

In addition, the nation seems to focus on insuring the youngest children a bit more. The uninsured rate for children aged younger than 6 years fell from 5.7% to 4.9%. However, for those aged 6 to 17 years, the rate fell from 7.8% to 6.5%.

Related: ACA benefits vary by state for kids

The center also says, “States that extended Medicaid coverage to more uninsured adults saw nearly double the rate of decline in uninsured children as compared with states that didn’t accept ACA’s Medicaid option.” That was probably because parents signed up their children when they enrolled themselves, the report says.

Every state has a slightly different story to tell, and there are many things in the ACA that impact children’s coverage, says Joan Alker, one of the report’s co-authors. Adopting the Medicaid option had a big effect in many states, she says.

On the other hand, Michael Tanner, senior fellow at the libertarian Cato Institute, cautions that, “What is an open question is how much benefit additional health insurance is getting these children, particularly since a large portion of the additional coverage is coming through the Medicaid system,” which he contends provides “pretty much an inferior quality of access and care.”

Tanner cites an Oregon study reported in 2013 that found that for adults who won a state lottery for Medicaid coverage, the insurance did not benefit their health after 2 years. He calls the Georgetown report not surprising: “If you give away, essentially, free health insurance, some people are going to get free health insurance.”


1. ACA helps bring chuild uninsured rate down. Available at: Accessed December 8, 2015.

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