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Rising Uninsured Rate Threatens Healthy Development of Young Children

State-by-state analysis finds the rate of uninsured young children is higher and increasing more rapidly in states that have refused to expand Medicaid coverage under the Affordable Care Act.
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The nation’s youngest children are increasingly losing health coverage, leaving them vulnerable at a time when they need regular check-ups, vaccinations and screenings to ensure their healthy development, according to a new analysis by the Georgetown University Center for Children and Families.
In a companion piece to its annual report on uninsured children, the Georgetown University center took a close look at health coverage for children under age 6 and found that more than 1 million lacked insurance in 2018. That’s up nearly 115,000 from 2016, a statistically significant increase that mirrors national trends for all children. The rate of uninsured young children climbed from 3.8 percent to 4.3 percent in that two-year period.
“This reverses years of progress in making sure children have access to quality health care,” said Elisabeth Wright Burak, senior fellow at the Georgetown University Center for Children and Families. “It’s particularly concerning that so many infants, toddlers and preschool-aged children are going without insurance. Young children need at least 15 check-ups by the time they are 6. Missing this critical care can affect their health and their school success in future years.”
During these early years, children experience rapid brain development and physical growth, making the period before kindergarten entry a critical window to address any development delays or health conditions before they escalate into greater challenges.
In addition, well-child visits are also increasingly seen as opportunities to engage parents and other caregivers in their own health and successful parenting, since positive relationships are the foundation of healthy development for young children.
The Georgetown University analysis showed 13 states had significant increases in the rate or the number of uninsured children under 6, and only one, Minnesota, had a significant decrease in the number. In seven states, the rate of uninsured young children was actually higher than the rate for older children, a troubling counter-trend.
The analysis found that the rate of uninsured young children is higher and increasingly more rapidly in states that have refused to expand Medicaid to low-income adults. Children often gain coverage when their parents enroll in Medicaid.
The report also outlines government actions that have made it harder for families to enroll and renew children’s coverage through Medicaid and the Children’s Health Insurance Program (CHIP). That includes cuts and delays in enrollment outreach funding and increased red tape for signing up children and parents. Federal policies and actions have also contributed to a climate of fear and hostility toward immigrants that have left many families afraid to sign up their eligible children.
“Addressing preventable delays and conditions early is not only important to school readiness, it can set a child on the course to healthy lifelong development,” said Maggie Clark, senior state health policy analyst at the Georgetown University center. “Without regular check-ups and screenings, small problems can grow into bigger ones, and limit a child’s ability to be successful in school and life.”

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