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Study: Ranks of Uninsured Kids Declined Under Health Law

By Marissa Evans, CQ Roll Call

October 28, 2015 -- The number of children without health insurance in the United States took a sharp drop in 2014 as key provisions of the Affordable Care Act took effect, according to a report issued Wednesday by the Georgetown University Center for Children and Families.

The population of uninsured children fell to 6.1 percent of the total from 7.1 percent in 2013, the study found, using data from the 2013 and 2014 American Community Survey. It was the biggest decline since at least 2008, when 9.3 percent of children lacked insurance, according to the center. 

"We expected we would see a decline but we were pleased to see such a significant one this year," said Joan Alker, the center's executive director. 

Researchers attributed the decline to the availability of government subsidies to help pay for coverage, the ease of enrollment through federal and state health insurance exchanges online and outreach efforts, especially to parents of children eligible for Medicaid.

"The Affordable Care Act contributed to a historic decline in the number of America's uninsured children," researchers wrote in the report. "States that took full advantage of the ACA's coverage options for parents and other adults saw sharper declines in the number of uninsured children."

The District of Columbia, Hawaii, Massachusetts, Vermont, and West Virginia had the lowest uninsured rates among children, according to the report; Alaska, Arizona, Nevada, Texas, and Utah had the largest. The study found that uninsured rates in 13 states were greater than the national average.

Just six states—Arizona, California, Florida, Georgia, Pennsylvania and Texas–were home to nearly half of the nation's uninsured kids, according to the report. And more than half of the children added to the rolls of the insured in 2014 lived in just five states—California, Texas, Florida, Georgia, and Nevada.

Colorado, Mississippi, Nevada, Rhode Island and West Virginia had the largest percentage point declines in their rate of uninsured children, according to the report. Nevada had the largest decline at 5.3 percentage points.

States that expanded Medicaid under the health care law added twice as many children to the ranks of the insured, the study found. In those states, the rate of uninsured children fell by 21.7 percent in 2014 while in states that declined to expand the health program for the poor only saw an 11.6 percent decrease.

The report notes that even though the Medicaid expansion states had lower rates of uninsured children before extending coverage, they still saw a larger decline in uninsured children compared to non-expansion states.

So far, 30 states and the District of Columbia have expanded Medicaid.

Alker said that while these gains are important there's still much room for improvement. She said there's still work to do to persuade the remaining states to expand Medicaid and getting states to have an easier renewal process so kids don't become uninsured again. 

"Streamlining enrollment and renewals practices is every bit of important as outreach," Alker said. "We tend to lose a lot of kids at renewals time and that's something we remain very concerned about and alert to."

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