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by Ciara Zachary

Last year we hoped it was one-year blip. Unfortunately, the trend in the decline of children’s health coverage seems to be continuing for the second year in a row. Today, the US Census released new data showing that more North Carolina children may be going without health insurance. In 2017, 119,000 NC children lacked coverage, but today’s data release shows further decline. More than 5 percent of NC kids – just over 130,000 – had no health insurance at all in 2018, according to the Census Bureau.* After decades of steady improvement, it is deeply disheartening to see children losing access to health coverage.

While North Carolina’s numbers may not be as alarming as some other states, this news underscores that our state’s leaders need to work harder to make sure every child can get the health care they need. So what is behind this trend?  We see three important factors:

  1. The federal administration continues to attack key health programs in an ongoing campaign to erode the Affordable Care Act. 
  2. Our state lawmakers’ resistance to expanding Medicaid has a direct impact on children’s coverage. There is significant evidence that when parents and caregivers have access to high quality and affordable health care, children are also more likely to gain coverage. We also know that when children have Medicaid coverage, they do better in school, are more likely to graduate high school and college, and grow up to be adults with higher paying jobs, which means that they are able to contribute back to their communities.
  3. Finally, growing anti-immigrant rhetoric and policy, such as the Public Charge rule, seem to be having a chilling effect on child coverage. Significant anecdotal evidence supports the fear that many families with an immigrant in the household are avoiding or disenrolling their children from Medicaid and other critical programs.

As advocates we need to speak up about the threats to child health coverage. Even though the Affordable Care Act is the law of the land, the federal administration is pursuing tactics that make it harder for people to enroll – and that affects children’s coverage too. When states adopt costly programs such as imposing Medicaid work reporting requirements, this creates unnecessary barriers to families getting and staying covered – which again has major impacts on child well-being. 

North Carolina has made great progress in child health coverage, with nearly 95% of children able to see a doctor when they need one in 2018. But these new data show us that these gains slip away unless our state and federal lawmakers enact, protect, and promote policy that helps children and families get covered and stay covered.

Ciara Zachary is NC Child’s Health Program Director

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* The 2018 NC child uninsurance rate of 5.3% is an estimate. Based on the Census Bureau’s margin of error, the true percentage of children in NC without insurance could be as low as 4.8%, or as high as 8.3%.

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