What Lies Ahead for Children's Health Coverage?

New interactive tool shows impact of changes to children’s eligibility for Medicaid and the Children’s Health Insurance Program and federal subsidies for marketplace coverage

We recently estimated how potential policy changes could affect the number and proportion of children without health insurance coverage (http://www.urban.org/publications/2000144.html). The availability of tax credits for marketplace coverage under the Affordable Care Act (ACA) in states that do not operate state-based marketplaces will depend on the Supreme Court decision on King v. Burwell, which is expected in June 2015. Federal funding for the Children’s Health Insurance Program (CHIP) will end in October 2015 unless Congress votes to extend it. In addition, under the ACA, states must maintain Medicaid and CHIP eligibility levels for children until 2019, but recently proposed legislation would allow states to cut back children’s eligibility. All three of these changes could happen in 2015.

We projected how many children would be uninsured in 2016 under seven different policy scenarios:

  • If the ACA had never been implemented and eligibility for Medicaid and CHIP remains unchanged.
  • Under the ACA as currently implemented, with three different options for eligibility:
    • CHIP extended and no change to Medicaid and CHIP eligibility
    • CHIP not extended, but child Medicaid eligibility unchanged
    • CHIP not extended and Medicaid eligibility cut to 138 percent of FPL in all states
  • Under the ACA, but without marketplace tax credits for states that did not establish their own exchanges (a decision in favor of the plaintiff in King v. Burwell). Three different options for eligibility:
    • CHIP extended and no change to Medicaid and CHIP eligibility
    • CHIP not extended, but child Medicaid eligibility unchanged
    • CHIP not extended and Medicaid eligibility cut to 138 percent of FPL in all states

In addition to developing national estimates for the universe of children aged 18 and under, we computed estimates for four different groups of states and for children in different income groups. The state groups were defined according to the combination of CHIP and marketplace policies in place in a given state (table 1). States were categorized by whether they have a federally facilitated or state-based marketplace since tax credits in the state-based marketplaces will not be affected by the King v. Burwell decision. States were also characterized by whether they have a separate CHIP program; if CHIP funding is not extended, these separate CHIP programs could be discontinued. Income was based on modified adjusted gross income as a percentage of the federal poverty guidelines (FPL) and categorized in four groups: less than 138 percent of FPL, 138 to 200 percent of FPL, 200 to 400 percent of FPL, and over 400 percent of FPL.

TABLE 1
States by Type of Marketplace and CHIP Program
Federally Facilitated Marketplaces
State-Based Marketplaces
Separate CHIP
(55% of children)
No separate CHIP
(11% of children)
Separate CHIP
(17% of children)
No separate CHIP
(18% of children)
Alabama
Delaware
Florida
Georgia
Illinois
Indiana
Iowa
Kansas
Louisiana
Maine
Michigan
Mississippi
Missouri
Montana
New Jersey
North Carolina
North Dakota
Pennsylvania
South Dakota
Tennessee
Texas
Utah
Virginia
West Virginia
Wisconsin
Wyoming
Alaska
Arizona
Arkansas
Nebraska
New Hampshire
Ohio
Oklahoma
South Carolina
Colorado
Connecticut
Idaho
Kentucky
Massachusetts
Nevada
New York
Oregon
Vermont
Washington
California
District of Columbia
Hawaii
Maryland
Minnesota
New Mexico
Rhode Island

Our tool allows users to select a policy scenario to see how uninsurance changes for children nationally as well as by state group and income.