Brief Children's Uninsurance Fell between 2019 and 2021, but Progress Could Stall When Pandemic Protections Expire
Jennifer M. Haley, Stacey McMorrow, Kristen Brown, Julia Long
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The pandemic and associated job losses threatened to reduce employer-sponsored health insurance coverage and increase uninsurance among American families. Though such risks were higher for adults because of the long-standing generosity of public coverage policies for children, the severity and novelty of the pandemic also had the potential to exacerbate children's coverage losses that had occurred between 2016 and 2019 and to jeopardize decades of progress in reducing their uninsurance rate. In this brief, we explore changes in coverage status and type among children from birth to age 17 from 2019 to 2021. To do so, we use data from the National Health Interview Survey (NHIS) and the Current Population Survey (CPS) Annual Social and Economic Supplement and administrative data on children’s enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) and Marketplace coverage through early 2022. We examine (1) changes between early 2019 and early 2021 to reflect the first year of the pandemic and the first round of pandemic recovery legislation passed in March 2020 and (2) changes from early 2021 through late 2021 and early 2022 to reflect continuing trends and initial responses to the second major federal recovery effort in March 2021. We find the following:

  • Children’s uninsurance rates were relatively stable between early 2019 and early 2021, according to both the NHIS and the CPS.
  • Recent NHIS data suggest a decline in uninsurance among children between early and late 2021; no data are yet available for this period from the CPS.
  • Overall, the NHIS indicates a decline in the annual uninsurance rate among children from 5.1 percent in 2019 to 4.1 percent in 2021, which translates to about 700,000 fewer uninsured children.
  • Both survey and administrative data sources suggest public coverage increased among children between early 2019 and early 2021.
    • The NHIS indicates a significant 4.9 percentage-point increase in public coverage and a roughly corresponding decline in private coverage over the period.
    • Changes in coverage on the CPS are much smaller in magnitude and not statistically significant but suggest offsetting public coverage gains and private coverage losses between March 2019 and March 2021.
    • Administrative data show that approximately 4 million more children were enrolled in Medicaid/CHIP in March 2021 than in March 2019.
  • Administrative data indicate further gains in Medicaid/CHIP and Marketplace enrollment among children between early 2021 and early 2022.

Policies such as the continuous coverage provision in the Families First Coronavirus Response Act, which has prohibited states from disenrolling people from Medicaid during the COVID-19 public health emergency since March 2020, appear to have limited the pandemic’s effects on children’s coverage rates. Enhanced Marketplace subsidies under the American Rescue Plan Act, passed in March 2021, and other economic recovery efforts seem to have further protected children’s insurance coverage. Together, these provisions may have even contributed to a decline in uninsurance by the end of 2021. The decline in children’s uninsurance observed on the NHIS is remarkable given the economic downturn, and if it is confirmed by other federal surveys, policymakers will have a better understanding of which policies can successfully mitigate coverage losses during recessions. But without federal and state actions to maintain the enhanced Marketplace subsidies and limit coverage losses when the continuous coverage requirement expires, children’s uninsurance could once again increase in 2022 and beyond.

Research Areas Health and health care
Tags Children's health and development COVID-19 Health insurance Medicaid and the Children’s Health Insurance Program  Private insurance
Policy Centers Health Policy Center
Research Methods Data analysis Quantitative data analysis