According to a new report by the Georgetown University Health Policy Institute, the number of uninsured children grew by 320,000 in 2019 to a total of 4.4 million children. The report, Children’s Uninsured Rate Rises by Largest Annual Jump in More Than a Decade, finds that since the start of the Trump Administration, 726,000 children have lost coverage, a full percentage point with the bulk of this loss in the states of Texas and Florida. Over the 2016 to 2019 period, Texas saw a coverage decrease of 243,000 children, and Florida saw coverage drop by 55,000 children over that same timeframe. The Georgetown report points out that these most recent decreases in coverage have come despite what had been an expanding economy.


The analysis points out that by the end of 2016, the nation had reached a historic high for coverage of children. The uninsured figure decreased to 3.6 million and 4.7 percentage of children without coverage. The increases in coverage were a combination of the Children Health Insurance Program (CHIP), the enactment of the ACA, and its related provision of expanded Medicaid coverage. In the 2012 Supreme Court decision upholding the ACA, the Court made the expansion of Medicaid optional. Gradually states have added the Medicaid expansion, but 12 states still do not take the option.

In several states over the past two years (Maine, Nebraska, Utah, Missouri), voters have forced the issue by approving an expansion by ballot. Both Texas and Florida are two of those states not expanding Medicaid, and the state of Texas has been leading the lawsuit to fully repeal the ACA in the current Supreme Court fall schedule.


There had been 7.1 million children without health insurance in 2009 before the ACA passage. That equals 9 percent of the children’s population. That percentage had decreased to the 2016 rate. Now we have a three-year gradual increase. The state of Texas leads the nation in the number of uncovered children at 995,000, with 12.7 percent without coverage.


New York was the only state with a significant increase in coverage in last year’s totals.

When analyzed by region, the South had 52 percent of the nation’s uninsured children, followed by the West at 20 percent, the Midwest with 17 percent, and the East at 9 percent of the nation’s total uninsured.


When uninsured children are split out by race and ethnicity, then 13.8 percent of Native American children have the highest percentage of uncovered children, followed by 5.6 percent for White Children, 4.6 percent for Black Children, 4,4 percent for Asian children, and 6.9 percent for multiple races or other categories of ethnicity and race.


The report does not indicate any potential impact the COVID-19 pandemic has on coverage now or in the future. An analysis by the Kaiser Family Foundation released on Wednesday, May 13, 2020, showed that, because of the unemployment caused by the pandemic, “Among people who become uninsured after job loss, we estimate that nearly half (12.7 million) are eligible for Medicaid, and an additional 8.4 million are eligible for marketplace subsidies [ACA marketplace], as of May 2020.”


The Texas numbers have some significance in that the Supreme Court, with either 8 or 9 members, has scheduled oral arguments on the constitutionality of the Affordable Care Act for November 10, 2020. The case is the State of California, ET AL. v. the State of Texas, ET AL. In June, the Trump Administration urged the Court to side with Texas and told the Court, “the entire ACA must fall.”


Last year the U.S. Fifth Circuit of Appeals agreed with Judge Reed O’Connor of the Federal District Court in Fort Worth, TX when he ruled that “the keystone” of the law was the individual mandate and, when Congress eliminated the individual mandate tax penalty, that it could not be severed from the entire ACA. That would mean that the whole law should be thrown out. Congress eliminated the tax as part of the December 2017 tax cut package. On December 18, 2019, the U.S. Fifth Circuit Court of Appeals in New Orleans agreed to strike down part of the Affordable Care Act provision, ruling that the requirement that people have health insurance was unconstitutional on a 2-1 decision and sent the case back to the lower Court in Texas for further analysis. As a result, the U.S. Supreme Court decided to take up the case in October.