For many years, the nation has been on a positive trajectory reducing the number and rate of uninsured children. Having health insurance is important for children as they are more likely to receive needed services, have better educational outcomes, and their family is protected from the financial risks associated with being uninsured—even for a short period of time. Recently released data show that this progress is now in jeopardy. For the second year in a row, the uninsured rate and number of uninsured children moved in the wrong direction. This is unprecedented since comparable data began to be collected in 2008.

The number of uninsured children now exceeds 4 million—wiping out a sizable share of the gains in coverage made following the implementation of the Affordable Care Act (ACA) in 2014 (see Figure 1). Coverage improvements for children began many years before the ACA was enacted through expansions of Medicaid and the creation of the Children’s Health Insurance Program (CHIP). The ACA primarily improved children’s coverage rates by increasing the likelihood that eligible children would be enrolled in Medicaid/CHIP when their parents obtained coverage, simplifying eligibility and enrollment procedures, funding new outreach and enrollment efforts, and establishing the individual mandate. Some children benefited from newly available subsidized coverage in the ACA Marketplaces as well.