That sort of red tape contributed to an increase in the number of uninsured children , rising by more than 400,000 and exceeding 4 million nationwide between 2016 and 2018. This reverses a long-standing positive trend and erased many of the gains achieved after the Affordable Care Act took effect. It’s troubling that the child uninsured rate increased at a time when the economy is relatively strong and children should be gaining coverage. A recession will surely worsen these trends.

Imagine taking a sick child to the doctor or the emergency room only to find that your insurance has lapsed. That is happening to thousands of families whose children are covered by Medicaid as they are required to submit more paperwork , verify their income more frequently and comply with unreasonable deadlines they don’t even know about because form letters never arrived in the mail.


The majority of uninsured children are eligible for Medicaid but are not currently enrolled. So why are so many children going without the health coverage they need to succeed?Our national leaders have shifted from a mindset that we should cover all children to one that doesn’t prioritize children and undermines successful affordable health coverage initiatives such as Medicaid and the Affordable Care Act.

These red tape barriers imposed by states are being put up either with the explicit encouragement or not-so-benign neglect by the Trump administration. That can take the form of added paperwork requirements, including verifying income more frequently. Other states are moving more quickly to cut children from health coverage during periodic reviews with unreasonable deadlines that don’t provide families with adequate time to respond.

The red tape is added under the guise of cracking down on fraud, but that is the wrong target for anyone serious about program integrity. Policymakers focused on program integrity should follow the money and put safeguards in place where the funding enters the health care system, largely through lightly regulated Medicaid managed care organizations, not make life harder for parents simply trying to take their children to the doctor.


Red tape isn’t the only barrier to coverage for children of immigrant parents. Many immigrant families are scared to interact with the government to enroll eligible children in any public program. This “chilling effect” among immigrant families stems from a climate of fear and confusion that has been created by the Trump Administration’s actions and rhetoric. One in four children in the United States has an immigrant parent, and 88 percent of them are citizens born here. Their parents may be naturalized citizens, lawfully residing, or undocumented, and they are worried about being deported or having trouble adjusting their status in the future and being separated from their families.

Our report also found the child uninsured rates are higher and rising faster in states that have refused to accept federal funding through the Affordable Care Act to expand Medicaid to low-income parents and other adults in low-wage jobs. This is because children often gained health insurance when their parents were newly enrolled in Medicaid. Children in the 14 remaining non-expansion states are about twice as likely to be uninsured as those in expansion states.

Medicaid is a cost-effective way to make a lasting impact on children’s lives. Research shows us that Medicaid coverage for children has long-term positive effects on health outcomes, educational attainment and even earnings as adults. It’s time to put politics aside for America’s children and renew the bipartisan commitment to ensure that children get the health care they need to grow up healthy and succeed in life. Their future depends on it and so does ours.


Joan Alker is executive director of the Georgetown University Center for Children and Families.