Rate of Uninsured Kids Held Steady Nationwide and Improved in 17 States in 2022

Gains Are At Risk and Inequities Persist

Updated November 27, 2023 | Posted September 27, 2022

By the Annie E. Casey Foundation

New data from the Census Bureau’s American Community Survey show that the U.S. rate of uninsured children held steady at 5% in 2022, maintaining the gains of 2021, and 17 states saw their uninsured rates decline. While this is positive news, nearly 4 million children under age 19 still lacked insurance coverage in 2022, and expiring pandemic-relief measures in 2023 are already causing numbers to climb.

Even when children’s uninsured rates are at their lowest, large disparities persist by children’s race and ethnicity, immigration status, age and geography, highlighting our country’s inequitable access to health coverage that must be addressed.

What Happened During the Pandemic

After the COVID-19 pandemic hit, Congress passed multiple relief measures that bolstered the insurance safety net for children and families, including:

increased state funding for Medicaid and continuous coverage protection to keep states from disenrolling people until April 1, 2023;
reduced costs for purchasing coverage through the Affordable Care Act (ACA) health insurance marketplace and expanded enrollment periods and outreach; and
expanded federal and state measures, such as the Children’s Health Insurance Program (CHIP), to improve access to insurance.

Now that the Medicaid continuous coverage protection expired in early 2023, an estimated 6 million individuals have already lost coverage this year and this number is expected to rise — unless policymakers take action.

What Are Medicaid and CHIP?

Census Bureau analysis indicated that increased enrollment in Medicaid and CHIP was behind the reduced U.S. rate of uninsured children in 2021, but what do these programs entail?

Medicaid is a large public health insurance program for children and adults who meet a low-income eligibility threshold. Under the ACA, states can expand Medicaid eligibility to more low-income families. In 2022, all but 12 states had expanded their Medicaid eligibility requirements.
CHIP is another public insurance program for children in families whose incomes are too high to qualify for Medicaid but likely too low to afford private insurance.
While kids and young adults can be covered under a parent’s or guardian’s insurance plan up to age 26, only children under age 19 can qualify for Medicaid or CHIP.

One-in-Three Children Rely on Public Insurance

Nationwide, about one-third of kids (34%) received public health insurance in 2022, while nearly half (48%) were covered through employer-based insurance. Far fewer children had other types of coverage, including a mixture of public and private insurance (5%), a plan purchased directly from an insurance company (5%) or other private insurance (2%).

At the state level, the share of kids who rely on public insurance ranged from 14% in Utah to more than half (52%) in New Mexico in 2022.

Why Insuring Children Matters

Kids with insurance are more likely to access timely medical care for health needs. They have improved physical, mental and behavioral health outcomes compared to those without coverage. Poor health during childhood can affect virtually every area of a child’s life, including school performance, and can have lasting consequences on health, well-being and financial security into adulthood.

Children eligible for public insurance are especially likely to see the benefits of health coverage, including increased economic stability for their families. For instance, when a family receives Medicaid, they can use more of their income on other basic needs like food and housing. Medicaid has also been linked to reduced medical debt and bankruptcies, and it is considered one of the nation’s leading anti-poverty programs.

Insuring parents helps children, too. It increases the likelihood of parental health and strengthens parents’ ability to care for their children.

Children’s Risk of Being Uninsured Varies by State

Differences in state policies and practices, as well as local economic conditions, largely influence the variation in access to coverage across the country. Overall, children are more likely to lack insurance in the Southern and Western regions of the nation. In 2022, the Northeast states of Massachusetts and Rhode Island had the lowest uninsured rates (both 2%), while Texas had the highest rate, with 11% — or 854,000 kids — lacking insurance.

CHILDREN AGE 18 AND BELOW WITHOUT HEALTH INSURANCE IN UNITED STATES

However, Texas was among the 17 states that improved in 2022, with its rate of uninsured children declining by one percentage point since 2021. The other 16 states and the District of Columbia that made gains in 2022 also saw declines of one to three percentage points. Despite this progress, rates of uninsured children increased in seven states in 2022, each by one percentage point.

Inequities Persist, Particularly for American Indian and Alaska Native Children

The rate of uninsured American Indian and Alaska Native children has been more than twice the national rate in all five years of data available on the KIDS COUNT Data Center, although the percentage for these kids improved for the second year in a row from 14% in 2019 to 11% in 2022. The uninsured rate for Latino children has also remained higher than the national level for five years but fell by one percentage point to 8% in 2022. Black children saw a slight improvement as well, from 5% to 4% of kids without insurance. From 2021 to 2022, figures remained even for kids of two or more races (6%), white kids (4%) and Asian and Pacific Islander (4%) children.

In addition, immigrant children, particularly those who are undocumented, are at increased risk of being uninsured compared to their peers with U.S. citizenship. The Census Bureau reported that 1 in 4 (25%) non-citizen children were uninsured in 2022, an increase from 23% in 2021. Figures were nearly as high for foreign-born kids as a whole, regardless of citizenship.

Young adults are vulnerable, too, as they are the most likely of any age group to be uninsured. The most recent data from the Census Bureau’s Household Pulse Survey in the fall of 2022 showed that 17% of young adults ages 18 to 24 lacked health insurance.

Addressing Inequities and Barriers to Health Insurance

Although pandemic-era policies helped many children and families access and keep coverage during this national health crisis, millions of children and young adults still lack health insurance, and concerning disparities in access to coverage remain. Concerted action is also needed just to maintain the gains made in recent years, recognizing that as the federal mandate for states to ensure continuous Medicaid coverage has ended. States, too, can take action to keep eligible families enrolled in Medicaid or help them enroll in other plans. Federal lawmakers can also make permanent the pandemic-era improvements to the ACA marketplace, as these were effective in increasing coverage but will expire after 2025.

Policymakers and leaders in multiple sectors must continue working toward systemic change to address the long-standing inequities and barriers that contribute to the disproportionately high uninsured rates among American Indian/Alaska Native and Latino children. Additionally, leaders should remove barriers for immigrant families to enrollment in Medicaid and the ACA health insurance marketplace, and support strategies to increase enroll among young adults. Leaders at all levels can take steps to simplify the system and improve access to coverage, particularly for the most vulnerable populations.