Troubling Trends: Uninsured Rate Triples for Hispanic/Latinx Kids

Amid a landscape of tough policy challenges, insurance coverage for Colorado’s kids has been a bright spot in recent years. But a troubling trend is emerging. While some groups continue their progress in gaining insurance coverage, others — especially Hispanic/Latinx children — were more likely to be uninsured in 2019 than just a few years ago.

The increase in the number of kids without insurance began before the COVID-19 crisis and accompanying economic downturn, which is causing more instability in many families’ financial situations and insurance coverage.

The downturn is likely to exacerbate the challenge: Legislators face a daunting task this spring to balance the state budget by cutting new and existing programs. The options recommended by staff if additional budget cuts are needed range from reducing eligibility for the Child Health Plan Plus (CHP+) program to eliminating it altogether, which would save the state more than $60 million but remove a coverage option for close to 80,000 kids and pregnant adults. The JBC staff who authored the recommendation write that “the potential savings are sufficiently large to justify the effort required to reduce eligibility.”

Having health insurance is important for children’s well-being and for their families’ economic security. Research suggests that children with insurance coverage are more likely to experience better medical, educational, and economic outcomes than those without insurance.

The uninsured rate among Colorado children — defined as those birth through age 18 — has historically been quite low. It dropped significantly between 2011 and 2015, when a record-low 2.5 percent, or an estimated 33,000 children, were uninsured, according to the Colorado Health Access Survey (CHAS). In 2019, however, 4.3 percent of children age 18 and younger (about 58,000 children) were uninsured.

A primary driver is the rise in uninsurance among Hispanic/Latinx children, which jumped to 7.9 percent from 2.4 percent in 2017. A combination of factors seems to have driven this increase, including the proliferation of inflammatory rhetoric, anti-immigrant sentiment, and policies such as the Trump administration’s “public charge” rule, which have heightened many immigrants’ fears of enrolling in public programs.

Data from the 2019 CHAS provide more insight into the growing number of uninsured children in our state in the past five years. As the state prepares for a significant change in its budget and public insurance programs, understanding where we have been and who was less likely to have insurance before the COVID-19 downturn can point to communities and areas that may need support or attention.

Children’s Coverage in Three Charts

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The Affordable Care Act expanded access to insurance and helped more kids get covered by covering their parents, and Colorado reached a low of 2.5 percent uninsured in 2015 thanks to robust outreach and enrollment efforts for programs including Medicaid and CHP+. However, since then, Colorado’s child uninsured rate has been inching back up. In 2019, 4.3 percent of children age 18 and younger were uninsured in Colorado. Those 58,000 children are nearly equal in number to the population of Grand Junction. While this rate is still lower than for the overall population in Colorado — which stood at 6.5 percent uninsured in 2019 — it’s clear kids' health coverage is trending in the wrong direction.

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More than 60 percent of children in the state were covered through a parent’s or guardian’s employer-sponsored insurance (ESI) plan in 2019. This is something to watch going forward, given how much instability employers are facing in 2020 amid business shutdowns and the economic squeeze caused by COVID-19. More than a quarter of children were covered through public insurance. Medicaid, which serves low-income Coloradans, covered 23 percent of children last year, while CHP+, which predominantly covers kids but also provides insurance for around 800 pregnant women, insured nearly 5 percent of kids. Another 5 percent of children were covered through private insurance sold on the individual market.

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Children’s uninsured rates differ by demographic group. The gap is especially large between kids who identify as Hispanic/Latinx and those who identify as non-Hispanic/Latinx white. In 2019, 7.9 percent of Hispanic/Latinx children in the state were uninsured. That’s compared to just 2.7 percent of non-Hispanic/Latinx white children in Colorado who went without insurance last year — making the rate of uninsured Hispanic/Latinx children nearly three times that of their non-Hispanic white counterparts.

Just two years earlier, uninsured rates for the two groups were similar (2.4 percent for Hispanic/Latinx children and 3.8 percent for non-Hispanic/Latinx white children) thanks to remarkable gains in insurance coverage among Hispanic/Latinx Coloradans between 2013 and 2017. As coverage options (and awareness about them) grew during that time, more adults signed up for coverage and they brought their children — many of whom had already been eligible — along. The rate of uninsured Hispanic/Latinx children more than tripled from 2017 to 2019, while it stayed roughly the same for non-Hispanic/Latinx white kids.

Understanding the Trends

So why are children, and especially Hispanic/Latinx children, still uninsured in Colorado? The CHAS provides more information, though it paints an incomplete picture. The most common reasons cited in 2019 for children lacking insurance coverage were a loss in eligibility for CHP+ or Medicaid, for which an improving economy and accompanying wage growth in 2018-19 could be a factor, or the lack of an employer-sponsored insurance option for the family. This is noticeably different than trends for adults, for whom cost is the most commonly cited reason for not having insurance. This may indicate that children are eligible for more (or more affordable) public insurance programs than adults, or point to how much value families place on providing insurance coverage for their children regardless of cost.

Other factors influencing Colorado children’s uninsured rate may include stubbornly high premiums on the individual market that keep those plans out of reach for some; federal immigration policies, such as the “chilling effect” on enrollment from the public charge rule; and administrative changes at the Department of Health Care Policy and Financing, such as a recent practice of disenrolling Medicaid recipients after receiving any returned mail.

The challenges illuminated by the 2019 CHAS stand to intensify in the wake of COVID-19 and its far-reaching negative social and economic impacts. It’s clear that the factors and processes standing between children and insurance coverage deserve our renewed scrutiny. Providing insurance offers more than peace of mind — it opens the door to services such as well-child and preventive care that help kids stay healthy throughout their lifetimes.

For more information on trends in Colorado’s insured rates, including a look at likely drivers of some demographic groups’ rising uninsured rate and policy options for addressing this troubling trend, read CHI’s new report on Coloradans who are eligible for but not enrolled in public coverage programs: “2017-18 EBNE: Momentum Reverses.” For example, this analysis found that children with parents who are noncitizens make up over one-third of the eligible but not enrolled (EBNE) population. CHI’s 2019 CHAS reports and data workbooks, including the summary report (“Progress in Peril”), offer additional context and findings. And CHI spoke with clinics and providers who have been observing concerning insurance trends for “Covering Colorado’s Kids,” a story focused on this issue.

Hieu Pham contributed to this blog post.

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