Uninsured Children in California

California

Health insurance is a critical factor in ensuring children receive the preventive and acute medical care they need to achieve and maintain good health. Benefits of health insurance coverage include increased access to and use of preventive, primary and specialty health care, as well as higher quality of care and improved health outcomes.

When compared with privately insured children, uninsured children have more health disadvantages, including:

• Unmet medical or dental care needs.
• More hospitalizations.
• Higher in-hospital mortality rates.

In 2021, 5% of children ages 0-19 were uninsured. Among those who had insurance, 61.9% were privately insured and 36.4% had coverage through public plans, including Medicaid, the Children’s Health Insurance Program (CHIP) and other government-sponsored health plans.

The prevalence of uninsurance is higher among:

• American Indian/Alaska Native and Hispanic children compared with non-Hispanic white, Black and Asian children.
• Children from lower-income families compared with those from higher-income families. The high cost of insurance is often cited as the reason for lack of coverage.
• Children living in states that did not expand Medicaid compared with children living in states that expanded Medicaid.

While the percentage of children covered by private plans has decreased in recent decades, the percentage covered by public programs has increased. Public programs such as Medicaid and CHIP have made significant strides in increasing access to and quality of care and improving health status for low-income children. States that expanded Medicaid eligibility under the Affordable Care Act have seen greater improvements in insurance rates for children, primarily under Medicaid and CHIP. Nearly 9 million children were enrolled in CHIP in 2021.

Increasing the proportion of Americans with health insurance is a Healthy People 2030 leading health indicator. The U.S. Department of Health and Human Services has a strategic goal to improve availability and accessibility of health insurance coverage by increasing enrollment of eligible children in CHIP and Medicaid.

Abdullah, Fizan, Yiyi Zhang, Thomas Lardaro, Marissa Black, Paul M. Colombani, Kristin Chrouser, Peter J. Pronovost, and David C. Chang. “Analysis of 23 Million US Hospitalizations: Uninsured Children Have Higher All-Cause in-Hospital Mortality.” Journal of Public Health 32, no. 2 (June 1, 2010): 236–44. https://doi.org/10.1093/pubmed/fdp099.

Cohen, Robin A., Emily P. Terlizzi, and Michael E. Martinez. “Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2018.” National Center for Health Statistics, National Health Interview Survey Early Release Program, May 2019. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf.

Keisler-Starkey, Katherine, and Lisa N. Bunch. “Health Insurance Coverage in the United States: 2021.” Current Population Reports. U.S. Government Publishing Office, Washington, DC: U.S. Census Bureau, September 2022. https://www.census.gov/content/dam/Census/library/publications/2022/demo/p60-278.pdf.

Marks, Caryn, Cathy Hoffman, and Julia Paradise. “The Impact of Medicaid and SCHIP on Low-Income Children’s Health.” Issue Brief. KFF, February 2009. https://www.kff.org/medicaid/issue-brief/the-impact-of-medicaid-and-schip-on/.

Medicaid and CHIP Payment and Access Commission. “MACStats: Medicaid and CHIP Data Book 2022.” Washington, D.C., December 2022. https://www.macpac.gov/wp-content/uploads/2022/12/MACSTATS_Dec2022_WEB-508.pdf.

Paradise, Julia. “The Impact of the Children’s Health Insurance Program (CHIP): What Does the Research Tell Us?” Issue Brief. KFF, July 17, 2014. https://www.kff.org/report-section/the-impact-of-the-childrens-health-insurance-program-chip-issue-brief/.

Racine, Andrew D., Thomas F. Long, Mark E. Helm, Mark Hudak, Budd N. Shenkin, Iris Grace Snider, Patience Haydock White, Molly Droge, and Norman "Chip Harbaugh " Jr. “Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations.” Pediatrics 133, no. 3 (March 1, 2014): e784–93. https://doi.org/10.1542/peds.2013-4059.

Szilagyi, Peter G., Mark A. Schuster, and Tina L. Cheng. “The Scientific Evidence for Child Health Insurance.” Academic Pediatrics 9, no. 1 (January 1, 2009): 4–6. https://doi.org/10.1016/j.acap.2008.12.002.

Tolbert, Jennifer, Kendal Orgera, Natalie Singer, and Anthony Damico. “Key Facts about the Uninsured Population.” Issue Brief. KFF, December 19, 2022. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/.