Professional Documents
Culture Documents
Child Uninsurance Rates 2014 ACA
Child Uninsurance Rates 2014 ACA
Key Findings
zz The rate of uninsurance among
October 2015
8.6%*
8.0%*
8.0%
7.5%*
7.0%
7.2%*
7.1%
6.0%*
6.0%
5.0%
2008 2009 2010 2011 2012 2013 2014
* Change is significant at the 90% confidence level. 2013 was the only year that did not show a significant oneyear decline in the national rate of uninsured children.
October 2015
Number of
Uninsured
Children
(in millions)
6.9
6.4*
5.9*
5.5*
5.3*
5.2
4.4*
2013
2014
7.2%
7.1%
6.0%*
26.5%
25.5%*
20.4%*
Adults (18-64)
20.6%
20.3%*
16.3%*
Seniors (65+)
1.0%
1.0%
0.9%*
October 2015
Children in families
living on the brink
of poverty (100 to
199 percent of FPL)
have the highest rate
of uninsurance.
Sources of Coverage
Nearly half of all children (46.7 percent) are
covered through employer-sponsored health
insurance, while more than one-third (34.9
percent) rely on Medicaid and CHIP coverage
(see Figure 4).
In contrast to past trends of declining
employer-sponsored insurance (ESI), the
number of children covered by ESI increased
significantly between 2013 and 2014,
and the share of children covered by ESI
remained stable. Since 2013, the share of
children with Medicaid coverage and directpurchase coverage has increased. Directpurchase coverage includes new subsidized
marketplace coverage.11
Medicaid/CHIP
46.7%
0%
10%
20%
Other*
34.9%
30%
40%
50%
60%
Directpurchase
Uninsured
70%
80%
90%
100%
* Other includes Medicare, TRICARE, VA, and two or more types of coverage. See methodology section for more information.
October 2015
8.9%
7.3%*
8.1%
7.1%*
3.6%
< 100%
100-199%
200-299%
3.0%*
> 300%
2014
Hispanic children
comprise less than a
quarter of the total
child population, but
almost two-fifths of
uninsured children.
13.9%
9.7%
7.5%
4.8%
5.9%
5.5%
Black
White
Asian/
Other
Native Hawaiian/
Pacific Islander
4.6%
American
Indian/Alaska
Native**
White,
nonHispanic*
Hispanic*
* For simplicity, racial and ethnic data are displayed in this chart, but Hispanic refers to a persons ethnicity and these
individuals may be of any race. See the methodology section for more information.
** Indian Health Service is not considered comprehensive coverage. See the methodology section for more information.
October 2015
As in past years, school-aged children (ages 6 to 17) are more likely than younger children (under
age 6) to be uninsured. Both age groups saw a significant decline in percent uninsured in 2014
(Figure 7), but school-aged children still account for nearly three out of four uninsured children in
the nation.
Older children
have higher
rates of
uninsurance
than their
younger peers.
6 to 17 years old
2013
2014
Geographic Region
Children living in the Northeast (3.8 percent)
and Midwest (4.7 percent) have lower
uninsured rates than the national average,
October 2015
8.2
4.6
7.8
3.8
5.7
5.9
9.6
4.4
6.9
5.4
10.0
3.3
5.6
5.5
7.3
7.2
8.7
11.0
3.3
3.8
3.2
5.3
9.4
4.4
5.2
4.8
7.2
3.0
4.3
3.1
6.3
1.5
3.2
3.7
4.6
3.2
5.7
2.1
5.2
5.2
4.8
5.5
5.3
3.8
7.6
5.2
9.3
11.4
5.7
2.2
No statistically significant
difference from the national
average (10 states)
Uninsured rate lower than national
rate (28 states including DC)
Uninsured rate higher than national
rate (13 states)
October 2015
Figure 9 shows the five states with the lowest and highest rates of uninsured children
nationwide. The states with the lowest uninsured rates remained stable from 2013 to 2014
except that West Virginia replaced New Hampshire. For the five states with the highest
uninsured rates, Utah replaced Florida, which now ranks 46th.
Figure 9: States with the Lowest and Highest Rates of Uninsured Children, 2014
States with Lowest Uninsured Rates
Massachusetts
1.5
Alaska
11.4
District of Columbia
2.1
Texas
11.0
Vermont
2.2
Arizona
10.0
West Virginia
3.0
Nevada
9.6
Hawaii
3.1
Utah
9.4
Because of differences in state size, demographics, and policy choices, a large share of the
nations uninsured children remain clustered in a small number of states. Almost half of the
nations uninsured children (48.9 percent) live in six statesTexas, California, Florida, Georgia,
Arizona and Pennsylvania, while only 36.9 percent of all children live in these states.
Figure 10: Half of the Nations Uninsured Children Reside in Six States
State
2014 Number of
Uninsured Children
As a Share of Total
Uninsured Children
Texas
783,938
17.8%
California
497,090
11.3%
Florida
377,987
8.6%
Georgia
189,035
4.3%
Arizona
161,854
3.7%
Pennsylvania
139,117
3.2%
2,149,021
48.9%
National Total
4,396,536
October 2015
Figure 11: States with the Greatest Decline in Rate of Uninsured Children, 2013-2014
State
2013
Percent
Uninsured
2014
Percent
Uninsured
2013-2014
Percentage Point
Change in Uninsured
14.9
9.6
-5.3*
Colorado
8.2
5.6
-2.6*
West Virginia
5.3
3.0
-2.3*
Mississippi
7.6
5.3
-2.3*
Rhode Island
5.4
3.3
-2.1*
Nevada
The states with the largest decline in the number of uninsured children from 2013 to 2014 were
California, Texas, Florida, Georgia, and Nevada (see Figure 12). The decline in uninsured children
in these five states431,326 childrenaccounted for more than half (51.5 percent) of the entire
decline in uninsured children in the nation.
Figure 12: States with the Greatest Decline in Number of Uninsured Children, 2013-2014
State
2013
Number
Uninsured
2014
Number
Uninsured
2013-2014
Change in Number
of Uninsured
California
673,208
497,090
-176,118*
Texas
888,305
783,938
-104,367*
Florida
445,035
377,987
-67,048*
Georgia
238,051
189,035
-49,016*
Nevada
98,509
63,732
-34,777*
West Virginia had the largest percent decline in number of uninsured children from 2013 to
2014 (43.7 percent) followed by Rhode Island (38.5 percent), Nevada (35.3 percent), Minnesota
(31.9 percent), and Colorado (31.4 percent). Vermonts decline fell into this range but was
not statistically significant. Percent change compares the decline in the number of uninsured
children from 2013 to 2014 to the number of uninsured children in 2013. This measure is useful
in analyzing the extent to which a state reduced its number of uninsured children regardless
of state size (see methodology section for more information). Refer to Appendix Table 3 for all
states rate of decline in number of uninsured children.
October 2015
States that extended Medicaid coverage to adults and parents in 2014 saw a larger decline in
the number and percent of uninsured children than those states that did not.13 Prior research has
shown that covering parents increases the rate of coverage for their children as well.14
As Figure 13 shows, states that expanded Medicaid had lower rates of uninsured children prior to
expansion, but despite having fewer uninsured children to begin with these states saw a sharper
rate of decline in uninsured children.15 Figure 15 on page 11 shows a state-by-state comparison of
childrens uninsured rates in expansion states and non-expansion states.
5.9%
4.6%*
Expansion states
Non-expansion states
2013
2014
As Figure 14 shows, Medicaid expansion states saw a decline of nearly half a million (495,789)
uninsured children while non-expansion states saw a decline of 342,007 in uninsured children.
This translates to a 21.7 percent decline in expansion states, nearly double the 11.6 percent
decline in non-expansion states.
Figure 14: Expansion States Saw Nearly Double the Rate of Decline in
Uninsured Children Compared to Non-expansion States
Population
Medicaid Expansion
States
Non-Expansion
States
2,287,593
2,946,739
1,791,804
2,604,732
-495,789
-342,007
-21.7%
-11.6%
10
October 2015
Medicaid
Expansion States
Non-Expansion
States
0.0%
2.0% 4.0% 6.0% 8.0% 10.0%
12.0%
* Alaska, Indiana, Montana, and Pennsylvania have or are in the process of expanding Medicaid since 2014.
** While Arizona expanded Medicaid, its CHIP program remains closed.
October 2015
11
Conclusion
The Affordable Care Act contributed to a historic
decline in the number of Americas uninsured
children. States that took full advantage of the
ACAs coverage options for parents and other
adults saw sharper declines in the number
of uninsured children. Nationwide, 6 percent
of childrenor 4.4 million childrenremain
Endnotes
G. Kenney, et al., A First Look at Childrens
Health Coverage under the ACA in 2014, Urban
Institute Health Reform Monitoring Survey and
the Georgetown Center for Children and Families
(September 2014), available at http://hrms.urban.org/
briefs/Childrens-Health-Insurance-Coverage-underthe-ACA-in-2014.pdf.
1
12
October 2015
October 2015
13
Methodology
Data Source
This brief analyzes single year estimates
of summary data from the 2013 and 2014
American Community Survey (ACS). The U.S.
Census Bureau publishes ACS summary data
on American Fact Finder. Where only number
estimates are available, percent estimates
and their standard errors were computed
based on formulas provided in the 2014 ACSs
Instructions for Applying Statistical Testing
to ACS 1-Year Data.All tests for statistical
significance use 90 percent confidence
intervals. Except where noted, reported
differences of rate or number estimates (either
between groups, coverage sources, or years)
are statistically significant. This years report
provides estimates over a 1-year time period,
as opposed to our previous reports, which
provided estimates over a 2-year time period.
Percent Change
Percent change measures differences relative
to the size of what is being measured. In
this report, percent change refers to change
in uninsured children from 2013 to 2014
compared to the original population of
uninsured children in 2013. For example, from
2013 to 2014, the number of uninsured children
in the United States declined by 838,000
childrenfrom 5,234,332 in 2013 to 4,396,536
in 2014. To measure percent change, we take
the change (-837,796) and divide by the original
population (5,234,332 uninsured children in
2013). The US saw a 16 percent decline in the
14
Geographic Location
We report regional data for the U.S. as defined
by the Census Bureau. The ACS produces
single year estimates for all geographic areas
with a population of 65,000 or more, which
includes all regions, states (including D.C.), and
county and county equivalents. Urban areas
are territories with a population greater than
50,000 people or densely developed territories
with 2,500 to 50,000 people. Rural areas are all
those territories outside urban areas.
Poverty Status
Data on poverty levels include only those
individuals for whom the poverty status can
be determined for the last year. Therefore, this
population is slightly smaller than the total
non-institutionalized population of the U.S. (the
universe used to calculate all other data in the
brief). The Census determines an individuals
poverty status by comparing their income in
the last 12 months to poverty thresholds that
account for family size and composition, as
well as various types of income.
Health Coverage
Data on sources of health insurance coverage
are point-in-time estimates that convey
whether a person has coverage at the time of
the survey. Individuals can report more than
October 2015
Demographic Characteristics
Children are defined as those under the age
of 18.
In the brief we report data for all seven race
categories and two ethnicity categories for
which the ACS provides one-year health
insurance coverage estimates. The U.S.
Census Bureau recognizes and reports race
and Hispanic origin (i.e., ethnicity) as separate
and distinct concepts.
To report on an individuals race, we merge the
data for Asian alone and Native Hawaiian
or other Pacific Islander alone. In addition,
we report the ACS category some other race
alone and two or more races as Other.
Except for Other, all other racial categories
refer to respondents who indicated belonging
to only one race.
October 2015
15
Appendix Table 1. Number of Uninsured Children Under 18, 2013 and 2014
State
United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
2013 Number
Uninsured
5,234,332
48,181
21,842
191,760
39,259
673,208
102,149
33,655
9,088
2,630
445,035
238,051
9,335
38,017
125,351
130,004
29,755
44,130
59,530
63,312
15,386
59,285
21,079
89,941
71,982
56,149
97,546
22,495
25,379
98,509
10,261
112,117
43,105
170,783
144,194
12,725
141,368
95,042
50,172
147,303
11,564
72,595
13,122
85,287
888,305
84,891
3,882
101,251
94,795
20,305
61,288
7,934
2014 Number
Uninsured
4,396,536
42,422
21,252
161,854
34,079
497,090
70,084
28,870
11,652
2,385
377,987
189,035
9,552
33,777
99,502
113,495
23,234
39,411
43,298
57,531
16,292
42,595
21,311
83,254
49,017
38,832
99,972
18,421
24,795
63,732
11,701
91,842
36,402
137,525
119,078
11,542
126,139
82,251
39,033
139,117
7,107
59,983
11,912
77,613
783,938
84,768
2,640
107,102
74,927
11,437
57,611
8,137
Note: CCF does not take margin of error into account when ranking states by the number of uninsured children.
16
October 2015
Appendix Table 2. Percent of Uninsured Children Under 18, 2013 and 2014
State
United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
2013 Percent
Uninsured
7.1
4.3
11.6
11.9
5.5
7.4
8.2
4.3
4.5
2.4
11.1
9.6
3.0
8.9
4.2
8.2
4.1
6.1
5.9
5.7
5.9
4.4
1.5
4.0
5.6
7.6
7.0
10.1
5.5
14.9
3.8
5.6
8.5
4.0
6.3
7.9
5.3
10.0
5.8
5.4
5.4
6.7
6.3
5.7
12.6
9.5
3.1
5.4
5.9
5.3
4.7
5.7
2014 Percent
Uninsured
6.0
3.8
11.4
10.0
4.8
5.4
5.6
3.7
5.7
2.1
9.3
7.6
3.1
7.8
3.3
7.2
3.2
5.5
4.3
5.2
6.3
3.2
1.5
3.8
3.8
5.3
7.2
8.2
5.3
9.6
4.4
4.6
7.3
3.3
5.2
6.9
4.8
8.7
4.6
5.2
3.3
5.5
5.7
5.2
11.0
9.4
2.2
5.7
4.7
3.0
4.4
5.9
Note: CCF does not take margin of error into account when ranking states by the percent of uninsured children..
October 2015
17
Appendix Table 3. Change in the Number of Uninsured Children Under 18, 2013 and 2014
State
United States
California
Texas
Florida
Georgia
Nevada
New York
Colorado
Arizona
Illinois
North Carolina
Minnesota
New Jersey
Washington
Mississippi
Maryland
Indiana
Kentucky
Ohio
Oklahoma
South Carolina
Oregon
West Virginia
Pennsylvania
Tennessee
New Mexico
Michigan
Iowa
Louisiana
Alabama
Arkansas
Connecticut
Kansas
Rhode Island
Idaho
Montana
Wisconsin
Vermont
South Dakota
North Dakota
Alaska
Nebraska
District of Columbia
Utah
Wyoming
Hawaii
Massachusetts
Maine
New Hampshire
Missouri
Delaware
Virginia
2013 Number
Uninsured
5,234,332
673,208
888,305
445,035
238,051
98,509
170,783
102,149
191,760
125,351
144,194
71,982
112,117
94,795
56,149
59,285
130,004
59,530
141,368
95,042
72,595
50,172
20,305
147,303
85,287
43,105
89,941
29,755
63,312
48,181
39,259
33,655
44,130
11,564
38,017
22,495
61,288
3,882
13,122
12,725
21,842
25,379
2,630
84,891
7,934
9,335
21,079
15,386
10,261
97,546
9,088
101,251
2014 Number
Uninsured
2013-2014 Change
in Number of Uninsured
4,396,536
497,090
783,938
377,987
189,035
63,732
137,525
70,084
161,854
99,502
119,078
49,017
91,842
74,927
38,832
42,595
113,495
43,298
126,139
82,251
59,983
39,033
11,437
139,117
77,613
36,402
83,254
23,234
57,531
42,422
34,079
28,870
39,411
7,107
33,777
18,421
57,611
2,640
11,912
11,542
21,252
24,795
2,385
84,768
8,137
9,552
21,311
16,292
11,701
99,972
11,652
107,102
-837,796*
-176,118*
-104,367*
-67,048*
-49,016*
-34,777*
-33,258*
-32,065*
-29,906*
-25,849*
-25,116*
-22,965*
-20,275*
-19,868*
-17,317*
-16,690*
-16,509*
-16,232*
-15,229*
-12,791*
-12,612*
-11,139*
-8,868*
-8,186
-7,674
-6,703*
-6,687
-6,521*
-5,781
-5,759
-5,180
-4,785
-4,719
-4,457*
-4,240
-4,074
-3,677
-1,242
-1,210
-1,183
-590
-584
-245
-123
203
217
232
906
1,440
2,426
2,564
5,851
2013-2014
Percent Change
-16.0
-26.2
-11.7
-15.1
-20.6
-35.3
-19.5
-31.4
-15.6
-20.6
-17.4
-31.9
-18.1
-21.0
-30.8
-28.2
-12.7
-27.3
-10.8
-13.5
-17.4
-22.2
-43.7
-5.6
-9.0
-15.6
-7.4
-21.9
-9.1
-12.0
-13.2
-14.2
-10.7
-38.5
-11.2
-18.1
-6.0
-32.0
-9.2
-9.3
-2.7
-2.3
-9.3
-0.1
2.6
2.3
1.1
5.9
14.0
2.5
28.2
5.8
* indicates that the percentage point change is significant at the 90% confidence level.
18
October 2015
Appendix Table 4. Change in the Percent of Uninsured Children Under 18, 2013 and 2014
State
United States
Nevada
Colorado
West Virginia
Mississippi
Rhode Island
Georgia
California
Arizona
Montana
Minnesota
Florida
Texas
Kentucky
Oklahoma
Oregon
Washington
Maryland
New Mexico
South Carolina
North Carolina
Idaho
North Dakota
Indiana
New Jersey
Vermont
Iowa
Illinois
New York
Arkansas
Kansas
South Dakota
Connecticut
Ohio
Louisiana
Alabama
Tennessee
District of Columbia
Pennsylvania
Michigan
Wisconsin
Alaska
Nebraska
Utah
Massachusetts
Hawaii
Missouri
Wyoming
Virginia
Maine
New Hampshire
Delaware
2013 Percent
Uninsured
2014 Percent
Uninsured
2013-2014
Percentage Point Change
7.1
14.9
8.2
5.3
7.6
5.4
9.6
7.4
11.9
10.1
5.6
11.1
12.6
5.9
10.0
5.8
5.9
4.4
8.5
6.7
6.3
8.9
7.9
8.2
5.6
3.1
4.1
4.2
4.0
5.5
6.1
6.3
4.3
5.3
5.7
4.3
5.7
2.4
5.4
4.0
4.7
11.6
5.5
9.5
1.5
3.0
7.0
5.7
5.4
5.9
3.8
4.5
6.0
9.6
5.6
3.0
5.3
3.3
7.6
5.4
10.0
8.2
3.8
9.3
11.0
4.3
8.7
4.6
4.7
3.2
7.3
5.5
5.2
7.8
6.9
7.2
4.6
2.2
3.2
3.3
3.3
4.8
5.5
5.7
3.7
4.8
5.2
3.8
5.2
2.1
5.2
3.8
4.4
11.4
5.3
9.4
1.5
3.1
7.2
5.9
5.7
6.3
4.4
5.7
-1.1*
-5.3*
-2.6*
-2.3*
-2.3*
-2.1*
-2.0*
-1.9*
-1.9*
-1.9
-1.8*
-1.7*
-1.6*
-1.6*
-1.4*
-1.3*
-1.3*
-1.3*
-1.2
-1.2*
-1.1*
-1.1
-1.0
-1.0*
-1.0*
-1.0
-0.9*
-0.8*
-0.8*
-0.7
-0.7
-0.6
-0.6
-0.6*
-0.5
-0.5
-0.5
-0.3
-0.3
-0.3
-0.3
-0.2
-0.2
-0.1
0.0
0.1
0.2
0.2
0.3
0.4
0.6
1.3
2013-2014
Ranking
1
2
3
3
5
6
7
7
7
10
11
12
12
14
15
15
15
18
18
20
20
22
22
22
22
26
27
27
29
29
31
31
31
34
34
34
37
37
37
37
41
41
43
44
45
46
46
48
49
50
51
* indicates that the percentage point change is significant at the 90% confidence level.
Note: CCF does not take margin of error into account when ranking states by the percentage point change of uninsured children.
October 2015
19
Source of Coverage**
Medicaid/CHIP
Direct-purchase
ESI
Uninsured
2013
2014
2013
2014
2013
2014
2013
2014
79.8%
81.5%*
3.2%
3.4%
10.9%
10.8%
8.9%
7.3%*
100-199% FPL
100-137% FPL
138-199% FPL
200-299% FPL
55.5%
66.5%
47.7%
25.8%
57.4%*
68.3%*
49.8%*
27.4%*
5.2%
4.2%
5.9%
7.9%
5.5%
4.7%*
6.1%
8.3%*
31.9%
22.0%
39.0%
60.2%
31.4%
21.9%
38.2%*
59.5%*
10.7%
10.7%
10.6%
8.1%
9.0%*
8.9%*
9.0%*
7.1%*
7.8%
8.3%*
8.8%
8.9%
81.2%
81.2%
3.6%
3.0%*
Appendix Table 6: Top Twenty Counties with the Highest Number of Uninsured
Children, 2014*
Geographic
Region
Number of
Uninsured Children
143,320
131,339
92,551
90,103
54,554
51,281
49,440
48,192
47,679
43,118
10
40,957
11
38,811
12
38,514
13
36,094
14
32,622
15
32,003
16
31,840
17
28,673
18
27,770
19
23,898
20
20
October 2015
Child
Population
Share of the
Population
Midwest
15,666,085
21.3%
Northeast
11,936,899
South
28,029,138
West
Total
Number of
Uninsured Children
Share of Nations
Uninsured Children
739,884
16.8%
16.3%
456,405
10.4%
38.2%
2,081,218
47.3%
17,808,151
24.2%
1,119,029
25.5%
73,440,272
100.0%
4,396,536
100.0%
Midwest - IA, IN, IL, KS, MI, MN, MO, NE, ND, OH, SD, WI
Northeast - CT, ME, MA, NH, NJ, NY, PA, RI, VT
South AL, AR, DC, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, WV
West AZ, AK, CA, CO, HI, ID, MT, NV, NM, OR, UT, WA, WY
October 2015
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