Decline in California’s Uninsured Rate Among Kids has Stagnated, Raising Concerns

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Los Angeles pediatrician Ilan Shapiro has seen a dramatic turnaround in how young patients get their health care since 2014, when the Affordable Care Act went into full effect.

Before the state expanded Medi-Cal, the government-funded health plan, to cover more low-income people including undocumented children, families would frequently bring their kids to the emergency room for health problems such as asthma, Shapiro recalls. These families are taking their children for routine checkups and preventative care instead, including at the nonprofit AltaMed health clinic in Boyle Heights where he works, he said.

“It’s amazing the difference,” said Shapiro. “The ER was kind of the primary care doctor for a lot of families… Now (primary care doctors) have the option to talk about (children’s) health condition and treat them and see them more often.”

But Shapiro, and many other health care providers who work with low-income people in California, are worried. Federal attempts to undermine the Affordable Care Act, along with hostile policies toward immigrants, are threatening to unravel the state’s progress toward getting almost all children insured. A new report by Georgetown University has heightened that concern.

The report, released last week, shows the number of children nationwide without health insurance went up last year for the first time since 2008, resulting in an additional 276,000 uninsured children. California’s uninsured rate for kids stagnated at 3.1 percent (around 300,000 children), down from 11 percent in 2008. That’s better than the situation in many other states, but it could be a sign that California is starting to feel the impact of the Trump administration’s policies, said Edwin Park, a Georgetown University research professor who contributed to the report.

“California is one of the states most supportive of the expansion of the Affordable Care Act, has been the most successful in reducing the ranks of the uninsured, not just among kids but among adults as well,” he said. “The fact that we didn’t see further declines does raise some worry that even California is having problems fighting against the headwinds that we’re seeing from what’s happening at the federal level.”

One key concern is that the rate of uninsured children nationwide will climb further in 2018 as a result of the Trump administration’s proposed changes to the public charge rule. The changes would make it harder for legal immigrants to obtain green cards if they’ve received public assistance such as Medi-Cal. Park and other health care researchers believe that could prompt immigrant families to avoid enrolling their children in the health insurance plan. That could have an outsized impact on uninsured rates in California, where one in four residents is foreign born, he said.

“We’d been making significant progress over the last decade in covering all kids and now we’re moving in the opposite direction,” Park said. “It’s a very troubling sign of things to come.”

For Shapiro, the public charge issue is just one factor that’s creating confusion and worry among families seeking health insurance for their kids. They’re also perplexed by the federal government’s removal of a mandate that required everyone to get health insurance or pay a fine, and conflicting news reports about other threatened changes to the health care law, he said.

“They just don’t know who to trust or what to do,” he said. “We are living in a critical moment. The Affordable Care Act was not perfect, but it was a good opening to create public health, population health… Those things are an amazing investment for the future. It would be extremely sad if we stopped doing it.”

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