Stark differences in kids' health coverage
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The odds of a child or teen being uninsured can vary a lot depending on where they live and their ethnicity, according to new census data.
Why it matters: The rate of uninsured children has been generally ticking upward since the end of the pandemic, and advocates and policy experts expect the trend to continue due to Medicaid policy changes from last year's congressional budget law.
- Lack of health insurance increases the odds of missed health screenings, vaccinations and early interventions when kids get sick.
Driving the news: Census data for 2025 released on Tuesday shows that children's health coverage is a geographic patchwork, with the uninsured population rising in the West and stubbornly high in Southern states.
- 5.8% of children under the age of 19 — about 4.4 million — did not have health insurance. That's down slightly from 2024.
- The uninsured rate was 8% in the South. And it rose 1.1% year-over-year in Western states, to 5.5%.
- Kids were likeliest to be insured in the Northeast, where the uninsured rate was 2.6%.
Policy experts aren't sure what's driving the rise in the West, but it could reflect the continued effects of aggressive post-pandemic Medicaid eligibility redeterminations in some red states, as well as large immigrant communities with generally higher uninsured rates.
- Lack of coverage for Hispanic kids was significantly higher (9.4%) than the census national average and compared with other racial and ethnic groups. It was substantially higher for foreign-born kids and those who aren't U.S. citizens.
Between the lines: The differences can partly be explained by the fact that fewer Southern states have opted into the Affordable Care Act's Medicaid expansion. Many also have stricter eligibility requirements for the nonexpansion population.
- Lower household incomes and less comprehensive employer coverage also play a part.
- But other states could see more children lose insurance in the years ahead, as Medicaid work rules, increased eligibility checks, provider tax changes and cuts to federal spending on the program take effect.
- Those policies are expected to hit expansion states harder, because they have more adults who are subject to reporting rules. And that could have an indirect effect on kids if families slip off program rolls.
- There's already been a 6% decline in children enrolled in the Medicaid and CHIP programs from May 2025 to May 2026, according to recent federal data.
"One thing we're certain to see is as Medicaid cuts are fully implemented ... states will be making cuts," said Edwin Park, research professor at the McCourt School of Public Policy at Georgetown University. "We know that when parents lose their coverage, their eligible children lose coverage as well."
- While the changes don't directly target kids' eligibility, the added verification, paperwork requirements and confusion over program eligibility are expected to have spillover effects, policy experts predict.
- A KFF analysis of Medicaid projections stemming from last year's reconciliation law found it will result in 3 million fewer insured children by 2034.
The new census figures show overall Medicaid coverage decreased by half a percentage point in 2025. At the same time, there was a 0.6 percentage point increase in Medicare enrollment as more Americans aged into the program.
- In 2025, 26.7 million people (7.9%) were uninsured for the entire year, which was essentially unchanged from 2024.
- Just over 4 in 10 adults age 65 and older had private coverage, which was down 2.8 percentage points from 2024. The decrease was driven by a drop-off in employment-based coverage for retirees and less direct-purchase coverage by seniors.
