Insurance Dynamics During Childhood in the Fragmented US Health System

How common is it for US children to rely on Medicaid and Children’s Health Insurance Program (CHIP) or experience uninsurance during their first 18 years of life?Based on a microsimulation synthesizing 2015-2019 national data, 61% of US children were ever enrolled in Medicaid or CHIP and 42% were ever uninsured by their 18th birthday. Among children born with Medicaid or CHIP, the share ever uninsured was 59% in states that did not expand Medicaid under the Affordable Care Act vs 36% in expansion states.These estimates indicate Medicaid and CHIP’s critical role in childhood, but insurance gaps are frequent nevertheless. Recent policy changes may worsen existing gaps.

Corresponding Author: Ye Shen, MSPH, Interfaculty Initiative in Health Policy, Harvard University, 8 Story St, Ste 380, Cambridge, MA 02138 (ye_shen@fas.harvard.edu).

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