In 2002 67.5% of American children were insured under private health insurance plans, either privately purchased or obtained through the parents' workplace (Robert J. Mills and Shailesh Bhandari, "Health Insurance Coverage in the United States: 2002," in Current Population Reports, U.S. Census Bureau, September 2003). Nearly one-quarter of American children (23.9%) were covered by Medicaid. (See Figure 6.5.) Medicaid covered a higher percentage of African-American children (41.2%) and Hispanic children (37.3%) than Asian (18.1%) or non-Hispanic white children (15.5%). (See Figure 6.4.)
Some health care industry observers believed that the 1996 welfare reform law, the Personal Responsibility and Work Opportunity Reconciliation Act (PL 104-193), would reduce enrollment in Medicaid. Under the 1996 law, federal money once dispensed through the Aid to Families with Dependent Children (AFDC) program was now given as a block grant (a lump sum of money) to states. In addition, the law no longer required that children who received cash assistance automatically enroll in the Medicaid program. The law gave states greater leeway in defining their requirements for aid, and in some states some families were no longer eligible for Medicaid.
Although it did not prove to reduce Medicaid enrollment dramatically, after three previous years of fairly steady enrollment, the percentage of children under eighteen enrolled in Medicaid dropped from 20.7% in 1996, when the welfare reform legislation was enacted, to 18.1% in 1999. For the same years, Medicaid enrollment dropped from 11.1% to 9.1% among the general population, but in 2000 Medicaid had risen to 9.5%. By 2002, 11.6% of the general population was covered by this entitlement program.
Some industry analysts attributed the declining proportion of uninsured children and children covered by Medicaid in the late 1990s to expansion of the State
TABLE 6.4
| Medicaid coverage among persons under 65 years of age, by selected characteristics, selected years 1984–2001 | |||||||||
| [Data are based on household interviews of a sample of the civilian noninstitutionalized population] | |||||||||
| Characteristic | 1984 | 1989 | 1995 | 1996 | 19971 | 1998 | 1999 | 2000 | 2001 |
| Number in millions | |||||||||
| Total2 | 14.0 | 15.4 | 26.6 | 25.8 | 22.9 | 21.1 | 21.9 | 22.9 | 25.2 |
| Percent of population | |||||||||
| Total, age adjusted2,3 | 6.7 | 7.1 | 11.3 | 10.9 | 9.6 | 8.8 | 9.0 | 9.4 | 10.3 |
| Total, crude2 | 6.8 | 7.2 | 11.5 | 11.1 | 9.7 | 8.9 | 9.1 | 9.5 | 10.4 |
| Age | |||||||||
| Under 18 years | 11.9 | 12.6 | 21.5 | 20.7 | 18.4 | 17.1 | 18.1 | 19.4 | 21.2 |
| Under 6 years | 15.5 | 15.7 | 29.3 | 28.2 | 24.7 | 22.4 | 23.5 | 24.3 | 25.8 |
| 6–17 years | 10.1 | 10.9 | 17.4 | 16.9 | 15.2 | 14.5 | 15.5 | 17.0 | 19.0 |
| 18–44 years | 5.1 | 5.2 | 7.8 | 7.6 | 6.6 | 5.8 | 5.7 | 5.6 | 6.3 |
| 18–24 years | 6.4 | 6.8 | 10.4 | 9.7 | 8.8 | 8.0 | 8.1 | 8.1 | 8.4 |
| 25–34 years | 5.3 | 5.2 | 8.2 | 7.8 | 6.8 | 5.7 | 5.7 | 5.5 | 6.2 |
| 35–44 years | 3.5 | 4.0 | 5.9 | 6.2 | 5.2 | 4.6 | 4.3 | 4.3 | 5.1 |
| 45–64 years | 3.4 | 4.3 | 5.6 | 5.3 | 4.6 | 4.5 | 4.4 | 4.5 | 4.7 |
| 45–54 years | 3.2 | 3.8 | 5.1 | 4.9 | 4.0 | 4.1 | 3.9 | 4.2 | 4.4 |
| 55–64 years | 3.6 | 4.9 | 6.4 | 5.9 | 5.6 | 5.0 | 5.3 | 4.9 | 5.2 |
| Sex3 | |||||||||
| Male | 5.2 | 5.6 | 9.2 | 8.9 | 8.1 | 7.5 | 7.7 | 8.0 | 8.9 |
| Female | 8.0 | 8.6 | 13.3 | 12.8 | 11.0 | 10.1 | 10.4 | 10.8 | 11.6 |
| Race3,4 | |||||||||
| White only | 4.6 | 5.1 | 8.8 | 8.7 | 7.5 | 6.7 | 6.9 | 7.2 | 8.1 |
| Black or African American only | 18.9 | 17.8 | 26.0 | 23.0 | 20.5 | 19.6 | 18.7 | 19.4 | 20.4 |
| American Indian and Alaska Native only | # | # | # | # | # | # | 41.3 | 44.2 | 15.5 |
| Asian only | 9.1 | 11.3 | 10.7 | *11.5 | 9.4 | 6.7 | 8.4 | 7.8 | 8.8 |
| Native Hawaiian and other Pacific | |||||||||
| Islander only | — | — | — | — | — | — | * | * | * |
| 2 or more races | — | — | — | — | — | — | 15.8 | 15.6 | 14.6 |
| Hispanic origin and race3,4 | |||||||||
| Hispanic or Latino | 12.2 | 12.7 | 19.8 | 18.5 | 16.0 | 14.1 | 14.1 | 14.2 | 16.0 |
| Mexican | 11.1 | 11.5 | 18.8 | 17.6 | 15.3 | 12.6 | 12.4 | 12.5 | 14.6 |
| Puerto Rican | 28.6 | 26.9 | 31.1 | 31.3 | 28.9 | 24.5 | 27.0 | 27.6 | 28.5 |
| Cuban | 4.8 | 7.8 | 13.8 | *13.1 | 8.2 | *9.1 | 8.3 | 9.7 | 12.2 |
| Other Hispanic or Latino | 7.4 | 10.4 | 16.9 | 15.0 | 13.9 | 13.9 | 13.8 | 14.1 | 15.0 |
| Not Hispanic or Latino | 6.2 | 6.6 | 10.2 | 9.7 | 8.7 | 8.0 | 8.2 | 8.6 | 9.3 |
| White only | 3.7 | 4.2 | 7.1 | 7.0 | 6.2 | 5.7 | 6.0 | 6.3 | 7.0 |
| Black or African American only | 19.1 | 17.8 | 25.6 | 22.7 | 20.3 | 19.4 | 18.7 | 19.3 | 20.3 |
| Age and percent of poverty level5 | |||||||||
| All ages:3 | |||||||||
| Below 100 percent | 30.5 | 35.3 | 44.7 | 42.9 | 38.8 | 37.9 | 36.8 | 37.2 | 39.0 |
| 100–149 percent | 7.5 | 11.0 | 18.0 | 17.4 | 17.5 | 16.0 | 18.6 | 20.3 | 23.5 |
| 150–199 percent | 3.1 | 5.0 | 7.9 | 8.0 | 7.4 | 7.2 | 9.8 | 10.8 | 13.3 |
| 200 percent or more | 0.6 | 1.1 | 1.8 | 1.7 | 1.7 | 1.8 | 2.0 | 2.3 | 2.6 |
| Under 18 years: | |||||||||
| Below 100 percent | 43.1 | 47.8 | 66.0 | 65.2 | 59.7 | 58.7 | 59.9 | 60.9 | 64.3 |
| 100–149 percent | 9.0 | 12.3 | 27.2 | 26.6 | 30.2 | 25.9 | 33.5 | 37.1 | 41.4 |
| 150–199 percent | 4.4 | 6.1 | 13.1 | 12.2 | 12.2 | 12.8 | 18.0 | 21.5 | 26.5 |
| 200 percent or more | 0.8 | 1.6 | 3.3 | 2.8 | 2.9 | 3.2 | 3.7 | 4.7 | 5.3 |
| Geographic region3 | |||||||||
| Northeast | 8.5 | 6.8 | 11.7 | 11.5 | 11.2 | 9.8 | 10.1 | 10.5 | 10.8 |
| Midwest | 7.2 | 7.5 | 10.3 | 8.7 | 8.2 | 7.5 | 7.3 | 7.9 | 9.0 |
| South | 5.0 | 6.4 | 11.1 | 11.1 | 8.6 | 8.6 | 8.9 | 9.4 | 10.7 |
| West | 6.9 | 8.2 | 12.4 | 12.4 | 11.4 | 9.7 | 10.3 | 10.2 | 10.6 |
Children's Health Insurance Program (SCHIP) that targeted children from low-income families and was instituted during the late 1990s. Others feel that the economic boom of the late 1990s may have played a role in preventing enrollment growth in Medicaid, and accurately predicted that the economic downturn and uncertainty of the early years of the twenty-first century would reverse the downward trend in both the share of the population without health insurance and Medicaid enrollment.
In 2004 many health care advocacy groups including the American Academy of Pediatrics (AAP), which represents fifty-seven thousand primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists, continued to agitate for federal legislation such as the MediKids Health Insurance Act (S.588/HR1205) to insure every infant, child, teenager, and young adult through age twenty-two. One of many supporters of the May 10–16, 2004, "Cover the Uninsured Week," the AAP also sought to protect Medicaid and
| #Estimates calculated upon request. | |||||||||
| *Estimates are considered unreliable. | |||||||||
| — Data not available. | |||||||||
| Notes: Medicaid includes other public assistance through 1996. Starting in 1997 includes state-sponsored health plans. Starting in 1999 includes State Children's Health Insurance Program (SCHIP). In 2001, 7.9 percent were covered by Medicaid, 1.2 percent by state-sponsored health plans, and 1.2 percent by SCHIP. | |||||||||
| 1In 1997 the National Health Interview Survey (NHIS) was redesigned, including changes to the questions on health insurance coverage. | |||||||||
| 2Includes all other races not shown separately and unknown poverty level. | |||||||||
| 3Estimates are for persons under 65 years of age and are age adjusted to the year 2000 standard using three age groups: under 18 years, 18–44 years, and 45–64 years. | |||||||||
| 4The race groups, white, black, American Indian and Alaska Native (AI/AN), Asian, Native Hawaiian and Other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with data year 1999 race-specific estimates are tabulated according to 1997 Standards for Federal data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to 1997 Standards. The 1999 and later race-specific estimates are for persons who reported only one racial group; the category "2 or more races" includes persons who reported more than one racial group. Prior to data year 1999, data were tabulated according to 1977 Standards with four racial groups, and the category "Asian only" included Native Hawaiian and other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. The effect of the 1997 Standard on the 1999 estimates can be seen by comparing 1999 data tabulated according to the two Standards: Age-adjusted estimates based on the 1977 Standards of the percent with Medicaid are; 0.1 percentage points higher for the white group; 0.1 percentage points lower for the black group; 0.8 percentage points higher for the Asian and Pacific Islander group; and 0.8 percentage points higher for the AI/AN group than estimates based on the 1997 Standards. | |||||||||
| 5Missing family income data were inputed for 15–17 percent of the sample under 65 years of age in 1994–96. Percent of poverty level was unknown for 19 percent of sample persons under 65 in 1997, 24 percent in 1998, 27 percent in 1999, and 26 percent in 2000 and 2001. | |||||||||
| 6MSA is metropolitan statistical area. | |||||||||
| SOURCE: "Table 128. Medicaid Coverage among Persons under 65 Years of Age, according to Selected Characteristics: United States, Selected Years 1984–2001," in Health, United States, 2003, National Center for Health Statistics, 2003, http://www.cdc.gov/nchs/data/hus/tables/2003/03hus128.pdf (accessed July 10, 2004) | |||||||||
| Percent of population | |||||||||
| Location of residence3 | |||||||||
| Within MSA6 | 7.1 | 7.0 | 11.1 | 10.4 | 9.5 | 8.5 | 8.4 | 8.8 | 9.8 |
| Outside MSA6 | 5.9 | 7.8 | 12.0 | 12.7 | 9.9 | 9.8 | 11.5 | 11.9 | 12.4 |
SCHIP, which together provide coverage to more than twenty-eight million children. Both programs have seen cuts in funding, services, and enrollment.
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