The number of uninsured children in the U.S. has started going the wrong way after nearly a decade of improvement. And Tennessee is part of the problem, according to a study published Thursday by Georgetown University's Center for Children and Families.
Tennessee is among nine states — mostly in the South — where a significant number of children have lost coverage in the last year — a total of 13,000 more Tennessee kids are uninsured.
The Georgetown report doesn't explain all of the reasons why, though it points out that three-quarters of the children who've lost coverage live in states like Tennessee that didn't expand Medicaid under the Affordable Care Act. That would have covered more people who are considered the working poor.
Many parents who just miss qualifying for Medicaid, known in the state as TennCare, would likely be able to enroll their kids, who fall under much looser income requirements. But many don't.
"Research shows that children's insurance status is often closely tied with that of their parents," says Mandy Pellegrin, policy director at the Tennessee-based Sycamore Institute. "It's really no surprise that we're seeing the same trend among children in Tennessee."
The uninsured rate for Tennessee adults is also on the rise, according to analysis by Sycamore.
For the primary explanation for Tennessee's sharp rise in uninsured children, Pellegrin and other state-based experts point to a corresponding drop in the number of people on TennCare. Patient advocates say many are losing coverage by mistake because of notorious paperwork problems.
TennCare's own data shows 50,000 fewer children are enrolled as of October 2018 compared to the prior year.
"We don't know where these children are," says Kinika Young, director of children's health at the Tennessee Justice Center. "It's sort of like a needle in a haystack because they may not know that they've been disenrolled."
Young says many families find out only when they show up at the doctor. And even if they can revive their coverage, the lapse can leave them responsible for medical bills.
Despite the uptick, Tennessee's rate of uninsured kids, up from 3.7 percent in 2016 to 4.4 percent in 2017, is still below average. That’s partly because even without Medicaid expansion, Tennessee saw larger improvements in uninsured rates than many other states when the Affordable Care Act first took effect.