Déjà vu all over again for kids’ health care
When Donald Trump took office in 2017 more U.S. children had health insurance than ever before. Four years later, more than 4 million children were without it.
Buckle up, because we’re likely to see this again. The number of U.S. children without health insurance has been on the rise since the first Trump Administration, with a brief pause when President Biden and Congress insisted that kids stay covered during the pandemic. Those protections have since expired. Today, the share of U.S. children without health insurance stands at nearly 6% — or more than 4.4 million kids.
The first Trump Administration single-handedly reversed more than two decades of progress on children’s health insurance, mainly by erecting bureaucratic barriers and threatening immigrant children with deportation. The number of children without health insurance increased every single year during that Administration, according to data from the U.S. Census Bureau, rising from a historic low of 4.7% in 2016 to 5.6% in 2020, or roughly 4.3 million children.
First Focus on Children President Bruce Lesley has some thoughts about this: “After the passage of the Children’s Health Insurance Program, we made 20 years of meaningful gains on children’s health insurance. Unfortunately, President Trump began to reverse those trends, and we have been backtracking ever since. Many of the policies outlined by President-elect Trump and his surrogates for this new Administration — slashing Medicaid, abolishing the Affordable Care Act, threatening childhood vaccinations and early interventions, and subjecting children with chronic conditions such as cancer or special needs to arbitrary coverage limits — promise to continue those attacks on children’s health care and even accelerate that decline.”
President-elect Trump’s allies and appointees outlined these strategies in their Project 2025 playbook.
First Focus on Children has worked for nearly two decades to expand eligibility, enhance benefits, and improve the quality of care for the nation’s children. Meeting that mission requires strengthening Medicaid and the Children’s Health Insurance Program (CHIP). Instead of gutting these programs, the country’s leaders must make CHIP permanent, provide continuous coverage from birth to age 6, remove barriers based on immigration status, improve children’s access to mental health services, ensure that hospitals are prepared to serve kids in their emergency rooms and enact many other improvements to help children be healthy, stay healthy and become healthy adults.
Policies during the first Trump Administration sparked the first increase in uninsured children in nearly two decades. These policies included:
- the chilling effect of the Trump Administration’s public charge rule and rhetoric related to immigration, which likely had a large effect on the numbers of uninsured Hispanic children
- increased bureaucracy and non-health related changes to Medicaid enrollment for adults and parents, including work requirements
- dramatically decreased outreach and consumer assistance efforts
- overall increases in red tape at the state level.
In 1997, 15% of all U.S. children were uninsured. The passage that year of the Children’s Health Insurance Program (CHIP) and its partnership with Medicaid cut the uninsurance rate among children by two-thirds, declining to just 4.7% by 2016. CHIP and Medicaid today insure more than 37 million children — or half of all U.S. kids. During the COVID-19 pandemic, Congress prevented states from removing children from these public health care programs. Since the expiration of those policies in 2023, the so-called Medicaid “unwinding” has resulted in a net 5.5 million children losing health care coverage, most of them due to administrative issues.
With Medicare and Social Security declared untouchable as the Administration seeks $2 trillion in cuts, Medicaid and CHIP could become the budget cutters’ ATM.
They were during the first Trump Administration. In 2017, Congress let CHIP expire, interrupting the care and treatment of 9 million children for more than four months. Just days after CHIP was restored, President Trump tried to raid the program’s contingency fund in order to offset half of his tax cuts for wealthy adults. The uncertainty surrounding children’s health care led to the first increase in the percentage of uninsured children in two decades. Find a complete timeline of events on X.
For comprehensive analyses of how Project 2025 would impact the nation’s children, please review our briefs on education, health care, poverty, child care, and other topics.