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Under Trump, gains in health care coverage for Latino children mostly erased

More than 1.8 million Latino children lacked health coverage as of 2019, an increase of 354,400 children compared to 2016.
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Members of the uninsured Morales family, with five children, wait to enter to be treated at a free dental clinic put on by volunteers Oct. 27, 2018, in Modesto, Calif.Mario Tama / Getty Images file

Latino children were disproportionately affected by an overall increase in child uninsured rates between 2016 and 2019 when Donald Trump was president, according to a recent study.

More than 1.8 million Latino children lacked health coverage as of 2019, a rate of 9.3 percent, according to the study from the Center for Children and Families at Georgetown University released June 8. That is an increase of 354,400 children compared to 2016, when the uninsured rate of Latino children was at 7.7 percent. The uninsured rate of non-Latino children increased from 3.7 percent in 2016 to 4.4 percent in 2019.

Although the number of uninsured Latino children was still higher than that of non-Latino children, the 2016 rate was a historic low believed to reflect an improvement in narrowing health coverage disparities between Latino children and their peers. But the study confirms that a lot of that progress was erased over those three years.

The comprehensive report shows how certain factors such as state of residency, country of origin and immigration status can make some Latino uninsured children more vulnerable than others. The study also points to the Trump administration's implementation of the now-rescinded “public charge” rule, which penalized immigrants looking to get a green card or become a U.S. citizen for using certain public programs, as a reason for worsening rates among uninsured Latino children.

Kelly Whitener, an associate professor at Georgetown University's Center for Children and Families and the main author of the report, told NBC News on Tuesday that the new findings were shared with President Joe Biden's administration as it develops solutions to ensure more Latino children have health coverage.

The new administration said that it is interested in addressing the equity issues raised and creating outreach programs targeting the families of uninsured Latino children, most of whom are eligible for coverage, according to Whitener.

Even though 95 percent of Latino children are U.S. citizens and were not subjected to "public charge," many Latino families avoided enrolling their children in Medicaid or the Children's Health Insurance Program out of fear of adverse immigration consequences.

The Trump administration also cut federal funds to outreach efforts meant to advise families worried about the public charge rule or make them aware of other possible affordable coverage options. Additionally, ongoing court battles and repeated attempts to repeal the Affordable Care Act left many families uncertain about the availability of coverage.

All of these factors had an impact on school-age Latino children. They saw a slightly sharper increase on their uninsured rates compared to young children, jumping 1.8 percentage points from 8.7 percent in 2016 to 10.5 percent in 2019, the study shows.

It matters where Latino children live

To Whitener's surprise, state of residency is the factor that "correlates more with uninsured rates" among Latino children, she said.

State-level policies play a key role in enhancing or limiting access to health coverage for Latino children, with uninsured rate ranges from 1.8 percent in Massachusetts to 19.2 percent in Mississippi, according to the report.

As many as 1 in 5 Latino children lack health insurance in Mississippi, which is among the five states with the highest rates of uninsured Latino children, the study shows. Other states with high rates of uninsured Latino children are Texas (17.7 percent), Tennessee (17.7 percent), Georgia (16.3 percent), South Carolina (15.3 percent) and Arkansas (15.5 percent).

All these states, except Arkansas, have yet to pass Medicaid expansion. Wyoming, South Dakota, Wisconsin, Alabama, North Carolina, Kansas and Florida also have not passed Medicaid expansion. Years of research show that expanding Medicaid coverage to more adults lowers the child uninsured rate as newly eligible parents enroll their whole family, according to the report.

The study found that Latino children in families with incomes at or below 137 percent of the 2019 federal poverty line ($35,278 for a family of four) lost the most ground: Their uninsured rate rose more than 2 percentage points, from 8.4 percent in 2016 to 10.5 percent in 2019.

The data shows that Medicaid expansion "is imperative" to ensure more Latino children have coverage, Whitener said. The uninsured rate for Latino children in states that had not implemented Medicaid expansion by 2019 is more than 2.5 times higher than expansion states, according to the study.

Family roots and immigration status also play a role

Differences in Latino children's health coverage across states and country of origin highlight how these communities face different barriers to access.

For instance, Puerto Rican children are born U.S. citizens and can get public or private health coverage without worrying about immigration-based restrictions. But Honduran and Venezuelan children are much less likely to be citizens, forcing them to overcome additional barriers. Nearly 15 percent of all children of Venezuelan descent in the U.S. are uninsured, according to the report.

A quarter of all children of Honduran descent are uninsured, a 6.2 percentage points increase from 2016. However, children of Guatemalan descent experienced the sharpest increase in their uninsured rate, which shot up more than 7 percentage points betweem 2016 and 2019. In 2019, nearly 18 percent of Guatemalan children had no coverage.

While Guatemalan children are most likely to live in California, roughly 1 in 5 live in Florida, Texas or Georgia — states with no Medicaid expansion. In California, children of Guatemalan descent have the highest uninsured rate in the state (7.5 percent). That rate is still significantly less than that of their counterparts in Georgia, the third state with the highest number of uninsured Latino children, where 32.2 percent of Guatemalan children are uninsured.

Most Honduran children also live in Texas and Florida. But in Georgia, nearly 1 in 2 Honduran children in the state is uninsured. For children of Mexican descent in the state, less than 1 in 5 are uninsured.

"What that says to me is that the barrier of coverage does not stem mainly from their country of origin, but stems from the states and whether or not they have policies and outreach programs to improve access," Whitener said.

A patient waits with her son to be treated at a free dental clinic put on by volunteers on October 26, 2018 in Modesto, Calif.Mario Tama / Getty Images file

While most of the nation's Latino children are of Mexican descent (65.6 percent), only 9.6 percent of them have no health coverage, according to the study.

Researchers found that the uninsured rate for Puerto Rican children residing in the states (4.2 percent) is on par with the uninsured rate for non-Latino children. Over the past three years, these children only saw their uninsured rate increase by a little over 1 percentage point. Other groups, such as Dominican children, saw no statistically significant change, remaining at 4.8 percent.

In Florida, Colombian and Puerto Rican children have the lowest uninsured rates — 3.8 percent and 5.8 percent respectively — while Cuban children have the same uninsured rate as non-Latino children (6.8 percent).

The current uninsured rates of all children of Colombian and Cuban descent in the U.S. stand at 6.8 percent and 5.9 percent respectively, the study shows.

Even though the overwhelming majority of Latino children are U.S. citizens, almost half of them live in mixed-status families, meaning they have at least one noncitizen parent. Researchers found that a disproportionate share of uninsured Latino citizen children belong to mixed-status families.

This became evident between 2016 and 2019 when the Trump administration proposed, finalized and implemented the "public charge" rule. While the final rule stipulated that children’s participation in Medicaid or the Children's Health Insurance Program would notaffect parents’ green card applications, almost 4 in 5 adults in immigrant families with children who indicated that they understood the Trump-era rule were unaware of this particularity, according to the report.

Additionally, the study found that Latino adolescents in Spanish-speaking households are more likely to be uninsured than Latino adolescents overall.

As the Biden administration works on outreach programs to address the lack of health coverage among Latino children, Whitener said she hopes these findings can serve to "help tailor those responses" and effectively curb misconceptions surrounding coverage eligibility for children.

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