Columbia University Mailman School of Public Health

Latest Census Bureau Report Tells an Encouraging Story About Children Under The Affordable Care Act

The first full year of data on the impact of the Affordable Care Act is in and the results are striking. More than 8.8 million people secured affordable health insurance last year and the share of Americans not covered by health insurance dropped from 13.3 percent in 2013 to 10.4 percent— the deepest year-over-year decline in America’s uninsured since 1987. Those results are true across populations and in every state—and the implications for children living in poverty are profound.

The Affordable Care Act increased access to affordable health coverage by giving states the option of expanding Medicaid to low-income families and offering financial subsidies to help low- and moderate-income households purchase private insurance. And soon after the ACA took full effect in January 2014, early data from several sources predicted a sharp decline in the number and share of America’s uninsured. Then, last week, the Census Bureau released the first comprehensive data on the impact of the Affordable Care Act using data from the American Community Survey and the Current Population Survey. For those of us focused on policies that affect child poverty, the Census report tells an important and positive story:

  • State Medicaid expansions and the provisions of the ACA helped to narrow the gap in children not already covered under state child health insurance plans. The share of uninsured children under 19 was 6.2 percent in 2014, a statistically significant decline of 1.3 percentage points from 2013.  Still, older children were more likely to be uninsured than younger ones:  11 percent of 18 year olds were uninsured in 2014 compared to 4 percent of children less than one year old.
  • The most dramatic impacts were in the number of working adults that secured health insurance in 2014. After several years of a relatively stable uninsured rate between 2008 and 2013, the number of uninsured Americans dropped from 41.8 million in 2014 to 33.0 million in 2013. And we saw none of the declines in employer-based coverage that some were concerned about: most people still reported health insurance from an employer (55.4 percent of the population), followed by Medicaid (19.5 percent), Medicare (16.0 percent), direct-purchase (i.e., private insurance purchased through the ACA marketplace, 14.6 percent) and military health care (4.5 percent).
  • The sharp increase in adults with health coverage was seen in states that expanded Medicaid—and in states that didn’t. All 50 states and the District of Columbia showed a decline in the uninsured rate last year, with year-over-year decreases ranging from 0.4 to 5.8 percentage points.
  • But, as expected, states that expanded Medicaid saw a more pronounced decrease in their uninsured. The uninsured rate in 2014 was 9.8 percent in states that expanded Medicaid, compared with 13.5 percent in non-expansion states. And between 2013 and 2014, the decrease in the uninsured rate was 3.4 percentage points in expansion states, compared with 2.3 percentage points in non-expansion states.
  • And while the news in health coverage is overwhelmingly positive, there’s still a critical gap between children living in poverty and those living in more economically advantaged households. In 2014, the uninsured rate for children younger than 19 in poverty (8.6 percent) was higher than the uninsured rate for children not in poverty (5.6 percent).

That the Affordable Care Act is helping millions of people to secure health coverage is good news in itself. But when you consider the benefits of health coverage — improved access to health care services, improved health outcomes, and less financial hardship — the implications of the latest Census report become much more profound. Not only are more children getting health coverage, but the adults who care for them are, too. And that puts the entire household on track for better health outcomes and more stable financial footing.

To learn more about how differing state requirements in public insurance programs affect America’s poor children, visit the NCCP 50-State Policy Tracker at