Study finds uptick in Iowa kids under private health plans

Iowa has low uninsured rate compared with nation, research finds

A photo illustration shows a stethoscope and blood-pressure machine. REUTERS/Regis Duvignau
A photo illustration shows a stethoscope and blood-pressure machine. REUTERS/Regis Duvignau

More Iowa children who have been covered by Medicaid are moving out of the public health care program and into being covered by private insurance, new research appears to indicate.

A report by the State Health Access Data Assistance Center shows a trend toward fewer children in Iowa being uninsured, and new data from 2017 indicates more parents may be getting health care coverage for children through employer-based plans.

Researchers of the report attributed Iowa’s historic support of health coverage to be a major contributing factor, leading Iowa’s uninsured rate to be below the national average.

“Iowa especially is pretty good. It has a pretty low rate compared to the nation,” said Elizabeth Lukanen, deputy director of the center affiliated with the University of Minnesota School of Public Health.

More than 20,500 Iowa children, or about 2.7 percent, were uninsured in 2017, according to the report, which was created using data from the American Community Survey conducted by the U.S. Census Bureau.

This is a slight uptick from 2016, when 2.2 percent were uninsured.

However, the data shows Iowa’s uninsured rate among children for the most part has been declining steadily for a number of years, said Lukanen. In 2011, 4.7 percent of children were uninsured.

The center found the highest uninsured rates were among children who either were from low-income families or who had parents with a high-school education or less. There also were higher uninsured rates among children of color compared with their white counterparts.


The report shows that Medicaid coverage declined between 2016 and 2017 by about 3 percentage points, from nearly 30 percent to 27 percent.

Lukanen said this drop would be concerning if not for a corresponding increase in private insurance — ticking up from about 68 percent in 2016 to 70 percent in 2017.

“I think it might be some of these kids are no longer eligible for Medicaid because their parents are getting jobs,” Lukanen said. “We’ll be interested in looking at the uninsured rate for 2018 to see if this slight uptick in uninsurance is real, but I think it’s more likely that they’re shifting from Medicaid to private coverage at this point.”

Nationwide, about 3.9 million children — roughly 5 percent — did not have health insurance in 2017, according to the center. This reverses “an almost decadelong decline of uninsurance,” Lukanen said.

There was a major policy shift on the federal level between 2016 and 2017, with the election of President Donald Trump, and along with that his criticisms of the Affordable Care Act, the Obama administration’s health care insurance initiative.

The Trump administration’s reduction of outreach and defunding of navigators — professionals federally funded to help individuals sign up for insurance through the individual market — may have contributed to the increase in uninsured children, Lukanen said.

Lukanen attributed Iowa’s low uninsured rate to the state’s “strong history” of supporting health insurance options.

Iowa “has a very generous eligibility thresholds for children, so it covers kids of much higher incomes than other states, and the state in general has been very supportive of the Affordable Care Act and legislation to get kids covered,” Lukanen said.


“One of the things we’ve seen strong evidence is when parents get coverage, their kids get coverage.”

Lukanen compared Iowa with Texas, which had the highest rates of uninsured children in 2017 at nearly 11 percent.

While Texas also had an increase in the number of children on employer-based health plans, it wasn’t enough to offset the decline in public health options, she said.

Measuring uninsurance rates among children is a key indicator to their future economic outcomes, Lukanen said. Research has shown if children don’t have health insurance, they are less likely to go to the doctor’s office for care and therefore are more likely to miss school.

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