Deep Inequities Persist in Children's Health Insurance Coverage


September 29, 2022  

CONTACT: Brianna Gavio (, 570-956-0201) 



American Indian and Alaska Native, Latino, Native Hawaiian and Pacific Islander children disproportionately uninsured  

Older, lower-income, and ruralchildren more likely to be uninsured  

Deep inequities for children who do not have health insurance persist across the country, according to a new analysis by the State Health Access Data Assistance Center (SHADAC), funded by the Robert Wood Johnson Foundation. While children 17 and younger are overall more likely to be insured than U.S. adults, there are wide gaps in kids’ coverage by geography, income,age, and whether they live in metropolitan locations 

Researchers say the result is that millions of children remain underserved by the U.S. healthcare system. SHADAC analyzed data on uninsurance rates in all 50 states and the District of Columbia for a five-year period, providing a comprehensive look at the status of insurance coverage for America’s kids.  

“The United States’ lower uninsurance rate for children is encouraging, but the overall data mask stubborn disparities that still limit many kids’ access to health care,” said Colin Planalp, a senior research fellow at SHADAC and lead author of the report. “Our study found clear inequities in health insurance coverage within all states. Plenty of work is still needed to achieve goals of ensuring children have equitable access to health insurance and health care, but the high coverage rates among some groups prove that progress is possible.” 

The analysis shows that 5% of children in the United States—roughly 3.6 million kidslacked health insurance between 2016 and 2020.Uninsurance rates vary widely within smaller segments of the population. This includes:  

  • Inequities based on race: The uninsured rates among American Indian and Alaska Native (14.1%), Latino (7.8%), and Native Hawaiian and Pacific Islander (6.0%) children are significantly higher than average; while Black (4.2%), White (3.9%), Asian (3.6%), and children of two or more races (3.6%) had rates significantly lower than average. 

  • Differences among states: Children’s uninsured rates vary significantly by state. Those with the highest rates of uninsured children are Texas (10.6%);Wyoming (9.3%);Alaska (8.4%);Arizona (8.2%); and Oklahoma and North Dakota (7.9%). Those with the lowest rates of uninsured children are Massachusetts (1.3%);Vermont (1.3%);DC (1.9%);Rhode Island (2.2%); and New York, West Virginia and Iowa (2.5%).  

  • Income differences: Children from lower (6.5%)and moderate (5.8%) income households are more likely to be uninsured than those from higher-income households (2.2%). 

  • Disparities in rural locations: Children residing in non-metropolitan areas (6.2%) are more likely to be uninsured than those in metropolitan areas (4.7%).  

  • Differences based on age: Older children ages 12 to 17 (5.8%) and six to 11 (4.8%) are more likely to be uninsured than those under five (4.3%). 


“Having health insurance as a child has lifelong benefits, including better health, higher educational attainment, and increased financial success,” said Andrea Ducas, senior program officer at the Robert Wood Johnson Foundation. “Disparities in children’s health insurance exacerbate inequities among populations that are often already disadvantaged. The data point to the need for more policy solutions at the state and national levels.” 

 The multi-year dataset allowed SHADAC researchers to examine differences among smaller population segments. Charts and data tables by race and ethnicity, income, age, and metropolitan or non-metropolitan location are available for each state.  

The information is helpful for policymakers as well as those who advocate for greater access and justice in the nation’s healthcare system.  

 “As a nation, we must address longstanding systemic issues that have hurt communities, families, and children,” said Emily Stewart, executive director of Community Catalyst. “As we work to reverse harms that have disproportionately impacted Black and brown communities and build an equitable health system, data like the ones published by our partners at SHADAC are essential to show where gaps persist and where policy changes are needed to move us forward.” 


Read the report here. 




About The Robert Wood Johnson Foundation  

The Robert Wood Johnson Foundation (RWJF) is committed to improving health and health equity in the United States. In partnership with others, we are working to develop a Culture of Health rooted in equity, that provides every individual with a fair and just opportunity to thrive, no matter who they are, where they live, or how much money they have. For more information, visit Follow the Foundation on Twitter at or on Facebook at  

About the State Health Access Data Assistance Center 

SHADAC is an independent, multi-disciplinary health policy research center, housed in the School of Public Health at the University of Minnesota, with a focus on state policy. SHADAC produces rigorous, policy-driven analyses and translates its complex research findings into actionable information for states. 

About Community Catalyst 

Community Catalyst is a leading non-profit national health advocacy organization dedicated to advancing a movement for health equity and justice. We partner with local, state, and national advocates to leverage and build power so all people can influence decisions that affect their health. 

Health systems will not be accountable to people without a fully engaged and organized community voice. That’s why we work every day to ensure people’s interests are represented wherever important decisions about health and health care are made: in communities, state houses and on Capitol Hill. For more information, visit Follow us on Twitter @CommCatHealth. 


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