By Rose Hoban
The number of North Carolina children lacking health insurance has decreased sharply over the past six years, reaching all-time lows, according to the annual Child Health Report Card released today by Action for Children North Carolina.
In 2007, 12.0 percent of children lacked coverage for even basic health care, but by 2012 that number had dropped to 8.4 percent, the report said. Children living in low-income families (earning less than 200 percent of the federal poverty level, $47,100 for a family of four) saw the steepest decrease in the rate of uninsurance, dropping from 20.6 percent in 2007 to 11.4 percent in 2012.
“Children who are insured are more likely to seek medical attention when they fall ill, which means they’re not missing school,” said Laila Bell, head of Action for Children North Carolina, which co-published the report along with the North Carolina Institute of Medicine.
“Kids with insurance don’t have to rely on costly ED visits,” Bell said. “They’re more likely to get preventative care such as well-child visits, vaccinations, dental screenings – all activities that help children stay in good health.”
She said the drop in the rate of uninsurance was possible even during the economic downturn because pubic programs such as Medicaid and the Health Choice (the state children’s health insurance program) picked up coverage for many children whose parents lost coverage along with their jobs.
About 1.1 million children in North Carolina are covered by those programs, Bell said, just under half the children in the state.
She also said it’s likely more North Carolina children will gain insurance in the coming year as the Affordable Care Act rolls out. According to the state Division of Medical Assistance (which runs the Medicaid program), about 70,000 people who were already eligible for Medicaid will be enrolled in the program this year; many of them will be children.
“We expect more families and their children to sign up for insurance in the Health Insurance Marketplace due to subsidies available,” Adam Zolotor, vice president of the North Carolina Institute of Medicine, wrote in a press release.
Zolotor noted that the ACA requires many preventative services, such as flu shots, to be delivered free of charge.
The annual report, financed by the Annie E. Casey Foundation, used recommendations for best practices and preventative services developed by the American Academy of Pediatrics to measure the well-being of children, Bell said.
Some stubborn measures
The report showed that the rate of childhood poverty leveled off in 2012 (see child poverty map here) after three years of sharp increases. Now more than one in four children in North Carolina lives in poverty, defined as $47,100 for a family of four.
Bell also noted that the state’s infant-mortality rate has had slight increases over the past two years after falling steadily for two decades. Even though the increases were small, they indicate that the state is no longer progressing on lowering the rate, she said.
“We’re still struggling with this infant-mortality issue,” said Bell, who said the state missed an opportunity by not expanding access to the Medicaid program for adults. “I hope people can see the link in women’s health before pregnancy and the health outcomes of their infants.”
Part of maternal health includes preventing smoking in pregnant women, which has been shown to increase the incidence of low birth weight in infants. More than 10 percent of babies in North Carolina are still born to mothers who smoke, a statistic collected on the state’s birth certificates.
But Bell said the state has made progress on some stubborn indicators, including dramatic drops in the fatality rate for children between birth and 17 years old, from 75.1 per 100,000 children in 2007 to 58.6 deaths per 100,000 children in 2012. She attributed that progress to the work of the legislative Child Fatality Task Force, which has pushed for state policies such as child seat belts and the creation of a statewide child-abuse response system.
She also pointed out the dramatic drop in the rate of teen pregnancies in North Carolina, which went from 34.8 pregnancies per 1,000 girls aged 15 to 19 years old in 2007 to 19.7 per 1,000 in 2012, which moved North Carolina from being an outlier to being in step with the national average.
“That’s because of the great work being done by communities, advocacy organizations, along with state investments and policy-makers. It’s a real homegrown success story,” said Bell.
“We managed to drop that rate because we were targeting evidence-based policies and practices, investing in child health and being intentional about the improvements we want to see in kids’ health,” she said.