Behind the troubling rise of uninsured American kids

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• Judy Woodruff:

  More than a million children have fallen off public health insurance programs since December 2017. For some of those children, their parents may have new jobs that come with health coverage.

  But researchers also see a troubling rise in uninsured children and say the Trump administration's efforts to vet families is a big part of the problem.

  As special correspondent Sarah Varney reports from Tennessee, that's meant families who could qualify for Medicaid are getting knocked off the rolls because of red tape and errors.

  Our story was produced in collaboration with partner Kaiser Health News.

• Sarah Varney:

  Seven-year-old Harrison relies on routine and order to make sense of his world. This morning, that world is a mess.

• Heather Hantz:

  Sit down here. Sit in your chair. No, not the phone.

• Sarah Varney:

  Heather Hantz says her son's struggles intensified after he was cut from Medicaid and missed five months of autism therapy.

  Last summer, Hantz called the state Medicaid office to change her mailing address and found out the state of Tennessee had canceled Harrison's health insurance. At first, she didn't understand why.

• Heather Hantz:

  They said it was a renewal packet, but we never received a renewal packet.

• Sarah Varney:

  Have they ever tried to come back to you since then and try and make amends, say, 'We apologize,' or…

• Heather Hantz:

  No.

  They said that it would take several months to have him reinstated, but you don't have several months with this type of child. He was very stressed. He started crying a lot, and that's not him.

• Sarah Varney:

  Harrison needs physical, behavioral, speech and language therapy — indispensable care that is hard to come by in rural Cleveland, Tennessee.

  Legal advocates waded through the paperwork to sign Harrison back up for Medicaid. But then he sat on a wait list until providers could see him again. The disruption caused problems at school.

• Heather Hantz:

  We had to bring him to a new school, where he could calm down and slowly, gradually bring him back into general education.

• Sarah Varney:

  As it turned out, it wasn't just Harrison. The state's Medicaid agency had canceled health coverage for more than 130,000 children.

  It was part of an effort championed by the Trump administration to closely vet Medicaid applicants and safeguard the integrity of the taxpayer-funded program.

  Those are top priorities for Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, a $1 trillion agency that pays for medical care for low-income people and seniors. A close ally of Vice President Mike Pence from Indiana, Verma has vowed to tighten Medicaid's eligibility rules.

• Seema Verma:

  We have an obligation to taxpayers to make sure that only the people that qualify for the programs are participating. And we also want to make sure that the programs are sustainable over the long term.

  I think there's a balance between making sure it's easy for people to apply, but we also have to make sure that we do the appropriate work to make sure that they qualify for the programs.

• Sarah Varney:

  But those efforts have led to pandemonium in Chattanooga, Tennessee, where Mayor Andy Berke and his staff have rushed to help parents fill out forms and send in appeals.

  Aides in the mayor's office say the state revoked Medicaid for one in eight kids in Hamilton County. Mayor Berke says the widespread cancellations across Tennessee's rural outposts and booming cities are part of Republican efforts to reduce public benefits — barriers put in place to disenfranchise the poor.

  And Berke wrote to Tennessee's top officials asking for help.

• Andy Berke:

  The response that we got back from the governor and from the lieutenant governor is, 'Well, the economy's improved, and, therefore, there are fewer kids on the rolls.'

  And that conflicted, of course, with the experience that we were having on the ground, which is, you know, these families still qualify. We know that they do. And there's no reason why they should be getting kicked off of Medicaid.

• Sarah Varney:

  All of those questions and rising frustrations have led back here, to Nashville. Tennesseans have been demanding answers from those in charge of their state's Medicaid program.

  So, how is the rollout of the new computer system going?

• Gabe Roberts:

  It's going well.

• Sarah Varney:

  Gabe Roberts oversees Medicaid in Tennessee. He says, after the Affordable Care Act went into effect in 2014, Tennessee, like many other states, spent its time and money building a new Medicaid computer system.

  While that work was under way, the Obama administration allowed states to suspend Medicaid verification, and the numbers of covered Tennesseans swelled.

  But, in 2016, the state began cleaning out the backlog, canceling coverage for children like Harrison when paperwork was missing.

• Gabe Roberts:

  We're extremely concerned about those comments, those allegations, those criticisms, and we take them extremely seriously.

• Sarah Varney:

  Roberts says the volume of cancellations was in line with his expectations, not evidence of widespread failures or nefarious intentions. And, in fact, enrollment has once again picked up.

• Gabe Roberts:

  Our message has been consistent. If you're eligible for Medicaid in Tennessee, we want you on our program. And if someone — if a child does come off the program, we can get them back on the program, and, a lot of times, we can get them back on the program with no real break in their coverage.

• Sarah Varney:

  But frontline workers at hospitals and clinics around Tennessee are dissatisfied with those explanations, where the rate of uninsured children has increased 43 percent since 2016.

  That's one of the highest in the nation.

  At Vanderbilt University's Children's Hospital in Nashville, pediatricians like Dr. Shari Barkin continue to find parents blindsided, even with the improved job market.

• Dr. Shari Barkin:

  I think what surprised us towards the end of 2018 and then through this year, 2019, is that the numbers went up to the degree of 15 to 20 patients a day coming to our clinic and not knowing that they no longer were enrolled.

• Sarah Varney:

  Barkin says that's led parents to make agonizing decisions when their children are ill. But some children have vanished from medical clinics altogether.

• Brian Haile:

  There's a real reluctance to re-enroll if the children or their parents are non-citizens.

• Sarah Varney:

  Brian Haile is the CEO of Neighborhood Health, a nonprofit group of clinics serving Nashville's poorest residents. Many are new immigrants.

  Tennessee's efforts to reconcile its Medicaid backlog came at the same time that the Trump administration adopted a punitive immigration policy that withholds green cards to legal immigrants who use public benefits, including Medicaid.

  Federal judges have temporarily blocked the rule from taking effect, but many families working in Nashville's booming construction and entertainment industries remain fearful that enrolling their kids in public health coverage will endanger their legal status.

• Brian Haile:

  These are still eligible individuals who are entitled to the benefit, but they hear so much anti-immigrant rhetoric from Washington that they feel really insecure.

• Sarah Varney:

  Whatever the reason, researchers at Georgetown University found that after years of gains insuring children in the U.S., the number of uninsured kids jumped to four million in 2018.

  The states with the highest uninsurance rates include Texas, Nevada, Arizona, Oklahoma, Alaska, Georgia, and Florida.

  Administrator Verma says it's not the Trump administration's Medicaid policies fueling the rise in uninsured kids, but the outrageous cost of health care. She says more parents are earning too much to qualify for government support but can't afford private health insurance.

• Seema Verma:

  And that's what the president is focused on. His health care agenda isn't just about putting out more subsidies and having the government pay more and more and creating unaffordable programs, but it is about addressing the underlying cost drivers in health care.

  That's why he's focused on prescription drug pricing, he's focused on transparency, price transparency, so that there's more competition in the market.

• Sarah Varney:

  While President Trump has put forth a number of health care proposals, few have taken effect.

  That all seems far away from the world Harrison inhabits. In East Tennessee, he's finding moments of delight riding a friend's aging pony.

  Heather Hantz says, when Harrison is vetted for coverage in the new year, she will keep a watchful eye on the state and on her son's future.

  For the "PBS NewsHour" and Kaiser Health News, I'm Sarah Varney in Cleveland, Tennessee.

• Judy Woodruff:

  We have Sarah's full interview with Medicaid Chief Seema Verma online, where the two discussed health coverage, the uninsured, and how the Trump administration would respond if Obamacare is struck down by the courts in the future.