Medicaid’s vital role for children in Trump country

By Priya Krishnakumar and Noam Levey

Medicaid and the related Children’s Health Insurance Progam, CHIP, provide critical protections to children in poor, rural parts of America. A majority of these areas backed Donald Trump last year. Now President Trump is pushing healthcare legislation that would dramatically cut the healthcare safety net.
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There are 780 counties in the United States where the majority of children are on Medicaid or CHIP. In the 2016 election, 617 of these counties voted for Donald Trump, and 163 voted for Hillary Clinton.

States that expanded Medicaid under the Affordable Care Act

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Medicaid and children’s health coverage

Medicaid and the related Children's Health Insurance Program have become an increasingly important source of coverage for children.

Sources of health insurance coverage for children, 2015
Other public2% Uninsured5% Medicaid/CHIP39% Employer/other private53% 0 10 20 30 40 50 60 Other public Uninsu r ed Medi c aid / CHIP Empl o y e r / o ther pri v a t e

Source: Kaiser Family Foundation

The percentage of children who lack health insurance has been falling steadily for two decades, in large part because of the expansion of public programs such as Medicaid and CHIP.

Uninsured rate (%)
’98 ’00 ’02 ’04 ’06 ’08 ’10 ’12 ’14 ’16 0 12 24 Children (0-17) Nonelderly adults (18-64) Affordable Care Act signed in 2010 2016:12.4% 5%

Source: National Center for Health Statistics

Note: 2016 data is from January through June

Children make up the the largest share of Medicaid beneficiaries, though they are much less costly than disabled and elderly Medicaid beneficiaries.

Who is on Medicaid (2014)
Elderly Disabled Nonelderly adults Children 0 10 20 30 40 50 E lderly Di s abled Nonelderly adul t s Child r en 34% 0 10 20 30 40 50 Elderly Disabled Nonelderly adults Children % of total enrollment Children43% Nonelderly adults34% Disabled14% Elderly9%

Source: Kaiser Family Foundation

Note: Data does not include CHIP.

The demographics of America's most Medicaid-dependent counties

The median household income is less than $40,000 in three quarters of the counties where the majority of children are on Medicaid or CHIP.

Median household income

$20K $30K $40K $50K $60K Many of the lowest-income counties are located in the Deep South.

In 574 Medicaid/CHIP-dependent counties, the majority of the population is white; 561 of these counties voted for Trump.

% of population that is white

50% 60% 70% 80% All counties in Washington and Oregon and most in Northern California where a majority of children are on Medicaid and CHIP voted for Trump. All of the counties in Washington and Oregon and most in Northern California where a majority of children are on Medicaid and CHIP voted for Trump. Almost every county in Appalachia-backed Trump in 2016. Almost every county in Appalachiabacked Trump in 2016.

There are 83 Medicaid/CHIP-dependent counties where the majority of the population is black. All but five of these counties voted for Democrat Hillary Clinton in 2016.

% of population that is black

50% 60% 70% 80% Many of these Southern counties have been Democratic strongholds for decades. Many of these Southern counties have been Democratic strongholds for decades.

There are 52 Medicaid/CHIP-dependent counties where the majority of population is Latino; 29 of these counties voted for Clinton and 23 voted for Trump.

% of population that is Hispanic or Latino

50% 60% 70% 80% 9 of the 13 counties that are on the U.S.-Mexico border voted for Hillary Clinton 9 of the 13 counties that are on the U.S.-Mexico border voted for Hillary Clinton

Sources: Georgetown University, Kaiser Family Foundation, U.S. Census Bureau, National Center for Health Statistics