American Community Survey Briefs

U.S. Department of Commerce

Economics and Statistics Administration

U.S. CENSUS BUREAU

U S C E N S U S B U R E A U

Helping You Make Informed Decisions

Health Insurance Coverage of 

Children Under Age 19: 

2008 and 2009

Introduction

Health insurance coverage, whether private or public, improves children’s access 

to health care services and the regularity 

with which children receive medical care. 

This improved access to care leads to better health for insured children compared 

to uninsured children.1 

Insured children are either covered by private health insurance as dependents on 

a parent’s or guardian’s plan or through 

public coverage available to eligible lowincome children. Children’s health insurance coverage is susceptible to changes 

in adults’ insurance coverage status as 

well as changes in a child’s eligibility for 

public programs.

Between 2008 and 2009, changes in 

children’s health insurance coverage type 

concurred with reduced access to private 

insurance and increased eligibility for 

public coverage. There were 9.4 million 

families with at least one unemployed 

member in 2009, up from 6.1 million in 

2008.2

 This increase suggests decreased 

access to private insurance for parents 

and children.3

 The increase in the poverty 

rate for children under age 18, from 18.3 

percent in 2008 to 20.0 percent in 2009, 

indicates that more children were eligible 

for public coverage.

1 Institute of Medicine, Health Insurance Is 

a Family Matter, The National Academies Press, 

Washington DC, 2002. 2 Bureau of Labor Statistics, U.S. Department 

of Labor, “Employment Characteristics of Families— 

2009,” June 10, 2010, <www.bls.gov/news.release

/famee.nr0.htm> (August 10, 2010). 3 Gerry L. Fairbrother et al., “The Impact of 

Parental Job Loss on Children’s Health Insurance 

Coverage,” Health Affairs, vol. 29, no. 7, 2010.

Two federal laws increased access to 

public coverage in 2009. First, the federal 

government reauthorized the Children’s 

Health Insurance Program—a program 

designed to provide health insurance 

coverage to uninsured children in families 

with income-levels above standards to 

qualify for Medicaid. The reauthorization 

took effect in April of 2009 and included 

funds for outreach and enrollment grants 

as well as provisions to remove barriers 

to enrollment. Second, the federal government passed the American Recovery 

and Reinvestment Act of 2009, which 

included funds to help states maintain 

Medicaid services for current enrollees 

and to defray costs associated with new 

enrollment from October 2008 through 

December 2010.4

 It is likely that these 

two Acts boosted enrollment in public 

programs shortly after the provisions in 

the Acts took effect.5,6

This report presents data on health 

insurance coverage of children under 

age 19 in the 2008 and 2009 American 

Community Surveys (ACS).7

 The data presented in this report are for the civilian 

noninstitutionalized population, which 

excludes active-duty military and persons 

in prisons and nursing homes. 

4 Kaiser Commission on Medicaid and the Uninsured, 

“American Recovery and Reinvestment Act (ARRA): 

Medicaid and Health Care Provisions,” March 4, 2009, 

<www.kff.org/medicaid/7872.cfm> (August 10, 2010). 5 Vernon K. Smith, et al., “The Crunch Continues: 

Medicaid Spending, Coverage and Policy in the Midst 

of a Recession,” September 2009, <www.kff.org

/medicaid/7985.cfm> (August 30, 2010). 6 Vernon K. Smith, et al., “CHIP Enrollment June 

2009: An Update on Current Enrollment and Policy 

Directions,” April 2010, <www.kff.org/medicaid/7642

.cfm> (August 30, 2010). 7 Data for children under 19 are presented because 

both Medicaid and the Children’s Health Insurance 

Program are available to eligible children under 19.

Issued September 2010

ACSBR/09-11

By

Annie Mach 

Laura Blumenthal 
2 U.S. Census Bureau

highlights

•	 Between 2008 and 2009, the

percentage of insured children 

in the United States increased 

from 90.3 percent to 91.0 

percent.

•	 In 2009, the uninsured rate of

children in the United States 

was 9.0 percent, and among 

the states the uninsured rate 

ranged from 18.4 percent 

in Nevada to 1.5 percent in 

Massachusetts.

•	 Between 2008 and 2009, the

uninsured rate for children 

decreased in the United States 

as well as in 17 states. The 

uninsured rate increased in two 

states (Alaska and Minnesota), 

and it was not statistically different in 32 states and Puerto 

Rico.

•	 The percentage of insured

children with private insurance 

decreased from 71.3 percent in 

2008 to 68.0 percent in 2009. 

The percentage of insured 

children with public coverage 

increased from 32.7 percent in 

2008 to 35.7 percent in 2009.

Health Insurance 

Coverage

The percentage of insured children 

in the United States increased from 

90.3 percent in 2008 to 91.0 percent in 2009, with 1.1 million more 

insured children in 2009 compared 

to 2008 (see table). Conversely, the 

percentage of uninsured children in 

the United States decreased from 

9.7 percent in 2008 to 9.0 percent 

in 2009, with 517,669 fewer uninsured children in 2009 compared 

to 2008. 

In 2009, Nevada had the highest 

percentage of uninsured children, 

18.4 percent, and Massachusetts 

had the lowest percentage of 

uninsured children, 1.5 percent. 

Compared to the percentage of 

uninsured children nationally, the 

percentage of uninsured children 

was higher in 16 states, lower in 

31 states and Puerto Rico, and not 

statistically different in 4 states 

(Figure 1). Between 2008 and 2009, 

the percentage of uninsured children increased in 2 states (Alaska 

and Minnesota), decreased in 17 

states, and did not change significantly in 32 states and Puerto Rico 

(Figure 2).

The increases in the number and 

percent of insured children in the 

United States between 2008 and 

2009 were accompanied by shifts 

in the coverage types held by 

MT

AK

NM

OR MN

KS

SD

ND

MO

WA

FL

IL IN

WI NY

PA

MI

OH

IA

ME

MA

CT 

AZ

NV

TX

CA CO

WY

UT

ID

NE

OK

GA

AR

AL

NC

MS

LA

TN

KY

VA

SC

WV

RI 

DE 

MD 

DC 

NJ 

Figure 1.

Uninsured Rates of Children by State and Puerto Rico: 2009 

VT

HI

NH

U.S. rate = 9.0 percent

Uninsured rates of children

(in 2009 inflation-adjusted dollars)

Higher than U.S. rate

Not statistically different

Below U.S. rate

Sources: U.S. Census Bureau, American Community Survey, 2009, Puerto Rico Community Survey, 2009. 

PR
U.S. Census Bureau 3

insured children. The number of 

insured children with private coverage decreased from 50.5 million 

in 2008 to 48.9 million in 2009, 

while the percentage decreased 

from 71.3 percent to 68.0 percent. 

The number of insured children 

with public coverage increased 

from 23.1 million in 2008 to 25.7 

million in 2009, while the percentage increased from 32.7 percent 

to 35.7 percent. The net effect of 

the change in overall coverage was 

517,669 fewer uninsured children 

in 2009 than in 2008—even though 

about 400,000 more parents were 

uninsured and the U.S. economy 

was in recession. Specifically, the 

percentage of insured children with 

employer-based insurance, the 

percentage with direct purchase, 

and the percentage with Medicare 

decreased, while the percentage of 

insured children with Medicaid or 

other means-tested public coverage 

increased between 2008 and 2009 

(Figure 3).

Measuring Health Insurance 

Coverage

The ACS asks respondents about 

current health insurance coverage 

at the time of the interview.

Respondents select one or more 

types of health insurance from a 

list or explain their coverage in a 

written response. Respondents who 

do not indicate a form of coverage 

or only select Indian Health Service 

(IHS) are considered uninsured.

Health insurance coverage in the 

ACS is broadly classified as private 

or public coverage. The following are definitions for the types of 

coverage captured by the ACS and 

discussed in this report.

Private Health Insurance

Employer-based: Insurance through 

a current or former employer or 

union. 

Direct-purchase: Insurance purchased directly from an insurance 

company. 

TRICARE or other military health 

coverage: Coverage for active duty 

service members, National Guard 

and Reserve members, retirees, 

their families, survivors, and certain former spouses.

Public Coverage

Medicare: Coverage for people 65 

and older or people with certain 

disabilities.

Medicaid or other means-tested 

public coverage: Medicaid, medical assistance, or any kind of 

government-assistance plan for 

those with low incomes or a disability (for example, Children’s 

Health Insurance Program—CHIP).

MT

AK

NM

OR MN

KS

SD

ND

MO

WA

FL

IL IN

WI NY

PA

MI

OH

IA

ME

MA

CT 

AZ

NV

TX

CA CO

WY

UT

ID

NE

OK

GA

AR

AL

NC

MS

LA

TN

KY

VA

SC

WV

RI 

DE 

MD 

DC 

NJ 

Figure 2.

Change in Uninsured Rates of Children by State and 

Puerto Rico: 2008 and 2009 

VT

HI

NH

2009 United States Index 0.469

Percentage of uninsured children 

between 2008 and 2009

(in 2009 inflation-adjusted dollars)

Increased

No statistically significant change

Decreased

Sources: U.S. Census Bureau, American Community Surveys, 2008 and 2009, Puerto Rico Community Surveys, 2008 and 2009.

PR
4 U.S. Census Bureau

VA Health Care: Provided through 

the Department of Veterans Affairs 

(includes those who have ever used 

or enrolled in VA Health Care). 

For More Information

For more information about health 

insurance estimates, go to the U.S. 

Census Bureau health insurance 

Web site at <www.census.gov/hhes

/www/hlthins/hlthins.html> or 

contact the Health and Disability 

Statistics Branch of the U.S. Census 

Bureau at 301-763-9112. 

Source and Accuracy

Data presented in this report are 

based on people and households 

that responded to the ACS in 2008 

and 2009. The resulting estimates 

are representative of the entire 

population. All comparisons presented in this report have taken 

sampling error into account and are 

significant at the 90 percent confidence level unless otherwise noted. 

Due to rounding, some details may 

not sum to totals. For information 

on sampling and estimation methods, confidentiality protection, and 

sampling and nonsampling errors, 

please see the “2009 ACS Accuracy 

of the Data” document located at 

<www.census.gov/acs/www

/Downloads/data_documentation

/Accuracy/ACS_Accuracy_of

_Data_2009.pdf>. 

Figure 3. 

Health Insurance Coverage of Insured Children 

by Type: 2008 and 2009

(Percent)

Sources: U.S. Census Bureau, American Community Surveys, 2008 and 2009. 

2008

2009

0

10

20

30

40

50

60

70

VA

Health Care

Medicaid/ Medicare

means tested

public

coverage

TRICARE/

military

health

care

Direct

purchase

Employerbased

insurance

What Is the American Community Survey?

The American Community Survey (ACS) is a nationwide survey 

designed to provide communities with reliable and timely demographic, social, economic, and housing data for the nation, states, 

congressional districts, counties, places, and other localities every 

year. It has an annual sample size of about 3 million addresses across 

the United States and Puerto Rico and includes both housing units 

and group quarters (e.g., nursing facilities and prisons). The ACS is 

conducted in every county throughout the nation, and every municipio in Puerto Rico, where it is called the Puerto Rico Community 

Survey. Beginning in 2006, ACS data for 2005 were released for geographic areas with populations of 65,000 and greater. For information on the ACS sample design and other topics, visit <www.census

.gov/acs/www>.
U.S. Census Bureau 5

Health Insurance Coverage of Children by State and Puerto Rico: 2008 and 2009

(Numbers in thousands) 

Area

2008 health insurance coverage 2009 health insurance coverage Change in health insurance 

coverage (2009 less 2008)

Number

Margin 

of error1

(±) Percent

Margin 

of error1

(±) Number

Margin 

of error1

(±) Percent

Margin 

of error1 

(±) Number

Margin 

of error1

(±) Percent

Margin 

of error1

(±)

 United States2 . . . . 70,827 78 90.3 0.10 71,895 70 91.0 0.09 *1,068 105 *0.72 0.14

Alabama . . . . . . . . . . . . 1,094 7 92.1 0.58 1,120 8 93.8 0.53 *26 11 *1.76 0.79

Alaska . . . . . . . . . . . . . . 169 3 87.5 1.31 169 3 85.4 1.62 – 5 *–2.11 2.09

Arizona . . . . . . . . . . . . . 1,514 13 84.4 0.73 1,590 11 87.3 0.56 *75 17 *2.86 0.91

Arkansas . . . . . . . . . . . . 682 6 91.2 0.80 697 6 93.0 0.67 *15 8 *1.78 1.04

California . . . . . . . . . . . . 8,898 27 89.5 0.26 8,988 23 90.0 0.23 *90 35 *0.55 0.35

Colorado . . . . . . . . . . . . 1,095 10 85.9 0.79 1,161 11 89.4 0.75 *65 15 *3.42 1.09

Connecticut . . . . . . . . . . 822 5 95.1 0.55 826 5 96.0 0.53 3 7 *0.90 0.76

Delaware . . . . . . . . . . . . 201 3 92.4 1.40 210 3 94.4 1.21 *9 5 *2.05 1.85

District of Columbia . . . . 119 3 96.3 1.37 122 2 96.6 1.30 3 3 0.28 1.89

Florida . . . . . . . . . . . . . . 3,513 21 82.7 0.48 3,635 21 84.7 0.46 *123 30 *1.94 0.66

Georgia . . . . . . . . . . . . . 2,381 14 88.6 0.49 2,419 14 88.4 0.46 *38 20 –0.20 0.68

Hawaii . . . . . . . . . . . . . . 290 3 96.4 0.85 297 3 97.1 0.67 *7 4 0.63 1.08

Idaho . . . . . . . . . . . . . . . 382 6 87.2 1.19 392 5 88.2 1.04 *10 7 1.02 1.58

Illinois . . . . . . . . . . . . . . . 3,194 13 94.4 0.33 3,197 12 95.1 0.30 3 18 *0.70 0.44

Indiana . . . . . . . . . . . . . . 1,513 13 90.1 0.66 1,524 11 90.9 0.62 11 17 0.82 0.91

Iowa . . . . . . . . . . . . . . . . 715 5 94.7 0.57 717 6 95.1 0.53 2 8 0.37 0.77

Kansas . . . . . . . . . . . . . . 685 7 92.2 0.66 679 6 91.3 0.71 –6 9 –0.96 0.97

Kentucky . . . . . . . . . . . . 992 8 93.1 0.63 1,001 7 93.1 0.59 9 11 –0.02 0.86

Louisiana . . . . . . . . . . . . 1,084 9 92.2 0.59 1,106 8 92.8 0.57 *22 12 0.67 0.82

Maine . . . . . . . . . . . . . . . 274 3 93.1 1.20 273 3 94.2 0.82 –1 5 1.14 1.46

Maryland . . . . . . . . . . . . 1,350 8 94.6 0.47 1,360 7 94.9 0.39 10 11 0.31 0.61

Massachusetts . . . . . . . . 1,498 7 98.2 0.24 1,517 6 98.5 0.20 *18 9 0.26 0.31

Michigan . . . . . . . . . . . . 2,420 9 94.7 0.30 2,372 9 94.9 0.27 *–48 13 0.14 0.40

Minnesota . . . . . . . . . . . 1,248 5 94.0 0.36 1,246 7 93.3 0.43 –2 9 *–0.69 0.56

Mississippi . . . . . . . . . . . 716 8 87.8 1.05 728 9 89.1 0.96 *12 12 1.29 1.42

Missouri . . . . . . . . . . . . . 1,392 7 92.8 0.40 1,404 9 92.7 0.51 *12 12 –0.14 0.65

Montana . . . . . . . . . . . . . 205 4 86.2 1.42 206 4 86.9 1.31 1 6 0.72 1.93

Nebraska . . . . . . . . . . . . 440 4 92.8 0.78 442 4 93.4 0.82 2 6 0.59 1.13

Nevada . . . . . . . . . . . . . 561 9 80.0 1.28 585 10 81.6 1.38 *24 14 1.64 1.88

New Hampshire . . . . . . . 295 3 94.8 0.84 295 3 95.1 0.82 – 4 0.26 1.17

New Jersey . . . . . . . . . . 2,010 10 92.9 0.40 2,019 8 93.3 0.32 9 12 0.36 0.51

New Mexico . . . . . . . . . . 461 6 86.2 1.00 482 8 87.7 1.08 *21 10 *1.59 1.47

New York . . . . . . . . . . . . 4,449 14 94.4 0.24 4,473 13 95.1 0.24 *24 19 *0.65 0.34

North Carolina . . . . . . . . 2,144 13 90.1 0.49 2,205 13 91.3 0.39 *61 18 *1.21 0.63

North Dakota . . . . . . . . . 141 3 92.8 1.41 144 2 94.3 0.96 3 4 1.54 1.71

Ohio . . . . . . . . . . . . . . . . 2,690 12 92.9 0.39 2,696 13 93.3 0.38 5 17 0.36 0.55

Oklahoma . . . . . . . . . . . 837 7 87.0 0.68 860 7 88.3 0.68 *23 10 *1.30 0.96

Oregon . . . . . . . . . . . . . . 803 9 87.7 0.87 827 9 89.1 0.73 *24 12 *1.45 1.14

Pennsylvania . . . . . . . . . 2,783 12 94.0 0.39 2,796 10 94.4 0.32 13 16 0.42 0.51

Rhode Island . . . . . . . . . 232 3 94.8 0.87 230 3 94.3 1.04 –2 4 –0.53 1.35

South Carolina . . . . . . . . 998 8 87.9 0.68 1,030 8 89.5 0.68 *32 11 *1.58 0.96

South Dakota . . . . . . . . . 192 3 91.2 1.28 193 3 92.2 1.14 – 5 0.91 1.71

Tennessee . . . . . . . . . . . 1,456 9 93.2 0.51 1,479 10 93.6 0.49 *24 13 0.35 0.71

Texas . . . . . . . . . . . . . . . 5,846 23 82.4 0.31 6,022 27 83.1 0.38 *177 35 *0.63 0.49

Utah . . . . . . . . . . . . . . . . 783 9 87.1 0.93 822 8 89.4 0.88 *39 12 *2.32 1.28

Vermont . . . . . . . . . . . . . 134 2 95.9 1.00 133 2 96.5 0.80 –1 3 0.56 1.28

Virginia . . . . . . . . . . . . . . 1,789 11 92.5 0.47 1,841 10 93.1 0.43 *52 15 0.62 0.64

Washington . . . . . . . . . . 1,506 9 92.0 0.51 1,544 9 92.6 0.50 *38 12 0.68 0.71

West Virginia . . . . . . . . . 384 4 93.4 0.83 385 4 94.0 0.85 1 6 0.55 1.19

Wisconsin . . . . . . . . . . . 1,322 6 94.9 0.40 1,313 7 94.7 0.45 –9 10 –0.15 0.60

Wyoming . . . . . . . . . . . . 125 3 91.1 1.71 124 3 90.7 2.03 –1 4 –0.35 2.65

Puerto Rico . . . . . . . . . . 994 6 95.1 0.47 976 5 95.3 0.47 *–18 8 0.19 0.66

* Statistically different at the 90 percent confidence level.

 – Represents or rounds to zero.

1

Data are based on a sample and are subject to sampling variability. A margin of error is a measure of an estimate’s variability. The larger the margin of error 

in relation to the size of the estimate, the less reliable the estimate. This number when added to and subtracted from the estimate forms the 90 percent confidence 

interval. 2

The U.S. estimates do not include Puerto Rico.

Sources: U.S. Census Bureau, American Community Surveys, 2008 and 2009, Puerto Rico Community Surveys, 2008 and 2009.