Florida is ranked 45th in the country, according to the latest Children's Health Care Report Card.
It's back to training wheels when it comes to getting children's health care coverage.
In just two years, the rate of uninsured Florida children jumped by 18% and earned the state an overall ranking of 45 in the latest Children's Health Care Report Card.
The second-highest number of children without health insurance now live in Florida.
That's according to the latest report by the Georgetown University Center for Children and Families that looked at national and state data from 2016 to 2018.
The report pointed to lags in Medicaid and the Children's Health Insurance Program (CHIP) enrollment as the main cause. Both are safety net programs that provide health coverage to millions of eligible U.S. children and are jointly funded by states and the federal government.
Almost half of Florida children depend on it for everything from developmental screenings and treatment of chronic conditions like asthma, to routine prescriptions and vaccinations.
In just two years, 51,000 Florida kids have lost coverage, reversing a historic low in 2016, bringing the current total to 339,000, or 7.6%.
Nationwide, more than 4 million now lack coverage compared to 3.6 million in 2016.
Despite overall wage increases and the lowest level of unemployment since 1969, one might assume those children moved toward employer-sponsored coverage, but "no statistically significant change in 2017-18 is seen in that regard," Joan Alker, executive director of the Center and lead author of the report said in a recent press call.
"Should an economic downturn occur, and we know one will eventually, we would expect many more kids to become uninsured," she said.
In 2008, almost one in ten children nationwide lacked access to health care coverage. But that number improved largely because of the Affordable Care Act that mandated everyone to get health insurance or pay a penalty. The Affordable Care Act provided subsidies for middle-income families and expanded Medicaid to more low-income people, leading to increased enrollment for children, among other provisions and protections.
As a result, by 2016, the number of uninsured children dropped by more than half and reached a record low of 4.7%.
Those gains have since eroded.
The report points to a few key reasons fewer children are enrolling in Medicaid and CHIP, including cuts in funding for outreach, delayed funding for CHIP that led to general confusion about eligibility, and the hostile environment surrounding immigration policy.
Some of those who saw the greatest losses were Latino and white children and children younger than six, "which is especially troubling because they need higher levels of preventive and routine care," Alker said.
Marivi Wright, community partnership manager at The Players Center for Child Health at Wolfson Children's Hospital in Jacksonville, said part of her role now includes overcoming fears for mixed-status families whose children are eligible for coverage, but fear being flagged for deportation, separated from family or considered a * "public charge" that might bar a legal path to permanent residency.
When families choose not to enroll, their children miss out on more than basic health care.
Research shows that kids covered by Medicaid and CHIP have long-term health and economic gains as adults, such as higher educational attainment and greater earnings.
"If the numbers are ignored, Florida is going to pay for it through emergency room visits, and in the future when there are fewer healthy workers who missed out on key interventions as children," said Anne Swerlick, a health policy analyst and attorney with the Florida Policy Institute. "There needs to be a lot more public information that tells parents that getting coverage for their children won't put them at risk," she added.
*The proposed public charge rule changes have been temporarily blocked. If they proceed, children's use of Medicaid will not affect a parent's determination of being a public charge."