In 2017, the United States saw its number of children without health insurance rise significantly for the first time in many years, a recent study found.
So did Indiana, which has one of the highest child uninsured rates in the nation.
"That is a disturbing reality that we've got to come to terms with," said Susan Jo Thomas, executive director of Covering Kids & Families of Indiana. "Because the long-term effects are dismal."
In 2017, Indiana had 106,000 uninsured children, the eighth-most in the country, up 7 percent from 96,000 the year before, according to the report from the Georgetown University Health Policy Institute's Center for Children and Families. Indiana's youth uninsured rate of 6.3 percent is ninth-highest in the U.S. (the national rate is 5 percent).
Indiana is listed in the study as one of 12 states with "rates of uninsured children that were significantly higher than the national average." The others were Alaska, Arizona, Florida, Georgia, Nevada, North Dakota, Oklahoma, South Dakota, Texas, Utah and Wyoming.
That's even though youth citizens whose parents don't have employer-sponsored insurance are eligible for publicly funded coverage through Medicaid or the Children's Health Insurance Program, aka CHIP (Indiana is not among the handful of states that extend health coverage to undocumented children).
Nationally, the research found, the number of kids without health insurance increased from 3.6 million in 2016 to 3.9 million in 2017.
"I've been running this report for eight years. This is the first time in the decade we've seen the number go up," said Joan Alker, executive director of the Center for Children and Families at Georgetown.
She said no states made significant gains in the number of insured kids; many, like Indiana, endured losses.
She blamed the national conversation over repealing the Affordable Care Act, which may have led people to believe they had lost or were losing their coverage, and the Trump administration's reduction in funding for advertising and outreach for that law's health care marketplace.
"At a very confusing time for families, these resources were being taken away," she said.
Congressional Republicans also repealed the law's individual mandate requiring that people carry insurance or face a fine.
Alker said the administration's crackdown and rhetoric on illegal immigrants also may have played a role.
"Immigrant families are probably reluctant to engage with the government," she said.
Indiana may not have one of the largest populations of illegal immigrants in the country, Thomas said, but they tend to be concentrated in rural areas where they work on farms.
Those places are also where "welfare" programs like Medicaid still carry shame, she said.
"So it's a double dose of stigma," she said. "The place you go to apply for a benefit is the local office of (the Indiana Family and Social Services Administration). In your community, in these small rural towns, everyone knows everyone.
"If you walk in that door, the chances are your neighbor or your neighbor's husband or wife, someone in that office, knows who you are or you may be related to them. There's just a whole lot of stigma attached."
Locally, HealthLinc — a safety-net medical clinic with locations including Valparaiso, East Chicago and Michigan City — had its number of uninsured kids decrease from 543 in 2016 to 390 in 2017, but then rise to 591 last year, according to Executive Director Beth Wrobel.
Northshore Health Centers CEO Jan Wilson said about 9 percent of the children her clinics (in Portage, Lake Station, Chesterton, Merrillville and Hammond) serve are uninsured, a rate that has remained fairly steady over the years.
She said kids often lose their public insurance because their parents forget to re-enroll them, which has to be done yearly starting at age 4 to determine if they still meet the income eligibility requirements.
But is there a reason all youth residents of Indiana shouldn't be insured?
"There's absolutely not because of the fact that they're eligible. Every child is," Wilson said.