More American children had health insurance during the pandemic than ever before. But now, as states are required to re-enroll those eligible for Medicaid, the number of uninsured is skyrocketing.

Nowhere is it more true than in Texas, where since what has called the "unwinding" started in April, already a half million children have lost coverage.

Stacey Pogue, senior policy analyst for the nonprofit policy institute Every Texan, said during COVID, federal government regulations prohibited states from removing individuals from Medicaid involuntarily, which benefited kids.

"Now that they've expired, we're back to business as usual in Texas, and Texas has become ground zero for children losing health coverage during unwinding," Pogue explained. "It's likely that most still qualify even though they've lost Medicaid."

A report from Georgetown University uses state-by-state data from the 2020 census. The number of uninsured American children dropped below 4 million in 2022, the first time it has happened in 15 years.

Overall, 21 states saw statistically significant declines in the rate or number of uninsured children, with Wyoming, North Dakota, Utah, New Mexico and Texas seeing the greatest improvements. Nonetheless, Pogue noted more than one in five uninsured children lives in Texas, more than any other state.

"It's just really clear from this report and these data that when federal law required Texas to remove barriers that parents face when they're trying to get their kids covered and keep their kids covered, that our child uninsured rate dropped notably," Pogue emphasized.

Valerie Borum Smith, a pediatrician in Tyler, said gaps in insurance coverage greatly affect whether parents seek help for their children, who she stressed have experienced crisis after crisis over the past several years.

"A yearslong pandemic, a national emergency on youth mental health, and last fall's 'triple-demic' of COVID-19, flu and RSV," Borum Smith outlined. "It's more important than ever that patients like mine have reliable access to care."

A New York organization believes universal public childcare can be implemented in five years.

New Yorkers United for Child Care is using its newly released roadmap to guide this plan, with the primary goal of saving people money.

Estimates show state residents spend $22,000 per year per child. New York families spend a combined $14 billion per year on child care.

Rebecca Bailin, executive director of New Yorkers United for Child Care said their plan would help families afford living in the Empire State.

"We will be able to retain middle-class families, retain the diversity, economically and racially in our state," said Bailin. "We would be able to make sure working parents can work productively - they don't have to miss as many hours or remove themselves from the workforce entirely."

A Fiscal Policy Institute report finds 40% of New York families are leaving because of the state's high child-care costs.

Enacting the plan would cost $12 billion per year - 6% of the state's current budget.

Some revenue streams to fund the program include a capital gains tax, a corporate tax, and a high-income earners tax - which combined could raise an estimated $40 billion.

The proposal's feedback has been positive, but Bailin said she knows these next five years will be challenging.

The plan involves expanding universal public child care over the five years. New York City already has universal pre-K and 3-K.

The goal is to strengthen programs like this, and age down. She said this program is necessary for all New Yorkers.

"It is really up to us to make this happen," said Bailin. "It's up to the parents and the would-be parents who are sick and tired of the status quo, who are thinking about having families or growing their families, and are just not being able to find a way out."

A Cornell University poll shows 51% of people say their biggest decision in choosing to stay at home was the high cost of child care.

Nearly one quarter said their biggest obstacle to employment was lacking accessible child care in their area.



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More than 1,000 organizations sent a letter to Gov. Gavin Newsom asking for California's children's programs to be shielded from cuts in the 2025-26 budget.

The coalition, called the Children's Movement, successfully lobbied to beat back cuts last year despite a $55 billion budget deficit.

Ted Lempert, president of the nonprofit Children Now, said policymakers face competing pressures this year.

"There could be extra pressures on the budget due to actions with the new administration in Congress," Lempert observed. "That said, the projected deficit is far smaller than last year."

The new fiscal outlook from the California Legislative Analyst's Office projects a relatively small budget deficit of $2 billion for next year, but cautioned against any spending increases. The governor usually submits his initial budget proposal in mid-January, which is a jumping-off point for negotiations in the Legislature.

California lawmakers are required to pass a balanced budget each year by June 15.

Lempert argued children's programs are chronically underfunded in California.

"Even though we're a relatively high-tax state, we're still around the middle of the pack in education funding, and we have one of the worst ratio of adults on campus," Lempert noted. "Meaning fewer teachers, fewer counselors, fewer nurses."

The coalition would also like to see more funding for child care and preventive health screenings.

West Virginia child care advocates said they are bracing for more center closures in the new year.

There are more than 60,000 children in the state with both parents in the workforce, and only around 39,000 licensed center slots available, according to the West Virginia Center on Budget and Policy.

Kristy Ritz, executive director of the West Virginia Association for Young Children, said parents are running out of options.

"Our worry is that children are sometimes being placed in unsafe situations because they can't afford registered or licensed child care programs," Ritz explained. "They may be using the best they can find."

Local Head Start programs can help fill gaps in child care. According to the Center for American Progress, the Trump administration has proposed cutting the early-childhood education initiative.

Anna Powell, senior research and policy associate at the Center for the Study of Childcare Employment at the University of California-Berkeley, said people who work with very young children are often paid significantly less than teachers of older kids.

"As a result, while about 13.1% of early care and education professionals are living below the federal poverty line, only 2.3% of elementary and middle school teachers are," Powell outlined.

The average yearly salary for Mountain State child care workers is 29% below preschool teachers and less than half of kindergarten teachers. Ritz stressed she supports state policies aiming to keep existing centers afloat, rather than incentivizing businesses to open on-site ones.

"We have we've talked to people. Businesses, they don't really want to open child care programs," Ritz reported. "It makes more sense for them to help with the existing programs so that they can stay open."

According to the Early Childhood Workforce Index, nationwide, nearly half of child care workers' families survive on public assistance such as SNAP and Medicaid.