Kentucky v. Tennessee – Which State Is Better at Covering Families?

July 31, 2020 // Heavyn Jennings

Tennessee and Kentucky have many things in common as neighboring Southern states. Children’s health is not one of them. Kentucky has a higher rate of insured children than Tennessee, and a key reason why is Medicaid expansion. Our neighbors in Kentucky implemented Medicaid expansion back in 2013, and Tennesseans are still pushing for it in 2020.

A comparison of Kentucky and Tennessee insured rates enlightens us of the ways Medicaid expansion could improve the health of adult Tennesseans and their children. Kentucky has done a better job of covering its citizens and has the 9th lowest uninsured rate of all 50 states, while Tennessee has 12th highest uninsured rate. Specifically, Kentucky has an uninsured rate of 5.5%, while Tennessee sits at 9.8%–almost double the rate of Kentucky. To make matters worse, many of these people are parents. From 2014 to 2018, the percent of children who had an uninsured parent decreased 5% (14% to 9%) in Kentucky while it only decreased 2% (16% to 14%) in Tennessee. Healthy parents are vital to nurture healthy children. Tennessee cannot expect the health of its children to improve when the state is letting parents go uninsured by not giving them affordable access to health care.

Without Medicaid expansion, many Tennessee children are left without insurance as well. Why is this the case if children are already eligible for Medicaid in both states, you ask? Parents are more likely to sign their children up for health insurance if they also have coverage. This fact is reflected in the uninsured rates of children. In 2018, 4.5% of children were uninsured in Tennessee while 3.8% were uninsured in Kentucky. Insured rates are a key factor in children’s health rankings, and the 2020 KIDS COUNT Data Book by the Annie E. Casey foundation ranked Kentucky 42nd in children’s health. Tennessee was ranked almost last, coming in at 48th place. Tennessee needs to insure over 10,000 more children to decrease its uninsured child rate to attain that of Kentucky’s. Tennessee can achieve these numbers by expanding Medicaid and following the lead of its neighbor and 37 other states.

Medicaid Expansion may also help decrease racial disparities in children’s health. Black and Hispanic/Latino children have increased usage of public health insurance when Medicaid is expanded. After Kentucky expanded Medicaid, the percent of Black children with public health insurance increased from 47% in 2015 to 55% in 2018. A parallel increase occurred for Hispanic/Latino children in Kentucky, where the percent with public health insurance rose from 47% in 2015 to 55% in 2018. Similar decreases in the uninsured rates accompanied these increases in public health insurance coverage for children of color. There was not as much of a change in Tennessee. The percent of Hispanic/ Latino children covered by public insurance increased merely 2% (from 53% to 56%) from 2015 to 2018.  More alarmingly, the percent of Black children on public health insurance remained at 52% from 2015 to 2018 in Tennessee, and 5% of Black children remained uninsured from 2015 to 2018. Children of color are insured at higher rates, and more are enrolled in CHIP (Children’s Health Insurance Program) when Medicaid is expanded. Kentucky’s decision to expand Medicaid revealed its dedication to improving the health of children and adults. Tennessee cannot say the same.

Kentucky took a step in the right direction, while Tennessee has been standing by and letting countless children go uninsured. Tennessee needs to be more like Kentucky: Expand Medicaid, and Insure Our Kids.