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For the first time in a decade, the number of children without health insurance rose nationally in 2017, a new report shows. And while Virginia’s slight increase isn’t statistically significant, its rate is still larger than most states that have already expanded Medicaid, suggesting Virginia could see an improvement in 2019 after expansion.

Between 2016 and 2017, the rate of uninsured children grew in Virginia from 5 percent to 5.1 percent, according to the Georgetown University Health Policy Institute’s Center for Children and Families. The change didn’t mark a significant difference and largely shows that Virginia wasn’t successful in getting more kids insured.

The national rate in 2017 rose to about 5 percent, as well.

But Virginia is far from alone. The report shows that no other state saw a statistical improvement in its rate of uninsured children, either, though Washington, D.C. was the exception. Nine states saw their rates worsen.

“At least in Virginia, there hasn’t been any movement up or down in the last year in the number of children uninsured,” said Ashley Everette, policy analyst with Voices for Virginia’s Children. “So the bad news with that is we’re not improving the rate of uninsurance in Virginia. And I think we still need to remain vigilant given the national trend we’re seeing with other states.”

Whether or not a state has already expanded Medicaid seemed to have the biggest influence on how their uninsured rate compared to the national average. According to the report, three quarters of the children who lost insurance between 2016 and 2017 were in states that had not expanded Medicaid to its adult populations.

Most, though not all, expansion states’ rates of uninsured kids were better than the national average. Twenty-five such states were below 5 percent, while the remaining seven were above.

Virginia is due to expand its program in January. The new rules apply to adults looking to sign up, but it could have a domino effect in getting more kids insured.

“Medicaid expansion often results — at least it has in other states — in an increase in the number of insured children because their parents come in, and that gets the kids in, too,” said Deborah Oswalt, executive director of the Virginia Health Care Foundation. “So we may well see that when the 2019 data becomes available.”

The Annie E. Casey Foundation’s Kids Count Data Center uses a slightly different data measurement to calculate the rate of uninsured kids, but according to its website, Virginia’s rate has been falling fairly steadily since 2007, when it was 9.9 percent.

Some advocates were most concerned with the Georgetown report’s details on children with immigrant parents, who account for a quarter of all kids and teens in the U.S. Policies targeting immigrant communities “are likely deterring parents from enrolling their eligible children in Medicaid or CHIP despite the fact that these children are U.S. citizens,” the report states.

“Those families are more hesitant to use the public benefit system with the political climate that we have right now,” said Jill Hanken, a health attorney with the Virginia Poverty Law Center.

The report details a few possible explanations for the increase nationwide after a decade of falling uninsured rates among children.

They include the congressional effort to repeal the Affordable Care Act and the attempts by President Donald Trump’s administration to undermine the ACA marketplaces by cutting outreach and enrollment funding and shortening the open enrollment period.

It also suggests the lengthy and unprecedented delay last year in reauthorizing the Children’s Health Insurance Program may have played a role.

“There’s more work to be done, and we know for sure how important health insurance is for children,” Hanken said. “I do think with Medicaid expansion, as we are encouraging all uninsured people to come forward to see if they qualify, we may well see an uptick in insured children.”