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More than 153,000 children in Pennsylvania are uninsured — the highest number in a decade — as rising costs, policy changes, and expiring federal supports make it harder for families to keep coverage.
That’s about 5% of children in the commonwealth.
“We're moving into a time period where we're just going to see the connection to health insurance get even harder…we’re very concerned,” said Becky Ludwick, vice president of public policy for the Pennsylvania Partnerships for Children, a child welfare and education nonprofit based in Harrisburg.
The assessment comes from a report that analyzes public data on children’s health insurance from January to June of 2024 and the factors that contribute to a child’s likelihood of being uninsured, including family income, race and ethnicity, geography, and age.
In Southwestern Pennsylvania — including Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Washington, and Westmoreland Counties — Greene and Indiana had the highest uninsured rates of children at 6%, about 1% more than the state average. Allegheny was the lowest at 1%.
“Being underinsured presents a major and often overlooked challenge. Families with inadequate coverage may delay or avoid care due to high out-of-pocket costs, limited provider networks, or restricted benefits,” said Ronnie Das, Allegheny Health Department public information officer. “This creates an undue burden on the public health system, which must step in to address preventable conditions that could have been managed earlier with adequate coverage.”
In Allegheny County, rates of chronic diseases such as diabetes, heart attacks, respiratory disease, and stroke all exceed national levels.
“Ensuring that children are fully and appropriately insured is not only a matter of individual health; it is vital for public health,” Das said. “When children are uninsured, health concerns are more likely to go untreated until they become more serious, placing both the child and the broader community at greater risk.”
For more information on no-fee and low-cost public health clinics in Allegheny County, visit this page on the Health Department’s website.
“Indiana County is one that we've noted is a bit higher than the statewide average. Unfortunately, we can't see what's playing into that necessarily, but we can see, you know, which children are more likely to be without insurance,” Ludwick said. “One of the things that stood out around Indiana County was looking at the percentage of children who qualify for Medicaid but aren't insured.”
Approximately 8.1% of children eligible for Medicaid in Pennsylvania are uninsured, with more than 49,000 kids who should have coverage, according to the report. In June 2025, 47% of Pennsylvania children relied on Medicaid, CHIP, or Pennie health plans. As of October, over 170,000 people in the state are enrolled in CHIP, and almost half a million Pennsylvanians are enrolled in Pennie, according to a 2024 annual report.
Congress passed legislation in the summer that will cut $990 billion from Medicaid over 10 years and add new work requirements. The Pennsylvania Department of Human Services estimates that 310,000 Pennsylvanians could lose coverage under these changes, which go into effect next year.
“We’ve been trying to point out is that's an adult figure, so that doesn’t even include the number of children,” Ludwick said. “What we do know is that parents who don't have coverage, we often see that that trickles down and that children don't have coverage.”
Ludwick fears this expected loss could even be higher as premium tax credits for Pennie will expire next year, and the cost of Pennie is expected to rise. The enhanced premium tax credits ensure that no enrollee spends more than 8.5% of their income on a health insurance premium. The Congressional Budget Office estimates that nearly 4 million more people will eventually be uninsured if the subsidies expire.
U.S. Rep. Thomas Suozzi (D., New York) introduced legislation last month, the Bipartisan Healthcare Optimization, Protection, and Extension (HOPE Act), to extend these credits, which was referred to the Rules Committee of the House. If passed, the bill would extend the credits until January 2028. A similar measure failed to pass in the Senate earlier this month.
Separately, four House Republicans joined Democrats in agreeing to delay the vote on the extension this week. A vote on the measure is now expected when Congress returns in January.
Pennsylvania ranked sixth in the nation of most uninsured children, according to the report. Of those states with larger child populations, only Texas and Florida have higher child uninsured rates than Pennsylvania, at 14% and 8%. New York has over 1 million more children than Pennsylvania and has a lower uninsured child rate of 3%.
Another key finding in the report was that for Hispanic children, uninsured rates jumped to 7.3%, the highest in five years, Ludwick said. Children who aren't Asian, Black, Hispanic, or white also remain disproportionately uninsured at 9%.
“There is a very real concern about children who don't have coverage not getting that consistent preventive care, so that includes things like vaccinations,” Ludwick said. “For the second year in a row, we’ve seen incoming kindergarteners below the 95% coverage target rate for measles, mumps, and rubella, which is something we basically eradicated 20 years ago … It’s a concerning trend to see these things coming back.”
Children in families living below the poverty line saw an increase in their uninsured rate, rising from 6.7% in 2023 to 8.1% in 2024.
“With changes to SNAP and the rising cost of everything, we’re expecting to see this increase as well,” Ludwick said. “We do want to make sure that, as we look at what's available in Pennsylvania, children are connected to insurance in every way possible.”
Open enrollment for Pennie was extended to Dec. 31. For those with questions on this and other public health resources, you can contact your local county assistance office.
Erin Yudt is a reporter with Pittsburgh Media Partnership Newsroom, part of the Center for Media Innovation at Point Park University. She most recently was a multimedia content producer and digital reporter at WKBN in Youngstown and is a graduate of Point Park University. Reach her at erin.yudt@pointpark.edu.
The PMP Newsroom is a regional news service that focuses on government and enterprise reporting in southwestern Pennsylvania. Find out more information on foundation and corporate funders here.