Photo: Getty

Donald Trump tweeted on Thursday morning that the United States is “booming!” Around the same time, Ivanka Trump retweeted a laudatory tweet about her visit, with Apple CEO Tim Cook, to an elementary school in rural Idaho. In the photo, she is giving a student a high-five. Later that same morning, Georgetown University’s Center for Children and Families released its annual report that, this year, shows the number of uninsured children in the country rose for the first time since they started publishing these reports in 2008. In fact, no state aside from Washington, DC saw its number of uninsured children decline. A majority of the children who lost their coverage lived in states that did not expand Medicaid; overall, coverage from public sources (such as Medicaid and the Children’s Health Insurance Program) declined last year.

“Never before have we seen such uniformity in state behavior,” Joan Alker, one of the co-authors of the report wrote in a blog post, pointing out that children losing their insurance was an extremely troubling trend, especially in a time of overall economic strength. (Workers’ real wages, however, remain stagnant, as they have for decades.)

The report notes that a majority of children who aren’t insured—56.8 percent—are actually eligible for Medicaid or CHIP. So what could have possibly happened in the last year to keep parents from seeking or knowing their kids were covered?

Maybe it was the repeated efforts by Trump and the Republican Party to repeal the Affordable Care Act over the past year. Or the fact that Republicans let CHIP expire for months, forcing many states to send out notices to parents that their children’s health insurance was going to end. Or perhaps it’s that Trump slashed the advertising budget for the ACA, so that fewer people enrolled. Or maybe it had to do with the fact, as the report points out, that one-quarter of children in the country have an immigrant parent—many who are rightfully terrified right now to have any interaction with the U.S. government.

“This constellation of national trends has likely created an ‘unwelcome mat’ effect where families are unaware of their options or deterred from seeking coverage,” according to the report.

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The Trump administration has proved again and again that it doesn’t actually have to repeal the ACA to do enormous damage—there are a myriad of ways to throw people off of their coverage. Children’s health insurance has long been considered a “bipartisan” value, since the original co-sponsors of CHIP in 1997 were Ted Kennedy and Orrin Hatch. (Hatch, it should be noted, said last year that there was not enough money for CHIP while pushing through a $1.5 trillion tax cut for the wealthy.) No politician really wants to say (out loud) that kids don’t deserve to be insured, but they manage to say it in plenty of other ways.