WASHINGTON - Hawai'i is rated fifth in the nation in making sure children have health insurance, according to a report released today.

But that still leaves about 18,000 uninsured children annually, or about 5.8 percent of Hawai`i's youngsters, according to the Families USA report, which analyzed data from 2005 to 2007. About 8.6 million children — about one in nine — were uninsured annually during the study period in the 50 states and the District of Columbia.

States with better rates than Hawai`i are Massachusetts with 4.6 percent uninsured; Iowa, 5.2 percent; Michigan, 5.5 percent; and Wisconsin, 5.7 percent.

The review period also occurred before the state started the Keiki Care Plan earlier this year to provide health coverage for uninsured children who did not qualify for Medicaid. But the state announced in mid-October that it is dropping the program as a way to save money because of lower-than-expected tax revenues.

Ron Pollack, executive director of Families USA, said that even with the demise of the state's Keiki Care Plan, which covered about 2,000 children, Hawai`i's earlier efforts to provide children's insurance "has helped put the state in a relatively good position compared to other states."

Families USA, an advocacy group of healthcare consumers, wants the new Congress, which convenes in January, to put a priority on reauthorizing the state Children's Health Insurance Program, which expires March 31.

Last year, lawmakers approved expanding the program to about 4 million uninsured children nationally, only to see President Bush veto the legislation.

"For the numerous children who count on (the state) Children's Health Insurance Program as their health lifeline, and for the 8.6 million children who are uninsured, support for continuing and expanding (the program) is critically important," Pollack said. "It will determine whether children get the preventive care they need so that they can remain healthy, learn in school and become productive citizens."

Pollack also said that because of the economic downturn, Congress is likely to consider providing higher federal matching funds to the states for the Medicaid program as part of an economic stimulus package. That would allow states to expand coverage as more families lose jobs and health insurance.

This measure would help not only those already uninsured but those who are likely to join the ranks of the uninsured due to the state of the economy, Pollack said.

Jennifer Sullivan, senior health analyst for Families USA, said that if Congress reauthorizes the program and provides more Medicaid reimbursement, Hawai'i might be able to come up with enough money to reinstate the Keiki Care Plan.

When the state pulled out of the program, officials said the program might be helping some children whose parents dropped private coverage to get them into the program.

But Sullivan said that children had to be uninsured for six months before they were eligible to enroll in Keiki Care. That should be protecting the state from most parents who drop their children's coverage to get them into the program, she said.

"While it may not be on the state's agenda to reinstate the program immediately, we certainly hope that with some additional federal support ... they can figure out a way to keep those kids covered," she said. "It would be a shame to be dumping kids off coverage at this point in the (economic) downturn."