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Explainer: What to Know About the Final “Public Charge” Rule

| August 16, 2019 |

The Trump administration has finalized a rule that will expand the definition of a public charge when determining eligibility for individuals applying for admission to the U.S. or for adjustment of status to that of lawful permanent resident (green card). This expansion will allow for the consideration of an applicant’s use of services such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), Federal, State and local cash assistance programs such as Temporary Assistance for Needy Families (TANF) and subsidized housing vouchers. To make this determination, DHS will look at the “totality of a person’s circumstances” including their age, health, assets, education, and financial status. A person may be deemed a public charge if he/she has used one or more public benefits for more than 12 months in the aggregate within any 36-month period (receipt of 2 benefits will count as 2 months). The rule is expected to go into effect on October 15, 2019.

The final rule included some changes from the proposed regulation. For instance, Medicaid will not be considered for those under the age of 21 and pregnant women through 60 days after giving birth. Additionally, the Children’s Health Insurance Program (CHIP), Headstart, WIC (Nutrition program for Women, Infants and Children), and Low-Income Home Energy Assistance Program (LIHEAP) will not be included in the list of services considered for a public charge determination. But the regulation directly targets family-based immigration and specifically singles out children. Here are some of the ways in which it will impact children.

Children are not exempt from the rule.

While there is a list of certain groups who are exempt from the public charge determination including victims of severe forms of trafficking or criminal activity (T and U-Visas), refugees and asylum applicants, Special Immigrant Juveniles, and others,[1] children are not exclusively exempt. In the rule, DHS recognizes that children are not making decisions to apply for benefits themselves, yet they make no exemption for those who fall under a head of household. Alarmingly, they go out of their way to argue that there is no need for a child to have the capacity to understand the consequences of these actions. While children are specifically exempt from Medicaid, other benefits such as the Supplemental Nutrition Assistance Program (SNAP) or federal, state and local cash assistance programs such as Temporary Assistance for Needy Families (TANF) will be used against children seeking when adjustment of immigration status.

Children are considered negative factors both for themselves and for the consideration of their parents in the totality of circumstances

The rule states that it will consider an age of less than 18 as a negative factor, as under 18 they are unable to be meaningfully employed. Additionally, household size will be viewed as a negative unless the household members are contributing to the household income. While the rule states it will not include the use of benefits by U.S. citizen children within the household, DHS may still count the U.S. citizen child as a negative factor in the totality of circumstances for the parent’s application. Therefore, the simple act of being a child within a home is weighed negatively on multiple accounts.

MILLIONS of children will lose access to health care, housing and nutrition services

While there are exclusions in Medicaid specifically for children, it is likely that the parents of these children will choose to forego health care coverage and services to avoid negative immigration consequences. According to a report by the Kaiser Family Foundation approximately 8 million children enrolled in CHIP and Medicaid live in a household with at least one noncitizen and may be at risk for disenrollment.[2] Research shows that when parents don’t have health insurance, their children are less likely to have health care coverage or seek health care services.[3]

When it comes to housing assistance, there is no way to separate benefits to parents and their children who live in the same home. You cannot divide up a home or an apartment based on who is eligible for assistance, so when parents lose assistance and housing becomes unaffordable, the entire family, including children, is put at risk of homelessness. In writing the rule, the Administration noted that it expects to see “Increased rates of poverty and housing instability…”

The rule threatens children’s access to food both at home and at school. Parents and children may disenroll from SNAP in order to avoid a public charge determination as approximately 3.4 million citizen kids who access SNAP[4] live with at least one non-citizen family member. Even if eligible children remain on the program, when parents drop out this means less food in the house. Additionally, kids enrolled in SNAP automatically receive free school meals. Once they forfeit SNAP enrollment, they would not have that automatic follow-through. They are unlikely to apply for free meals at school because of a host of issues including, language barriers, lack of enrollment information, and fear of negative immigration outcomes.

The impact will reach beyond the intended targets

Beyond those families directly subject to the rule, expanding the public charge determination will have a broad chilling effect and will deter all immigrant households from accessing any essential services out of fear it will negatively impact their immigration status. Parents may choose to also give up benefits not covered out of general fear of repercussions and an increase in distrust of government services. We have already seen the chilling effect responsible for a 10 percent decline in SNAP participation during the first half of 2018 by eligible families.

The rule disproportionately affects family-based immigration.

The public charge rule is a direct attempt to cut family-based immigration. In 2016, approximately 68 percent of the total persons who obtained Legal Permanent Resident (LPR) status were immediate relatives of U.S. citizens or had a family-based sponsor.[5] The rule would make it more difficult for families to stay together or reunify, as families both in the U.S. and abroad will be forced to meet the new requirements for a wide range of demands.

The Administration is knowingly subjecting children to these hardships. They acknowledge in the rule that children and other vulnerable populations will be impacted. It specifically states that disenrollment from public programs will result in declining child health, increased poverty and homelessness, reduced productivity and educational attainment.


[1] https://www.uscis.gov/greencard/public-charge

[2] https://www.kff.org/disparities-policy/fact-sheet/public-charge-policies-for-immigrants-implications-for-health-coverage/

[3] http://hrms.urban.org/quicktakes/health-insurance-coverage-children-parents-march-2017.html

[4] https://fns-prod.azureedge.net/sites/default/files/ops/Characteristics2016.pdf

[5] https://www.dhs.gov/immigration-statistics/yearbook/2016/table6


The Loss of the ACA Would Be Devastating for Children – Here’s Why

| July 24, 2019 |

When we talk about the Patient Protection and Affordable Care Act (ACA), we focus on the politics. Discussions of the law almost always lead to heated partisan debates, and health care has been a major issue for presidential hopefuls. Nevertheless, what we should question is how changing this law would affect millions of children.

Yet another court case attempting to demolish the ACA began oral arguments in early July. The case could potentially move to the Supreme Court in the thick of the 2020 presidential election. While you can bet that partisan politics will be at the forefront of the discussion, the implications of this direct attack on the ACA cannot be ignored.

Depending on the outcome of Texas v. US in either the judicial system, we could see a complete eradication of the ACA. Should that happen, 20 million Americans, many of them children, would lose access to quality, affordable health care.

Since its passage in March 2010, almost 3 million children have gained coverage and millions more have benefitted from the groundbreaking transformations the ACA made to our health care system.

While researching the impact of the ACA, I have learned about its life-saving effect on America’s children. Children born with pre-existing conditions, such as asthma, juvenile diabetes, cystic fibrosis, and many other diseases are no longer denied coverage. Lifetime and annual dollar limits on care were eradicated, meaning that children with health conditions that require extensive care will not exhaust their coverage amounts in their early years. Losing the ACA would be disastrous for these and other children.

It is important to remember what losing the ACA would actually mean for tens of millions of Americans, especially children. Before the ACA, a child born in the NICU could exhaust his or her entire health care coverage in those first few months of life because of the misfortune of being born with birth defects. A child with asthma may not have had access to medicine that helps him or her breath because it is too expensive, and insurance would not cover it. Too many times, parents were faced with an impossible decision: foregoing life-saving medical care or going bankrupt trying to do what is best for the health and well-being of their children. These scenarios were harsh realities for millions of families and their children before the ACA, and they could be the realities of our future, should it be rescinded.

If we believe that children are the future, we must prioritize upholding the Patient Protection and Affordable Care Act to protect the health and well-being of America’s children.

To learn more, check out our our full issue brief on the dire consequences for children if the ACA is dismantled.


Issue Brief: How Dismantling the Patient Protection and Affordable Care Act Will Harm Children

| July 23, 2019 |

Since its passage in 2010, the Affordable Care Act (ACA) has withstood many challenges at the state, local and federal levels in court and from within Congress. In the House, votes to repeal the ACA have been on the floor more than 60 times. During the summer of 2017, the ACA came within just a few votes of repeal in the Senate, but the vote failed after massive public outcry. As the law faces yet another court challenge, we are reminded what children stand to lose if the ACA is dismantled and all its benefits disappear.

Though not thought of as the principal beneficiaries of the ACA, the law has impacted the health and lives of children in dramatic and unanticipated ways. From coverage for pre-existing conditions to well-child visits without co-pays, Medicaid coverage for former foster youth, and reduced maternal and infant mortality rates, children have benefitted from the ACA and would suffer if the law were dismantled. The Affordable Care Act provides children with services and benefits that improve their lives and health outcomes. 

In this issue brief, we examine the potential consequences of dismantling the ACA–in taking away the provisions and services that children need to grow and develop, we would reverse positive trends in children’s health that have emerged since the law’s implementation.

See our full issue brief.


A Crisis of Compassion at the Border

| July 18, 2019 |

In anticipation of the House Oversight subcommittee hearing entitled “Kids in Cages,” I waited in the halls of the Rayburn House Office Building for more than two hours to secure a seat in the hearing room. Given the high-profile subject matter, many others from Capitol Hill and human rights organizations stood alongside me hoping for the chance to hear Yazmin Juárez’s emotional testimony about the loss of her daughter Mariee six weeks after being released from detention by U.S. Immigration and Customs Enforcement. The hallway was crowded and hot and the standing was uncomfortable.

In that moment, I thought about the children in Clint and Dilley and El Paso.

I pictured them separated from their parents, denied knowledge of their whereabouts, deprived of basic safe and sanitary conditions, and unsure about when the nightmare would end. As I walked out of the hearing room after hours of testimonies, tears and calls to action, I felt as though I had gotten a very small glimpse of the emotional and physical damage forced upon these immigrant children at the border.

Congress recently allocated more than $4 billion to assist with conditions at detention centers, but money cannot and will not solve this moral crisis. Children should not be separated from their families unless there is an immediate threat to the child and they should never be placed in cage-like facilities. Detention of children and families is utterly cruel and traumatic. Ms. Juárez testified that she immediately recognized sick children upon her arrival at the facility in Dilley, Texas and called the cells “ice boxes” due to the extreme cold. She vehemently emphasized that the conditions she faced failed to meet the definition of “safe and sanitary” as outlined by the Flores agreement. To her, the United States represented the land of opportunity, liberty, dreams, work and great doctors…the land in which she could do the things she was unable to do in Guatemala as a result of threats to her and her daughter’s safety. Yazmin’s experience in detention gave her a picture of America that will forever be tainted by the negligence and apathy that robbed her of her daughter.

Our current immigration system not only lacks humanity, it revels in unnecessary institutional cruelty. Despite the necessity to always consider the best interest of the child, children are kept in conditions that blatantly contradict the safe and sanitary guidelines set by the Flores agreement. Since lawyers, pediatricians and politicians gained access to the centers, the truth has emerged regarding children in filthy conditions. Many children smell rank, lack access to clean toilets and showers, are unable to brush their teeth, cannot protect themselves from the extreme cold, face lice infestations, are exposed to flu outbreaks, and do not receive adequate nutrition, among other things. Above all else, many are forced to endure their lengthy detention without the comfort of their parents.

Detention is portrayed by the Trump Administration as a deterrent and a way to hold immigrants accountable for attending court proceedings. However, according to Syracuse University’s Transactional Records Access Clearinghouse, which obtained court records through the Freedom of Information Act, 99 percent of families who were released from detention with representation attended all of their hearings.[1] When the family is released from detention but not represented, 80 percent still attended all of their hearings.[2] When families do fail to appear, it is most often not because they want to skip the hearing, but because they could not read the English instructions, received incomplete information, or failed to receive any information at all. In fact, absentia rates have rarely ever been a problem. Department of Justice statistics report that between 2013 and 2017, 92 percent of asylum seekers appeared in court to receive a final decision on their claims.[3] Despite historically high attendance, the current system punishes children and their families under the pretense of an attendance problem that does not exist. In fact, the Administration has testified that the reason they ended the successful family case management program, which served as a cost-efficient alternative to detention, is because the number of removals wasn’t high enough. When children and families have representation, they are better equipped to navigate our broken immigration system, and therefore have more successful outcomes.

Children are being used as pawns to advance a political agenda when our priority should be the safety and well-being of these innocent lives. These children face incredible risk on the journey to the U.S.-Mexico border. They should not also have to fear for their safety once in the custody of American officials.

During the “Kids in Cages” hearing, one statement in particular stood out to me. Rep.Lacy Clay (D-Mo.) said: “We as Americans should be ashamed of what has transpired at these detention centers and if you are not, you have lost your soul and compassion for others.”

First Focus Campaign for Children urges the Administration and members of Congress to support legislation that protects immigrant children in our custody.

The Humanitarian Standards for Individuals in Customs and Border Protection Custody Act (H.R. 3239) offers much needed provisions to meet medical, nutritional and safety standards for children and families. We call on Congress to pass this bill and others like it that will assure clean, safe circumstances for children and mitigate the trauma they suffer at our border. We can and we must do better by the children.


[1] https://trac.syr.edu/immigration/reports/562/#f1

[2] https://trac.syr.edu/immigration/reports/562/#f1

[3] https://www.humanrightsfirst.org/resource/fact-check-asylum-seekers-regularly-attend-immigration-court-hearings


Child Nutrition Reauthorization Represents a Chance to End Summer Hunger

| June 26, 2019 |

Summer vacation is supposed to be the highlight of a child’s year. But for far too many children in the U.S., it is the hungriest time of the year. As Congress works this year to reauthorize our federal child nutrition programs, it is time to end summer hunger once and for all.

Food insecurity is a devastating reality for 12.5 million—or 1 in 6—children across the country. For these children, many of whom are already exposed to the harmful effects of poverty, this inconsistent access to enough healthy food creates yet another obstacle to their ability to learn, grow and thrive. That is why the National School Lunch and School Breakfast Programs, which provide millions of low-income children with free or reduced-price meals at school, are critically important. These supports are proven to reduce child food insecurity and boost healthy eating

Unfortunately, a striking 83 percent of participating children lose access to that support when school breaks for summer. This means that more than 17 million children who participate in reduced-price school lunch do not participate in the Summer Food Service Program (SFSP), which reimburses program operators who serve free healthy meals and snacks to children in low-income areas. In addition to nutritious meals, many SFSP sites offer programming and educational enrichment, making them an ideal place for children to safely play and stay ready to learn. However, there are administrative, logistical and funding challenges that make it difficult for sponsors to participate SFSP. Many children also face barriers to accessing program sites when they are available, such as a lack of transportation.

Given the scope of the problem, it will take a multi-pronged approach to ensure that all U.S. children have enough to eat during the summer months. This includes:

  • Strengthening and expanding summer meal sites so that they are accessible to more children. The bipartisan Summer Meals Act of 2019, from Senators Murkowski (R-AK) and Gillibrand (D-NY) and Representatives Young (R-AK) and Larsen (D-WA), would make investments that streamline and expand the program. Critically, it would lower from 50 percent to 40 percent the share of income-eligible children a region requires for a congregate site to qualify for SFSP, called the “area-eligibility threshold.”
  • Establishing alternative, non-congregate models that fill any remaining gaps and provide additional pathways for children to safely access nutritious food. The bipartisan Hunger Free Summer for Kids Act of 2019 from Sens. Boozman (R-AR) and Leahy (D-VT) offers a helpful framework by which states can prioritize summer meal sites but also deploy the Summer EBT and non-congregate options in those areas where the congregate sites are not feasible.

Child Nutrition Reauthorization in the 116th is an important opportunity for Congress to end summer hunger. Thankfully, several lawmakers are leading the way, and their legislative efforts provide an excellent starting point for developing a comprehensive package to make summer hunger a thing of the past. 


Junk the Cadillac Tax

| June 24, 2019 |

Our nation is not suffering from a condition of having too much insurance coverage. A recent series by Noah Levey in the Los Angeles Times highlights how the rapid move to high deductible plans and greater imposition of cost sharing upon consumers by insurers is making health care increasingly unaffordable, causing families to delay critically necessary care, and driving a growing number of people toward bankruptcy.

The private health care crisis is increasingly one of underinsurance.

As Drew Altman, president of the Kaiser Family Foundation (KFF), told the Los Angeles Times:

There has been a quiet revolution in what health insurance means in this country. This happened under the radar while everyone was focused on the Affordable Care Act.

Altman adds:

We forgot that most people get their insurance through an employer, and for them, the issue is medical bills that they increasingly cannot afford.

Levey highlights these disturbing facts from a survey that the Los Angeles Times conducted with KFF:

Nearly half of those in a plan with at least a $3,000 individual deductible or a $5,000 family deductible reported problems affording healthcare.

One in six Americans who get insurance through their jobs say they’ve had to make “difficult sacrifices” to pay for healthcare in the last year, including cutting back on food, moving in with friends or family, or taking extra jobs. And one in five say healthcare costs have eaten up all or most of their savings.

Half said costs had forced them or a close family member to delay a doctor’s appointment, not fill a prescription or postpone some other medical care in the previous year.

Hardest hit in the cost shift are lower-income workers and those with serious medical conditions such as diabetes, heart disease and cancer — who are more than twice as likely as healthier workers. . .to report problems paying medical bills and to say they’ve cut back on spending for food, clothing and other household items.

The “Cadillac Tax” Is a Solution in Search of a Problem

The Affordable Care Act (ACA) played a critically important role in helping millions of previously uninsured Americans find health care coverage through its combination of a Medicaid expansion for lower-income families and premium tax credits and exchanges to purchase more affordable private insurance for people with income above 138 percent of poverty.

Unfortunately, there is one provision in the ACA that, if allowed to go into effect, could be potentially harmful to people enrolled in private health plans, including children. That provision is referred to as the “Cadillac Tax” and it would worsen the underinsurance problem, as insurers and employers would be incentivized to shift more costs to employees and families to avoid the tax.

Fortunately, bipartisan bills, the “Middle Class Health Benefits Tax Repeal Act of 2019” (S. 684 by Sens. Martin Heinrich (D-NM) and Mike Rounds (R-SD) and H.R. 748 by Reps. Joe Courtney (D-CT) and Mike Kelly (R-PA)), have been introduced that would eliminate this unfortunate tax.

As background, the ACA’s “Cadillac Tax” language that would impose a 40 percent excise tax on employer-sponsored health benefits if the value of the employer plan, which is the premium costs for both the employer and employee, exceeds an arbitrarily set $11,200 for individual coverage and $30,150 for family coverage in 2022.

The “Cadillac Tax” was originally set to take effect in 2018 but has been delayed on two occasions, including most recently in the Extension of Continuing Appropriations Act passed by Congress in January 2018.

Support for the provision’s underlying premises are deeply flawed. First, a recent Washington Post editorial claims, “. . . the tax exclusion also incentivizes consumption, because — other things being equal — the more services a plan covers, the bigger the tax benefit.”

That is nonsense. In a series of tweets in support of eliminating the Cadillac Tax, Ben Speilberg correctly points out that health care is not a consumer or luxury good.

For children, comprehensive insurance coverage translates to getting chemotherapy for cancer treatment, wheelchairs and leg braces for children with disabilities, immunizations, and glasses so children can read. Gaining access to a doctor to get medical treatment, an immunization, or chemotherapy is nothing like buying a Mercedes Benz or a Cadillac. As Jonathan Cohn reiterates, “Medicine is not a consumer good.”

Second, supporters assume that private health coverage is overly generous, particularly with respect to family coverage. The vast majority of employer coverage plans share significant costs with employees. It is a myth that private plans are overly generous today.

According to an annual survey of employers by KFF, “On average, covered workers contribute 18% of the premium (or $1,186, on average) for single coverage and 29% of the premium (or $5,547, on average) for family coverage.”

On average, workers contribute 4.68 times more toward premiums for family plans than individual plans, even though the average overall premium cost is 2.84 times more expensive ($19,616 for family plans to $6,896 for individual plans).

These consumer costs are on top of the expenses that an individual or family bears for deductibles, copayments, and benefit limitations. Families USA’s Stan Dorn points out in a Health Affairs piece entitled “The Cadillac Tax: It’s Time to Kill This Health Care Zombie” that the average deductible for family coverage increased from $638 in 2008 to $2,426 in 2018, “nearly four times the average family deductible in 2008.”

First Focus Campaign for Children is particularly concerned that, even though families already pay a much higher share of the costs of coverage than individuals, the “Cadillac Tax” would exacerbate the problem. If allowed to go into effect, the threshold for the excise tax to take effect is set at just 2.69 times the expense of that for individual plans ($11,200 for single coverage and $30,150 for family coverage in 2022), which is below the current 2.84 ratio between individual and family coverage. In other words, the tax would disproportionately hit family coverage plans.

More likely, employers would seek to avoid the tax, but that creates an added incentive to impose higher deductibles and copayments and limit or eliminate certain benefits, particularly for family coverage. This would be most troubling for families with children with disabilities and children with special health care needs.

Dorn explains:

Once it activates, the tax is likely to spur further cuts to health benefits. A recent analysis in Health Affairs found that, by 2025, the Cadillac tax would affect roughly one out of every four workers receiving ESI — 23.5 percent of those with single coverage and 27.9 percent of people enrolled in family plans. . .

The Cadillac tax will incentivize a large and ever-growing share of employers to reduce the generosity of health insurance, further raising deductibles and other out-of-pocket costs. The non-partisan Congressional Research Service thus found that the Cadillac tax “could lead to an overall decline in the quality of health services financed by private insurance,” with businesses cutting their spending on employee health benefits by $47.6 billion to $69.2 billion in 2025 alone.

One disturbing trend in employer-sponsored coverage has been to impose a per person deductible on top of the premium differential for families. Consequently, a $1,500 deductible for an individual becomes a potential $6,000 deductible for a two-parent family with two children. Children’s health coverage is far less expensive than adult coverage but that fact is typically not adjusted for by per person deductibles.

To protect families from having these trends further incentivized, First Focus Campaign for Children has endorsed the Middle Class Health Benefits Tax Repeal Act of 2019,” as it would fully repeal the “Cadillac Tax.”

The Alliance to Fight the 40, a coalition of businesses, patient advocates, private sector and public sector employer organizations, consumer groups, and other stakeholders that support employer-provided health coverage, also wrote a support letter for the legislation to the U.S. Senate:

Contrary to the notion that only “gold-plated” high-value plans would be affected, the tax will eventually have an impact on virtually all employer plans. The first plans to be hit will not be “Cadillac” plans that have the most extensive benefits — they will be plans that are expensive because they cover older Americans, retirees, women, families and other individuals with chronic health conditions, those who have suffered catastrophic health events, and those living in higher-cost geographic areas.

The letter cites Mercer’s National Survey of Employer-Sponsored Health Plans, which estimates that “[t]wenty-three percent of the plans that trigger the tax in the first two years will have actuarial values in the lowest (i.e. 60–70 percent) allowable range.”

Making health care more unaffordable for families is not a solution to any of the failures of our health care system.

Third, proponents argue that the “Cadillac Tax” is needed to raise revenue. The Washington Post editorial goes so far to make the ridiculous argument that it would be “raising revenue for expanded care for lower-income people.”

That simply is not true. The federal budget does not work that way, as there is no Medicaid Trust Fund for any revenue generated by the imposition of the excise tax. Any money raised simply goes into the Treasury and not to lower-income people or even health care more generally.

Even worse, as employers shift more costs to employees in response to the excise tax, the health care safety net and government programs will likely bear an increased burden as individuals and families attempt to shift their coverage to more affordable options, such Medicaid, the Children’s Health Insurance Program (CHIP), and the ACA exchanges, or use these programs to supplement their increasingly unaffordable private coverage.

Fourth, proponents of the excise tax argue that its repeal would harm efforts to slow the growth of health care costs. However, the vast majority of employers, including our organization, have little ability or way to control health care costs. The consequence is that employers use what little tools they have to simply reduce their own costs by shifting a growing share of the health burden to employees and their families.

Taxing the health benefits of employees does not reduce the health care costs of consumers — it just makes care more expensive and threatens their health.

The Growing Support for Repeal of the “Cadillac Tax”

In fact, the real health care cost issue facing families is the growing crisis of underinsurance. Levey explains:

The explosion in cost-sharing is endangering patients’ health as millions, including those with serious illnesses, skip care, independent research and the Times/KFF poll show.

The shift in costs has also driven growing numbers of Americans with health coverage to charities and crowd-funding sites like GoFundMe in order to defray costs.

Our nation needs to address the growing problem of underinsurance rather than incentivize the expansion of this trend through imposition of the “Cadillac Tax.” Recognizing this, over 650 national, state, and local organizations that represent business, insurers, and consumers that have some together to support repeal of the “Cadillac Tax.”

If there are holdouts on the Democratic side of the aisle, they should recognize that the “Cadillac Tax” is an arbitrary limit on health care spending that is set to grow at a slower rate than expected medical inflation. This should be a familiar concern because it is one of the top reasons why progressive groups strongly oppose arbitrary caps on spending like Medicaid block grants or per capita caps. Arbitrary limits on health care spending would lead to the rationing of care and that will have a disproportionately impact on vulnerable populations, such as people with disabilities and children.

As for any holdouts on the Republican side of the aisle, they should recognize that the “Cadillac Tax” undermines private health coverage helps fuel arguments for single payer, government-run health coverage. If private health coverage cannot be counted on to truly protect people when then need health care coverage, the alternative is an expansion of public coverage, which conservatives oppose.

To find better solutions that will eliminate “economic distortions that drive high costs and inadequate health outcomes in the US health care system,” First Focus on Children has joined Families USA, the American Academy of Family Physicians, the American Benefits Council, the American Federation of State, County and Municipal Employees, the American Federation of Teachers, and the Pacific Business Group on Health as a member of “Consumers First: The Alliance to Make the Health Care System Work for Everyone.”

Consumers First will be focused on six issues for action:

· High and rising health care prices

· Distortions created by provider payments systems

· Increased health care industry consolidation

· Insufficient oversight over nonprofit institutions

· Flawed workforce policy

· Inadequate access to data and transparency

Consumers First believes the “health care system should work for families to ensure the best health possible without threatening their economic independence and vitality.”

Rather than supporting arbitrary caps represented by the “Cadillac Tax” that undermines private health coverage or Medicaid block grants that would harm millions of Americans, it would be far better working to get to the important work of transforming our health care system so that it better serves us all.


Putting the Spotlight on Child Poverty

| June 21, 2019 |

By Sarah Morrison

The following guest blog was originally published on the Coalition on Human Needs site, and has been republished here with permission.

Editor’s note: CHN Intern Sarah Morrison is a rising senior at the University of Maryland. She is studying Economics and Non-Profit Leadership.

As we approach the upcoming months of summer vacation, it’s easy to imagine the flurry of excitement for students awaiting long days of snow cones and playing at the pool. However, this is often not the case. For many children, this time of year means losing access to school meal programs and facing the threat of hunger. This was a major point of conversation at the Spotlight on Child Poverty event at the Capitol on June 12, part of First Focus’ Children’s Week 2019.

Congresswoman Lucille Roybal-Allard (D-CA) giving a compelling speech on the nationwide prevalence of child hunger. (Photo Credit: Samuel Chasin, @shmuley)

Rep. Lucille Roybal-Allard (D-CA) shared her own experience,  painting a clear image of how detrimental poverty can be to a child’s well-being. When visiting an elementary school in her district, a teacher pointed out a young girl and shared that “she cries every Friday, because she knows she will be hungry over the weekend without school-provided meals.”

Unfortunately, stories like this are not uncommon. The Supplemental Nutrition Assistance Program (SNAP) does not fill the gap, and a mere 17 percent of children who are eligible for meal assistance programs during the school year are able to make use of them during the summer months. Congress  now can, and should, prioritize the Child Nutrition Act reauthorization in order to expand funding to programs providing benefits to needy children.

Humanitarian and renowned chef Jose Andres was in attendance as a guest speaker, bouncing in enthusiastically donning his red nose in support of Comic Relief’s Red Nose Day to reduce child poverty, Comic Relief being one of the event’s main sponsors. Offering his own unique perspective and experiences, Andres repeatedly announced that “children don’t want our pity, they want our respect. And they are here to help us lead the way.”

Citing stories of young children living in deep poverty who he has met over his years of activism, he told of children’s generosity and leadership ability. Notably he told the story of Lola, a 12 year-old he met during his time working in Puerto Rico to alleviate hunger. With two parents who worked in the food truck business, Lola immediately made herself known by working in the sandwich lines, and rising quickly to supervise the adults making sandwiches. It is kids such as Lola who the adults in the world should be looking to when they seek to understand both the issue of and solutions to child poverty.

Nate Mook (World Central Kitchen), Bruce Lesley (First Focus), Congresswoman Barbara Lee (D-CA), Chef Jose Andres, and Congresswoman Lucille Roybal-Ballard (D-CA) all in attendance to support reducing child poverty. (Photo Credit: Samuel Chasin, @shmuley)

A number of speakers present commented on the current political climate in Congress. “We all need to be more political – not partisan – political. Let’s get the pressure on Congress,” said Rep. Jim McGovern (D-MA), Chairman of the Congressional Hunger Caucus.

According to Kate Leone, Chief Government Relations Officer for Feeding America (and a Board member of the Coalition on Human Needs), experts have found that there is child poverty in every single congressional district. When the health of our nation’s children is at risk, it puts a unique perspective on the senselessness of a deeply polarized government.

Partisanship aside, research has proven that making meaningful reductions in childhood poverty is within reach. The National Academies of Science, Engineering, and Medicine (NASEM) created a Roadmap to Reducing Child Poverty that includes four “packages” that could reduce child poverty and deep poverty by up to 50 percent in 10 years. Considering that the cost  of providing the means-tested policies suggested by NASEM is offset by reduced expenditures related to the multiple hardships stemming from child poverty, the report should appeal to all policymakers.

Members of Congress are at a pivotal moment; they have the research in hand to alleviate child poverty. It seems to be only a matter of summoning up the political will to turn intentions into outcomes. As CEO and Executive Director of Kids Forward Ken Taylor reminded the room, “Children are one-fourth of our population, but all of our future.” It only seems just that we provide them with the quality of life that they need to thrive.


#ChildrensWeek2019 Podlet: An Interview with Helen Blank

| June 13, 2019 |

This year to highlight issues in advocacy for early education, our Averi Pakulis and Karen Howard sat down with Helen Blank, who has been working to expand children and families’ access to high quality child care and early education for more than 30 years.

In this conversation, they reflect on how far the child care community has come in the advocacy space and what needs to happen to ensure that children, families, and caretakers get what they need to thrive.


Congress nearly doubled CCDBG funding last year. So why are advocates asking for more?

| June 13, 2019 |

By Jacob Stewart, MPP, Manager, Policy and Governmental Affairs, Child Care Aware of America

In 2018, our national child care system scored big. The Child Care and Development Block Grant (CCDBG), the largest source of federal funding for child care, received a $2.37 billion increase in the FY2018 appropriations process, nearly double its previous funding. An increase that large and dramatic is nearly unprecedented for a discretionary program.

Early childhood programs Head Start and Early Head Start also saw increases of $610 million and $200 million, respectively. This momentum carried into FY2019, when lawmakers added another $50 million to CCDBG and $200 million to Head Start and Early Head Start.

Given this success, you might be surprised to learn that advocates are now asking for even more money for CCDBG. In fact, $5 billion more—a near doubling of what was just doubled.

Advocates are asking Congress to double what they just doubled. Greed or need? 

But before concluding that these advocates are just plain greedy, it’s important to understand why we’re asking.  

First, CCDBG has been chronically underfunded for years, diminishing its impact over time. In 2000, the number of children served each month by CCDBG peaked at 1.8 million, according to the U.S. Department of Health and Human Services. But fast forward to 2017, and preliminary data reveals that the number dropped to a historic low of 1.32 million. To understand just how troublesome that number is, consider that the number of children living in poverty is more than 25 percent higher than it was in 2000. The bottom line: we’re spending even less on a need that’s gotten larger. Consequently, CCDBG currently serves fewer than 1 in 6 eligible children.

In 2014 CCDBG was reauthorized with tremendous bipartisan support. This reauthorization added important health and safety requirements for child care providers, but did not come with sufficient funding to allow providers to adopt all of these improvements. As a result, there is a dire need for additional funding to provide high quality, safe, and healthy child care to the growing number of children who qualify. Over the years, inflation also did its part to devalue CCDBG funding: even after last year’s funding increase, federal money for child care still fell $1 billion short of what it was in FY2001, when adjusting for inflation. While five billion dollars may seem like a lot of money, it is necessary to overcome the two decades of non-investment in this critical program.

Second, while a $5 billion increase seems high, at least that much is required to meet each state’s true child care needs. A summary released today by Child Care Aware® of America provides this context by showing why CCDBG funding is important in each state. In addition, this summary illustrates how much each state would receive with a $5 billion increase. For example, $5 billion adds just $86 million for Alabama, $26 million for Nebraska, $5.8 million for Wyoming, and so on. States could easily spend their portions and more to meet the needs of their families.

Finally, the nation is currently facing a child care crisis, underscored by a lack of affordability and high rates of providers leaving the field in some states. As a result, many states are seeing the rise of so-called “child care deserts”, or areas with too few options for child care. Low wages, along with low profit margins, are fueling this crisis, and a large public investment is needed to stop it.

As the renowned child care advocate Helen Blank explains in the First Focus podlet, increasing CCDBG funding is an important first step to fixing the crisis. It not only increases both access for working families and pay for child care workers in the short-run, but it lays the foundation for a child care system in which high-quality care is available to all families and our vital child care workforce is well supported and sustained.

So yes, advocates scored big in 2018, but their work is far from over. An even larger investment is needed to repair the system and meet the needs of American families. Let’s not leave this job half finished.


We’ve come a long way — now let’s keep kids covered

| June 11, 2019 |

When I worked in Iowa as a child health advocate I picked up the phone one day to find a pediatrician I’d never met on the line. He had seen my name in a newspaper article about the state legislature’s passage of twelve-month continuous coverage for kids in Medicaid and CHIP in a bold health care bill. I had helped get it passed.

“Thank you,” the doctor said. “This is a very important policy for kids. It means when we treat a child with cancer, we can design a year of treatment and know the chemo will be covered, hospital stays will be covered, and tests and referrals will be reimbursed. The parents’ stress level is lowered and that helps the patient, too.”

To me this call said it all: When kids are sick, their coverage should be stable and usable. It should meet their health needs and allow them to see the providers they need to see.

Today, kids in roughly half the states receive continuous Medicaid and CHIP enrollment for 12 months from the day they join. Most use that coverage for well-child visits, vaccinations, developmental screenings, the occasional injury or accident, or things like earaches. For some children though, Medicaid and CHIP cover speech therapy, habilitation services for a disability, chemotherapy for cancer or other special needs. For all of these kids and their parents, CHIP and Medicaid’s affordable and child appropriate health coverage, with pediatric providers and benefits, provide peace of mind, a sense of safety, and financial relief.

In fact, 12-month continuous coverage has worked so well that advocates have begun to consider what might happen if we covered kids for the entirety of their early childhood years, from birth through age five when they start school. What if they had coverage every day while their brains are developing, while they’re acquiring language and honing motor skills? What if children with special health care needs could enjoy long-term treatment plans? What if their families could be spared the planning and paperwork currently required to juggle multiple medical providers, treatments and even case managers?

We can be pretty sure about one outcome: Costs would likely go down. In a 2013 paper, policy experts Leighton Ku and Erika Steinmetz wrote that the average monthly Medicaid benefit cost for kids coverage averaged $151. When care was extended to six months of continuous coverage, the cost dropped to $140 per month. At 12 months of coverage, the cost plummeted nearly 30 percent to $110 per month.

Why do the benefits cost less with 12 months of continuous coverage? When coverage is maintained continuously, care isn’t skipped or delayed, therapy is regularly scheduled, and medicine is taken as prescribed and refilled on time. Children and parents can develop trusting relationships with providers, and establish a medical home, boosting the regularity of screening, growth and development assessments, and needed referrals. New illnesses and concerns are treated earlier, and the interventions are often less intrusive and costly. Chronic illnesses like asthma can be treated with effective primary care while reducing emergency room visits. Regular oral health services covered under Medicaid and CHIP help reduce the chronic condition of tooth decay.

So just imagine what improvements we could achieve in children’s health with continuous coverage to age six. Children with special health care needs might have fewer hospital stays or emergency room visits. Kids could receive early intervention even sooner for social/emotional and developmental issues. By the time kids enroll in kindergarten, they could be in better health with more of their needs met.

Sadly, recent developments suggest that we are going backwards instead. A new study by the Georgetown University Center for Children and Families found that since 2017, enrollment in Medicaid and CHIP has declined by nearly one million kids. When the Census data is released in September we may find that this number is actually much higher. This unprecedented drop in coverage runs counter to the trend of dramatically increased coverage for children over the last several decades. In fact, in 2016, this country achieved an all-time low rate of uninsured children of 4.7 percent. The years of battles to protect the Affordable Care Act (ACA) and Medicaid, and the protracted fight to renew CHIP funding in 2017/18, hinted at this outcome. But it is still deeply troubling to see so many kids fall off public coverage.

During Children’s Week, we ask those who make policy decisions for children to make the smart choice: Make sure all kids have the health coverage they need during those early, vulnerable years. Let’s give kids continuous coverage from birth through to age six. Let’s keep them covered. It’s not just good for them. It’s good for the country.