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CHIP Waiting Periods Must End

| May 15, 2020 |

When my oldest brother was a few months short of 65, he started asking me what I knew about Medicare. (Turns out I know little.) He was in the process of enrolling, even though his birthday was four months away.

You can do that with Medicare. In fact, you can even begin using Medicare before you actually turn 65! The Department of Health and Human Services’ website says “coverage starts the first day of the month you turn 65. If your birthday is on the first day of the month, your coverage starts on the first day of the prior month.”

So, if my 65th birthday is July 20, I can get coverage under Medicare on July 1. If my birthday is July 1, I’m covered starting June 1.

Smart, right? Providing seamless coverage is exactly how health insurance should work. Unfortunately for children, the opposite is true.

While most states got rid of waiting periods after the Affordable Care Act limited their length to 90 days (some states previously had waiting periods for kids that were as long as six months!), a total of 13 states still require children to wait those 90 days to enroll in the Children’s Health Insurance Program (CHIP).

What does a waiting period mean to a parent or grandparent who wants to enroll their child in CHIP? It means they must weigh the risk of having that child go without coverage for a month or two or three before they can be covered by CHIP. If the child is enrolled in the parent or grandparent’s employer or other coverage plans, they would actually have to drop that coverage and then wait the 30, 60, or 90 days depending on state rules.

If your child has a condition that needs regular care or medication, waiting for those 30 to 90 days may feel just too risky. Even if your child doesn’t typically need medical care very often outside of well-child visits, you may not want to risk your child being uninsured for any length of time. So, parents and grandparents who are unwilling to risk their child’s health can’t take advantage of the benefits of CHIP even though their child is eligible.

The 13 states that still have waiting periods are — Arizona, Arkansas, Florida, Illinois, Indiana, Iowa, Louisiana, Maine, New Jersey, South Dakota, Texas, Utah, and Wyoming. Two of those states, Texas and Florida, have very large numbers of uninsured kids, some of the biggest in the country. The uninsured rate for children in Texas is more than 11% and in Florida, it is nearly 8%. The national rate is 5.5%.

Kids are the only population for whom waiting periods still exist. We should take a lesson from Medicare and approach children with the idea of make coverage timely and accessible. Newborns should be covered, whether by Medicaid, CHIP, or private coverage, before they leave the hospital so they go to their first well-child appointment days later with coverage. We should keep children covered continuously from birth through age five while their brains are growing and they see their medical provider numerous times until they go to kindergarten. We should streamline enrollment and renewal systems to prevent eligible kids from falling off coverage. We should get rid of the five-year wait for lawfully present immigrant children and pregnant women to be eligible for CHIP and Medicaid.

It shouldn’t be harder for kids to get covered than older adults. We know what to do. After all, CMS is The Centers for Medicare & Medicaid Services. They know how to do this for older adults and should promote such coverage for kids. States should design their CHIP programs without waiting periods, and Congress should eliminate the option for them all together. They should do it for kids.

Covering All Kids

| May 13, 2020 |

“There can be no keener revelation of a society’s soul than the way in which it treats its children.” — Nelson Mandela, May 8, 1995

Almost 25 years ago to the day, Nelson Mandela spoke these words. The health of our nation’s children is one of those tests.

In the coming days, Joe Biden and Bernie Sanders are working to establish joint policy task forces on the economy, education, criminal justice, immigration, climate change, and health care. These are all issues that are critically important to children and child advocates should be paying close attention. We will be urging those involved to carefully think about and consider how their policy proposals will impact and treat children.

Unfortunately, when it comes to public policy, children have often been treated as an afterthought. This has been true in health care policy discussions in the past, and is exemplified by how the Congress and the Trump Administration allowed the Children’s Health Insurance Program (CHIP) to expire for four months in 2017 and 2018. Child advocates remain hopeful but are still uncertain if this will change in the future.

Fortunately, in an interview with Ali Velshi on MSNBC earlier this month, Sen. Bernie Sanders was asked what he thinks would be a good fallback or first step since Medicare For All is unlikely to occur. Sanders replied:

At least what we should do is lower the eligibility age of Medicare from 65 to 55 and cover all of the children in this country, and then we can figure out ways that we can expand and improve the ACA. Those are some of the things that Joe Biden can do. . . .

A year ago, Vox’s Matthew Yglesias argued that a first step toward covering all Americans would be to “create a universal insurance program for children.”

Yglesias explained:

A Medicare for Kids program could accomplish a couple of key things. For one, it would cover the 4 million children who still lack health insurance. But beyond that, by simply and clearly guaranteeing coverage for all kids, it would offer peace of mind to all families that their children would have coverage no matter what happens. Last, it would offer a small subsidy to middle-class parents who are currently spending money for their kids’ insurance (both directly through premiums and indirectly through employer-size contributions), which would could help offset the enormous costs of parenting.

Leaving aside exactly what path this should take for the moment, the idea of “covering all kids” is particularly timely and welcome right now.

After the passage of CHIP in 1997, the uninsured rate for children dropped by more than two-thirds over two decades (15 percent in 1997 to just 4.5 percent in 2016). Unfortunately, due to the imposition of a number of new bureaucratic and administrative barriers to health care coverage by the Trump administration and states, progress for kids has reversed and the uninsured rate has increased to 4.3 million children or 5.5 percent in 2018.

Even worse, more children are losing coverage daily. In an American Prospect article, Joel Dodge explains:

The number of uninsured children will undoubtedly rise precipitously during the coronavirus crisis. When parents lose or change jobs, their children’s health coverage is often lost or disrupted too. But already during the coronavirus economic shutdown, a stunning 52 percent of people under age 45 — that is, around the age when people are raising a family — have either lost a job, been put on leave, or had their hours reduced.

In fact, in an analysis by the Urban Institute, they estimate that 6.6 million children would lose employer-sponsored insurance if the unemployment rate hits 20 percent. The report expects 90 percent of those kids would find alternative coverage through Medicaid, the Children’s Health Insurance Program (CHIP), or the Affordable Care Act (ACA) marketplaces, but that an estimated 700,000 children would become uninsured.

Coverage for Children Matters

Numerous studies confirm that coverage for children matters.

Every child in America needs and deserves to have affordable, comprehensive, high-quality health insurance coverage. During the last major debate over health care reform, a July 2009 National Opinion Surveys poll found that American voters supported “ensuring that all children have health coverage” by an 87–11 percent margin.

Every child deserves health coverage for health conditions like cancer, diabetes, heart disease, asthma, spina bifida, cystic fibrosis, acute flaccid myelitis (AFM), or any disabling condition, including the need for care during public health crises such as Zika and COVID-19.

Every child needs to have access to developmental screenings, physical and speech therapy, immunizations, mental and behavioral health services, vision care, and all other health care services, such as physician, hospital, and prescription drug coverage.

Ever since Medicaid was created in 1965, the goal of advocates has been to build upon that foundational coverage for low-income children to achieve coverage for all kids, just as Medicare has for people over the age of 65.

We have made tremendous progress in this country on the issue of children’s health. Since the passage of CHIP and up until the Trump administration, the improvement in children’s health coverage had been a national bipartisan success story.

First, Medicaid’s role in that success has been critical. Medicaid has provided the foundation for children’s coverage when it was created 55 years ago.

New York Times reporters Kate Zernike, Abby Goodnough, and Pam Belluck explain:

Medicaid now provides medical care to four out of 10 American children. It covers the costs of nearly half of all births in the United States. It pays for the care for two-thirds of people in nursing homes. And it provides for 10 million children and adults with physical or mental disabilities. . .

The program is so woven into the nation’s fabric that in 2015, almost two thirds of Americans in a poll by the Kaiser Family Foundation said they were either covered by Medicaid or had a family member or friend who was. The program not only pays for 16 percent of all personal health care spending nationwide, but also accounts for 9 percent of federal domestic spending.

In 2018, the Medicaid and CHIP Payment and Access Commission (MACPAC) estimates 36 million children received coverage through Medicaid at some point.

Medicaid works for children.

In 1997, the Children’s Health Insurance Program (CHIP) was created to give states the flexibility to either expand coverage for children through Medicaid or to allow states to build a separate but related health program specific to children whose families have too much money to qualify for Medicaid but not enough to afford private health insurance.

Over the last 23 years, CHIP has played a critically important role in the children’s health coverage system. MACPAC estimates 9.6 million children received coverage through CHIP at some point in 2018.CHIP is a bipartisan national success story.

The Future of Child Health

The American people understand that investing in the health of our children is investing in America and its future. When our children develop and thrive, we are paving the way for our country’s next generation of workers and leaders. And when our kids aren’t healthy, they do not learn and we will fail to stay the world’s leader in innovation.

Most Americans oppose the notion that children should be sick, live in pain, or go without preventive care like vaccinations and annual check-ups just because their parents have lost their job or simply can’t afford health insurance.

Today, health care coverage for children is at a crossroads. There are a few different directions our nation can take, but reversing course is not an acceptable path. Unfortunately, the Trump Administration’s policies have directly contributed to the increase in uninsured children.

These policies include:

  • Increased bureaucracy and non-health related changes to Medicaid enrollment for adults and parents, including work requirements;
  • Failure to pass an extension of CHIP in 2017 for four months;
  • The chilling effect of the Trump Administration’s public charge rule and rhetoric related to immigration, which has undoubtedly led to a disproportionate increase in the numbers of uninsured Hispanic children;
  • Slashed outreach and consumer assistance efforts; and,
  • Increased bureaucracy and red tape in a few states.

Rather than seeking to fix these problems and reverse this negative trend, the Trump Administration’s budget proposal for fiscal year 2021 would make things even worse, as it recommends cuts to Medicaid and the Children’s Health Insurance Program (CHIP) by $920 billion over 10 years. Trump’s budget supports a 2017 legislative proposal by Sens. Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson to (1) “repeal and replace” the Affordable Care Act (ACA); and, (2) cap and cut Medicaid by block-granting the program.

It is important to highlight the proposed Medicaid budget cuts would likely disproportionately harm children. Adding insult to injury, the Trump budget also proposes to cut a few billion dollars out of CHIP.

Source: Avalere Health

No child would benefit and millions would be harmed by such an approach. Fortunately, the Senate rejected it in 2017.

Sen. John McCain (R-AZ), as his Senate colleagues look on, delivers the key vote with his “thumbs down” against (49-to51) a Senate amendment to repeal parts of the Affordable Care Act (ACA) on July 27, 2017.

In contrast, others have crafted proposals that would seek to expand health coverage through some combination of a single-payer system or expansions of Medicare, the ACA, Medicaid, and/or CHIP.

In April 2019, Bryan Sperry, former president of the Children’s Hospitals of Texas, and I explained that there is a great deal of promise that some of these proposals “could achieve the goal of ensuring that all children have coverage. . . .”

But we also warned of “the potential harm, as some of these proposals completely repeal present coverage options for millions of children to be replaced with an entirely new system.”

Therefore, the question arises as to the best approach to cover all kids.

Children Have Unique Health Care Needs

First and foremost, any approach must recognize that children are not little adults. Children have unique health and developmental needs that are vastly different from adults, particularly senior citizens.

Children have special health care needs because they are immature and both their bodies and minds are developing and growing. Consequently, children are sometimes more susceptible to environmental toxins and certain diseases, but they are also typically more responsive to medical treatment and have a better ability to bounce back and heal from health challenges than others. This is why there is more of an emphasis on prevention, habilitation, and developmental milestones with children, as opposed to maintenance and rehabilitation for adults or senior citizens.

There is a reason we have pediatric medicine, pediatricians, pediatric nurses, and children’s hospitals. Children have special needs due to the fact that disease, stress and trauma, and health interventions are almost always different for kids than adults because they are growing and developing. Consequently, in a number of ways, pediatric care, supports, and services are quite different and can be more complicated than that for adults.

As an example, children often need habilitation, which aims to help a child develop motor skills that they have yet to accomplish. In contrast, rehabilitation, which is the focus of adult care services, refers to regaining skills, abilities, or knowledge that may have been lost or compromised as a result of illness, injury, or acquiring a disability.

In his book Healing ChildrenDr. Kurt Newman, President and CEO of Children’s National, explains:

[Children] need specialty centers with doctors, nurses, psychologists, social workers, orderlies, administrators, and maintenance staff devoted to fostering an environment attuned to their unique psychology, biology, and medical conditions.

As a result, general hospital emergency departments sometimes fail to have the right-sized equipment to take care of children in all their developmental stages and sizes from infants, to toddlers, and up to adolescents. Among other things, children need different endotracheal tubs, resuscitation bags, laryngoscopes, suction catheters, intravenous catheters, needles, chest tubes, blood pressure cuffs, and medications. Children need more intensive and specialized pediatric nursing care, as children cannot be given instructions for self-care or left unattended in the same way adults are. Hospitals that care for kids must have expertise in child abuse and maltreatment. Children that have certain medical procedures, such as orthopedic and cardiology, sometimes have to repeat them as they grow and develop.

Even among children, there is an enormous array of different services and care needed. Babies are different from toddlers and their special needs, including services, equipment, and training required, are vastly different than those for adolescent medicine. As Dr. Newman says:

Babies are that different from children, as different biologically and anatomically as children are from adults. Medical intervention on infants, from surgical strategy to the calibration of anesthesia, from pain management to pain control, is completely different.

Unlike the rest of the health care system, CHIP recognizes these differences and has been developed to specifically address the needs of children. The benefits, the providers, the quality standards, the systems, the administration, etc. are all child-focused.

When you think about these differences, it becomes rather obvious. But somehow, when it comes to health care reform over the years, children are often not treated uniquely or with special consideration. Instead, they are often treated as an afterthought.

That must change. As Michael Freeman writes in his book The Moral Status of Children:

It is important that all those that formulate policy should be compelled to consider the impact their policies have on children.

Child advocates would urge that key principles should including:

  • Making progress toward the goal of “covering all kids.”
  • Recognizing that children need a pediatric health care system that is right-sized for their unique and special health care and developmental needs.
  • Adopting a “do no harm” standard that asks and affirmatively answers this fundamental question: Is it good for the children?

“Medicare For Kids”?

For advocates pushing to get to universal coverage in this country, it is terrific that there are a number of voices pushing for children to be a first or top priority.

Like Yglesias, Dodge argues the American people would support an approach to expand coverage to all children and cites a recent Data for Progress poll in which, by a 60–32 percent margin, voters supported “extending universal health care to all American children by giving all Americans under the age of 26 coverage in a government health plan modeled off of Medicare, known as ‘Medicare for Kids.’”

However, “Medicare For Kids” means different things to different people. Some propose moving all children and young adults into the Medicare program, others would create a Medicare-like option on the Affordable Care Act (ACA) marketplaces in order to expand health coverage, and others would seek to create an entirely new Medicare-like system for children and young adults.

If children were all moved to Medicare, CHIP would be abolished (not sure what would happen to pregnant women covered by CHIP) and tens of millions of children would be taken out of Medicaid and moved into Medicare. Since Medicaid and CHIP were created with children in mind and have pediatric-specific benefits, pediatric networks, and stronger affordability protections than Medicare, this approach leaves child advocates with numerous questions as to how those protections and standards (built into Medicaid over the last 55 years and CHIP over the last 23 years) will be established and guaranteed in a new Medicare system. Employer health coverage of dependent children and individual market coverage would also be eliminated under this option.

Proponents of this approach point out that Medicare provides continuous enrollment without the need to repeatedly apply for coverage. The default is coverage and Medicare eligibility is based on age rather than income, although Medicare premiums and the prescription drug benefit are means-tested.

Opponents of moving millions of children into Medicare point out that, since Medicare is a program made for and dedicated to the care and treatment of senior citizens and people with disabilities, it lacks pediatric benefits, pediatric quality standards, pediatric provider networks, or much of anything with a focus on children. The only children receiving Medicare coverage are those with end-stage renal disease (ESRD). This is a significant concern and Medicare would need to be dramatically overhauled from top-to-bottom before children would be safely enrolled.

Medicare is also a far more complicated benefit than Medicaid or CHIP. Medicare has four different parts (Parts A, B, C, and D) and annual enrollment requirements related to Parts C and D.

Another concern is that Medicare’s premiums, deductibles, and out-of-pocket costs are much higher than Medicaid and CHIP.

Medicare also lacks important benefits like habilitation, dental coverage, etc. that are critical to children. To compensate for this shortcoming, low-income senior citizens and people with disabilities (known as dual eligible) apply for Medicaid to provide a secondary or wrap-around cost-sharing and benefits while middle class and wealthier senior citizens and people with disabilities have secondary private insurance that acts as a wrap-around or they purchase Medigap coverage, which offers 10 different types of Medicare supplemental insurance.

The American people support the idea of “covering all kids.” However, by an overwhelming 3-to-1 margin, American voters have opposed eliminating or phasing out CHIP if it meant alternative coverage would be more costly for families and provide fewer benefits for children.

To ensure millions of children are not left worse off by this approach, Medicare would need to be kid-sized (radically change benefits, quality and access standards, and provider networks) AND radically changed to either:

  1. Eliminate most cost-sharing for all children;
  2. Means-test the coverage and benefit, much like Medicare prescription drug coverage, which makes Medicare more like Medicaid; or,
  3. Retain both Medicaid and CHIP to serve as secondary payers or wrap-around benefits for Medicare.

The first is politically impossible, the second undermines the major pro or point of moving coverage to Medicare, and the third is nonsensical.

In the latter case, it is critically important to highlight the role that Medicaid plays for children with special health care needs, including children with intellectual/developmental disabilities, physical disabilities, and/or mental health disabilities, and special populations like foster kids. Medicaid provides far more comprehensive services, including habilitative services and supports like transportation, targeted case management, and in-home care, including private duty nursing, attendant care, and assistive technology, that help children with special health care needs remain at home with their families, etc. than any other private health plan or Medicare does.

To address this shortcoming in other forms of insurance, Medicaid often becomes the secondary payer. In this context, it seems to make little sense to move millions of children out of Medicaid and CHIP but then have to retain Medicaid and CHIP to serve as secondary payers to cover those services and supports that Medicare fails to cover for children. Moreover, even that would not truly hold children harmless because having two forms of coverage with different requirements, standards, provider networks, etc. is far more complicated than one.

Finally, it is critically important to highlight that the health care system does not operate in a vacuum. Today state Medicaid and CHIP programs coordinate with WIC, Head Start, the Maternal Child Health (MCH) Block Grant, public health immunization projects, Ryan White HIV/AIDS, the Individuals with Disabilities Education Act (IDEA), the Indian Health Service (IHS), and the child welfare system. Efforts to improve developmental screenings, maternal depression, immunization rates, back-to-school campaigns, school health programs, and health services for foster kids are all critically important. These relationships happen at the state and local levels and something that is virtually impossible for Medicare to replicate.

Therefore, this all raises the obvious question as to whether Medicare, which is a program created for and focused on the health of senior citizens and people with disabilities, is the right program and approach for children, whether it could be dramatically overhauled to meet the unique and special needs of children, and whether it could be reoriented to ensure kids would not be less worse off or treated as a low-priority or afterthought.

Other “Medicare For Kids” pathways could entail modifying the ACA or creating a new health coverage program for children would face similar challenges and problems that moving children into Medicare would.

For example, we already know that ACA coverage for children has a lower actuarial value, fewer pediatric benefits, and yet, costs more than Medicaid and CHIP.

If the argument is to “simplify” coverage without leaving children worse off, an incredibly complex piece of legislation would need to be enacted that would radically overhaul pediatric coverage in either Medicare, the ACA exchange plans, or an entirely new program. This is anything but simple.

And that leads to the ultimate irony, which is that proponents of the elimination of Medicaid and CHIP are pushing for changes that would radically overhaul other forms of insurance to be more like . . . Medicaid and CHIP.

This begs the ultimate question: why end Medicaid and CHIP in order to try to recreate them?

Covering All Kids

Another approach or pathway favored by a number of child advocates would seek to adopt the best of all systems of care for children to get the country back on the road of progress.

This approach would build upon what is working for children in Medicaid, CHIP, the ACA, and private coverage while conforming to Sanders’s call to “cover all of the children in this country.” In fact, Sanders’s supporters should recognize that Sen. Sanders and Rep. Bobby Scott (D-VA) introduced legislation adopting such an approach in 2007, when 9 million children were uninsured, called the “All Healthy Children Act” (S. 1564).

As Rep. Scott said at the time, “How we take care of our children speaks to our very values as a society.”

A “Covering All Kids” approach would achieve the goal of providing coverage to the more than 4 million (and rising) uninsured children in this country today.

The following options are from ideas put forth by First Focus Campaign for Children in its “Proactive Kids Agenda,” the Children’s Hospital of Pennsylvania’s PolicyLab in its “Universal Health Coverage for Children: Current Barriers and New Paths Forward” report, and Georgetown Center for Children and Families in its “Covering All Children” options paper.

They include:

Eliminating Barriers to Care and Coverage: The first step would be to eliminate what does not work, which includes the increasing paperwork and bureaucratic barriers by the Trump Administration that prevent families from receiving health coverage and care for their children. Families should not be asked to fill out onerous and invasive forms, prove over and over that they are eligible for coverage, and jump through other bureaucratic hoops that are causing the number of uninsured children to rise in recent years.

Enrolling All Eligible Children: The majority of uninsured children in this country are eligible for but unenrolled in Medicaid or CHIP. Rather than move all children to Medicare, this approach would adopt a new expectation or default that all children and young adults below the age of 18, 21, or 26 would be covered.

This approach should include a combination of ways to enroll, retain, and renew coverage, including expanded outreach to families with children, such as enhanced use of culturally competent navigators, community health workers, and parent mentors; enrollment at key moments and places such as at birth and during enrollment in WIC, Head Start, early childhood, and education programs; simplifying paperwork and eliminating bureaucratic barriers; presumptive and express lane eligibility; continuous eligibility from birth under age six and at least 12 months or longer periods for younger children to eliminate churn and improve continuity of care; streamlined renewal of coverage; and, the elimination of any waiting periods in CHIP.

Information technology should be used to help families obtain and retain coverage for children rather than the reverse. The default should be coverage of children, just as it is for senior citizens in Medicare.

Making CHIP Permanent: CHIP works well for kids, but its major shortcoming is that it is temporary and includes out-year funding cliffs that make it vulnerable to political hostage-taking and gamesmanship when it repeatedly is set to expire. CHIP is the only federal health insurance program that is not permanent, which forces the child advocacy community to repeatedly have to push for extensions simply to maintain the status quo. Congress would never gamble with the coverage of senior citizens in Medicare or their own coverage, and nor should they do that to children.

Dodge is right to point out this problem. However, Dodge’s proposed “Medicare For Kids” solution, which would abolish CHIP and move kids into Medicare, would be extreme, difficult to pass, and potentially harmful to kids. It is the right problem but the wrong solution.

Instead, a far more simple and direct solution that builds on what already works for children would be to pass bipartisan legislation by Reps. Abby Finkenauer (D-IA) and Vern Buchanan (R-FL) called the CARING for Kids Act (H.R. 6151) to make CHIP permanent.

Finkenauer points out, “Too many kids’ futures are on the line if CHIP funding expires even temporarily. This bill will cut out uncertainty and help protect the health and well-being of our next generation.”

Buchanan adds, “Investing in affordable health care coverage for our nation’s children saves money in the long run — and it’s the right thing to do.” We agree. It is time to protect the health of millions of children and make CHIP permanent.

Expanding CHIP to 300 Percent of Poverty: For families with incomes above current Medicaid or CHIP limits but who still cannot afford or do not even have an offer of employer coverage, states should be given the flexibility to expand CHIP eligibility up to 300 percent of poverty with higher cost states allowed to cover children up to 350 percent of poverty.

Allowing Families and Businesses to Buy-In to CHIP or Medicaid: Parents want what is the best for their children. If families and businesses find that Medicaid and CHIP would provide better pediatric care that is more affordable for their children, they should be allowed to buy-in to either Medicaid or CHIP, as five states already do and others are exploring.

For example, CHIP in Pennsylvania covers children up to 314 percent of poverty and families above that limit can buy-in or purchase coverage through the program by paying the full rate negotiated by the state.

Under current law, Medicaid and CHIP are able to enact “premium assistance programs” to purchase employer-sponsored health coverage for children, but the reverse should also be allowed. If Medicaid or CHIP is more affordable and provides better care for children, employers and employees should be able to buy-in to that coverage. Parents and businesses should be allowed to do what is best for children.

Eliminating Medicaid Block Grants for Everybody: Medicaid is a critically important insurance program that is there for individuals and families when it is needed. That must be protected. The current dual COVID-19 and economic crises highlight two of the many reasons why it makes no sense to arbitrarily cut, cap, or limit Medicaid coverage through the imposition of block grants.

Health care needs and costs rise during economic recessions, natural disasters, public health epidemics, changes in demographics (i.e., a rapidly growing elderly population or population growth), advanced technologies that promote cures to health problems, etc. and Medicaid automatically adjusts for such changes. Unfortunately, the Trump Administration has repeatedly pushed for such caps and hundreds of billions of dollars in cuts to Medicaid coverage for millions of children, people with disabilities, adults, and senior citizens.

Medicaid block grants should be rejected, and that should include lifting arbitrary caps on funding for Puerto Rico and the territories that is devastating their health care systems and the care of children.

Covering Legal Immigrant Children and Pregnant Women Without Waiting Periods: Under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, states are required to impose a five-year waiting period for children and pregnant women to receive coverage. Under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), states were given the option of waiving the five-year prohibition on coverage. As of January 2020, 33 states and the District of Columbia have waived the five-year waiting period for qualified, lawfully residing children and pregnant women in this country.

No child with cancer, asthma, spina bifida, cystic fibrosis, etc. or that needs eyeglasses, mental health services, or COVID-19 testing and treatment should be asked to wait five years to get necessary health coverage. Furthermore, it is ludicrous to ask pregnant women to wait five years to get health care. These barriers to care for children and pregnant women should be eliminated.

Enact the Health Equity and Accountability Act: Passage of this legislation would help improve the health, equity, and well-being of all families and children, including immigrants, across the nation.

Improving the ACA Coverage of Dependents: The ACA has successfully reduced the uninsured rate for millions of people across the country but has had less impact on the health coverage of children. One major barrier is that the ACA’s affordability provision or “family glitch” has had the inadvertent effect of making it more difficult to cover dependents, including children. A component of a “Covering All Kids” health reform should also address this unintended “glitch” for dependents.

The proposals cited in this section all meet the following principles:

  • Making progress toward the goal of “covering all kids.”
  • Recognizing that children need a pediatric health care system that is right-sized for their unique and special health care and developmental needs.
  • Adopting a “do no harm” standard that asks and affirmatively answers this fundamental question: Is it good for the children?

These ideas all build upon and improve our health system to promote a healthy start in life, the growth and development of children, and improved equity.

In 2016, the uninsured rate for children had dropped to a record low 4.5 percent. Unfortunately, health coverage for children has declined under the Trump Administration.

Now is the time to embrace our past success, build on what works, fix what doesn’t, and get our nation back on the path toward “Covering All Kids.”

Building a Better America and World for Our Children

| April 21, 2020 |

We are living in a life-changing moment where it is clear that the future will look quite different than we had imagined. We are all sheltering at home, practicing social distancing, and focusing most of our attention on the twin crises of COVID-19 and the related worldwide economic recession. Obviously, it is critically important to find that balance between protecting the health of people worldwide and protecting the economy from collapse and the harm that will have on people’s lives.

Focusing on the need to improve the care and delivery of services to children and families is desperately needed, but we often forget that such work goes hand-in-hand with advocacy. The funding and delivery of services to children and families come from both the private non-profit sector and government. The latter is hopefully responsive and accountable to the public. We must not forget the important role that advocacy plays in ensuring there is funding even available for the delivery of services and supports.

However, because corporations, interest groups, and the wealthy are engaged in politics and bring money and influence to the table, the needs of children are often an afterthought in public policymaking.

During consideration of President Trump’s tax legislation in 2017, the final bill provided nearly $2 trillion in tax cuts for corporations and the wealthy but managed to leave some families with children worse off. In a package where a few trillion were been doled out to the well-heeled, the dependent exemption was eliminated and changes to the Child Tax Credit to try to hold families “harmless” failed to address the problem that, as Sophie Collyer and David Harris explain, “23 million children are ineligible for the full Child Tax Credit because their parents earn too little to qualify.”

The House and Senate measures shower enormous benefits on households at the top of the economic ladder, a group that by all indications is older and whiter than the population overall. Then it hands the bill for those benefits largely to younger generations, who will pay through more federal debt; less spending on programs that could benefit them; and, eventually, higher taxes.

Ron Brownstein, The Atlantic:

Compounding the injury, while President Trump and Congress were working for several months on the tax bill, they allowed funding for health coverage of 9 million children covered by the Children’s Health Insurance Program (CHIP) to expire, leaving critical healthcare for vulnerable children hanging in limbo for four months.

This occurred despite a Kaiser Family Foundation poll finding 62 percent of the American people believed “reauthorizing CHIP funding” should have been the top priority of President Trump and Congress in November 2017 compared to 28 percent believing “reforming the tax code” should have been a top priority.

Combined with subsequent policy changes that also negatively impacted health coverage for kids, the uninsured rate for children is now rising for the first time in two decades.

That is unacceptable and it must change. Children deserve better.

To create a government that will pay attention to, better serve, and be more responsive to the needs of children, we must engage in advocacy. As Jon Meacham, author of The Soul of America: The Battle for Our Better Angels, explains:

The battle begins with political engagement itself. . . Those who disdain the arena are unilaterally disarming themselves in the great contests of the soul.

Meacham adds:

To believe something creates an obligation to make that belief known and to act upon it within the arena. Politicians are far more often mirrors of public sentiment than they are molders; that is the nature of things in a popular government and should be a course of hope for those who long for a change of presidents or of policy.

To increase the chance of progress for children, we must engage with and demand that policymakers make kids a greater priority and push them to agree to the notion that the “best interest of children” should guide and direct any and all policy decisions that involve them.

Unfortunately, every aspect of the lives of children are being negatively impacted by both the COVID-19 and economic crises. School closures have deepened the inequity and learning gaps in our society.

The economic shutdown and increased family stress are leading to a rise in child abuse and family violence as well. In Fort Worth, emergency room doctors are reporting an increase in deaths of children caused by blunt-force head trauma.

The dual crises are also increasing child poverty, homelessness, and hunger in children. With respect to child nutrition, the federal government’s promise to help the 22 million children that rely on free or reduced meals at school through a Pandemic Electronic Benefits Transfer (EBT) program has failed to reach the vast majority of children. Even if the Department of Agriculture and states finally get this assistance to children, the provision expires in a few weeks.

Today, children are also at an even greater risk of sexual assault, suicide, substance abuse, and trauma. Children need a more focused, coordinated, and effective response to protect children in our country and around the world.

Despite Elon Musk’s tragically inaccurate tweet claiming that kids are “essentially immune,” the health of children is at tremendous risk because the virus is infecting them too, but also because of its impact on families and the shutdown is causing children to miss developmental screenings, pediatric appointments and services, and immunizations. As an example, UNICEF estimates that 117 million children will fall behind on immunizations across the world.

Therefore, beyond focusing on “reopening the economy,” sending children back to school, starting the baseball season, rethinking safety at concert venues, and deciding what the “new normal” looks like, we must be working on ways to come out of these crises with the hope of a better America and a better world for the next generation.

In November, we will be having elections that determine the next president, more than one-third of the Senate, the entire House of Representatives, governorships, state legislatures, judicial races, city councils, county commissions, and school boards. These elections will give voters the opportunity to decide what kind of leadership we want in search of a better vision of “what we can be.” That process must be more open and accommodating of voters than the Wisconsin debacle a few weeks ago, and we must make children’s issues part of that conversation and debate.

Children, their well-being, and future are on the ballot. We must push for candidates to put forth a positive agenda to improve the lives of children and educate the public so they fully understand what is at stake.

The American Academy of Pediatrics has promoted and First Focus Campaign for Children has supported their #VoteKids campaign in past elections.

Vision matters. The stories our leaders tell us matter — almost as much as the stories our parents tell us as children — because they orient the country to what is, what could be, and what should be. We must understand what worldview and values they hold as sacred and what it means for our future, particularly for our children.

Leadership and policy matters. Leadership is the art of the possible. At critical moments in time, certain leaders rise to the occasion and unite the country toward justice and fairness. While some politicians may choose to demonize and scapegoat the most vulnerable or divide the nation, others will inspire the nation with a vision of unity and civility for all people. History tells us that some of the world’s leaders are better equipped to handle such moments than others.

In a New York Times piece entitled “The America We Need,” the editorial board points out:

The crucible of a crisis provides the opportunity to forge a better society, but the crisis itself does not do the work. Crises expose problems, but they do not supply alternatives, let alone political will. Change requires ideas and leadership. Nations often pass through the same kinds of crises repeatedly, either unable to imagine a different path or unwilling to walk it.

Franklin D. Roosevelt led our nation through the dual crises of the Great Depression and World War II. Roosevelt said of such moments:

All our great Presidents were leaders of thought at times when certain historic ideas in the life of the nation had to be clarified.

Elections are about our future. Even before the current crisis, 1 in 6 children in America were living in poverty and child poverty was 54 percent higher than that of adults.

Unfortunately, the economic recession will undoubtedly cause child poverty to get significantly worse and, unless the nation affirmatively tackles this problem, it will have long-term consequences for the next generation. Jason DeParle of the New York Times explains:

Poverty is also likely to rise disproportionately among children, a special concern because brain science shows that early deprivation can leave lifelong scars. Children raised in poverty on average have worse adult health, lower earnings and higher incarceration rates.

Source: Jason DeParle, “A Gloomy Prediction on How Much Poverty Could Rise,” New York Times, Apr. 16, 2020.

However, this is tragic, but it’s solvable. Over a year ago, Save the Children’s Mark Shriver and I wrote:

The National Academy of Sciences, Engineering and Medicine released a landmark study confirming child poverty in the United States is a solvable problem if there is the political will to address it. Written by a committee of the nation’s leading experts on child poverty, “A Roadmap to Reducing Child Poverty” puts forward an evidence-based policy agenda that, if prioritized and implemented by our nation’s lawmakers, would cut our child poverty rate in half within a decade.

Elections matter. Candidates for political office should offer all Americans a vision of the future direction of the country and a set of policy solutions to get us there. Through that process, children must never be treated as an afterthought.

Unfortunately, politicians often ignore the needs of children because kids don’t vote, they don’t contribute to political action committees (PACs), and they aren’t dues-paying members of organizations that hire lobbyists to push their interests.

And yet, children’s issues can be politically powerful. A number of politicians that voted to slash education funding can attest to the power of parents, teachers, and child advocates who voted them out of office.

The fact is that the 74 million children in this country are a top priority of their parents, their grandparents, their aunts and uncles, their teachers, pediatricians, child care workers, and the employees of businesses that focus on and benefit from the well-being of children and families (from infants, to toddlers, to school-aged kids, and youth). And those people vote.

“Fund Our Future” rally in Richmond, Virginia, led by the Virginia Education Association on January 27, 2020.

In an American Viewpoint poll, voters said that, if they had to make a choice, they would make the “needs of children” a greater priority than both defense spending and the “needs of the elderly.” In the latter case, voters chose the “needs of children” by a wide 51–24 percent margin. This prioritization of children was even supported by both male (43–25 percent) and female (40–26 percent) voters over the age of 60.

Voters have repeatedly demonstrated that they want children to be a priority of our nation’s policymakers. A May 2019 poll found that children’s issues were the top choice of voters, as 80 percent of Iowa voters said “improving the health, education, and wellbeing of children” was a high priority that presidential candidates need to address.

The Children’s Policy Coalition, led by Every Child Matters, commissioned this poll in May 2019.

Candidates for public office must be asked to put forth an alternative vision or set of policies for children for a second term. That agenda should address the following problems:

To enable the dreams and aspirations of the next generation, it is well past time to mobilize a national movement in support of children. In the book, Who Speaks for America’s Children? The Role of Child Advocates in Public Policy, Theda Skocpol and Jullian Dickert argue:

A revitalized movement for children and families in America will depend on the ability of advocates to find new ways to link their efforts nationally and across state and local lines, and to reach out more effectively to parents and communities.

Let’s resolve to make children a greater national priority today and into the future. Parents, child advocates, and all adults that work with or care about the well-being of children must work together to demand change.

As a first step, child advocates must stop selling ourselves short. Child advocates are notorious for compromising with ourselves, watering down requests so as not to “bother” politicians or their staffs, allowing non-kid groups that do not prioritize or fully understand the unique needs of children to carry our agenda, and shying away from asking politicians to support children unless we know it will likely be supported.

The latter is self-fulfilling. Failing to push for change is the opposite of being an advocate. If you don’t bother to ask for policy change or funding, it will never happen. Policymakers might ignore us or say “no” to our requests, but they will never say “yes” unless they are at least asked. We cannot back away from demanding positive change and progress for our kids.

At First Focus on Children and the First Focus Campaign for Children, we are working on ways to empower voices for children and hold candidates and politicians more accountable. Here are seven examples:

  • Children’s Network: We are working on building a formal Children’s Network of advocates across the country to be voices for children in the halls of Congress and state capitols.
  • Children’s Budget Coalition: We have created our annual Children’s Budget to help track whether the President and Congress value and invest in children, and we work with more than 80 cross-sector national organizations to make children a national priority through the federal budget and appropriations process.
  • Children’s Agenda: Before each new session of Congress, we work closely with child advocacy organizations and people across the country to develop a comprehensive proactive agenda for children to present to the President and Congress. A number of bills in Congress have come from this compilation of public policy proposals that would improve the lives of children.
  • Bill Tracker: We have created a federal Bill Tracker to capture all the key congressional votes and bills so that child advocates in D.C. and across the country can see what legislators are doing (or not doing) in real-time on key legislation before the U.S. House of Representatives and Senate.
  • Champions for Children: At the close of each year, we go through all the key votes, bill introductions, and bill cosponsorships related to children for our Legislative Scorecard. We publicly release the report so that child advocates, legislators, and the media can see which legislators are Champions and Defenders of Children and which lawmakers are failing children.
  • Children’s Week: During the week of June 14–20, First Focus Campaign for Children, in partnership with members of the Children’s Budget Coalition, will sponsor our third annual Children’s Week to raise awareness on Capitol Hill and on social media about key children’s policy concerns and needs. If Capitol Hill is still shut down, our efforts will likely include a series of webinars, tweet chats, and other social media efforts.
  • Commit To Kids Campaign: We are working to roll-out a “Commit To Kids” Campaign to ask people across all aspects of society to make a commitment to the future of our children. Stay tuned for that.

We urge child advocates and partner organizations to use and add to these resources to help us all hold our political leaders accountable for their actions on issues of importance to children.

Children deserve nothing less, and frankly, it is in the interest of all of us.

As President John F. Kennedy once said:

Children are the world’s most valuable resource and its best hope for the future.

Thinking of donating your stimulus check? Here are some ways to help children & families in need

| April 16, 2020 |

This week, a good portion of Americans will start to the $1,200 coronavirus relief check show up in their bank accounts. For many, this will be a welcome relief during a trying time. For others, who fortunately haven’t seen the crisis affect their finances, this may be an opportunity to pay it forward. If you find yourself in that latter group, we have attempted to provide a few ways to support organizations that are working to help children and families who need help in this uncertain time.

To ensure this list was relevant, we have made sure to include national organizations, but we also encourage folks to seek out local chapters or community-based organizations in your own neighborhood if those options are available to you.

Also, If you have other worthy causes that you think should be included, we would love to hear them, shoot us an email here.

CDC Foundation: Supports the critical health protection work of the Centers for Disease Control and Prevention. It is raising emergency response funds to enable the CDC to respond to COVID-19.

Center for Disaster Philanthropy COVID-19 Response Fund: Supports nonprofit organizations working in areas identified as having high numbers of affected individuals and those working with the most vulnerable populations. Areas of emphasis include helping health-care workers with purchases of masks, gowns, gloves and other protective equipment; supporting quarantined and vulnerable individuals, and hygiene promotion campaigns to limit the spread of the virus.

Direct Relief: Works in the United States and internationally to equip doctors and nurses with lifesaving medical resources. The organization is delivering protective masks, exam gloves, and isolation gowns to health-care organizations in areas with confirmed COVID-19 cases.

Feeding America: With a nationwide network of 200 food banks and 60,000 food pantries, donations to its COVID-19 response fund will help food banks across the country support the most vulnerable communities affected by the pandemic — you can also find your local food bank here.

World Central Kitchen: Founder Chef José Andrés is turning the kitchens in some of his restaurants into community kitchens offering free to-go lunches for those in need.

No Kid Hungry: Deploys funds to ensure access to free meals continues for children in need, especially with schools closed. It is providing $5 million in emergency grants immediately — with more to come — to help schools and community groups feed kids during the outbreak and making sure families know how to find meals while schools are closed.

Feed the Children: Works with thousands of partner agencies across the country including food pantries, shelters, soup kitchens, and churches.

National Diaper Bank Network COVID-19 Emergency Response Fund: With your help, the National Diaper Bank Network (NDBN) is actively supporting our 200+ member organizations’ response to the Coronavirus epidemic. Every dollar donated to the COVID-19 Emergency Response Fund will help diaper banks serve the specific needs of their community.

First Book: Donations will help deliver 7 million books to children in need who don’t have Internet access or home libraries to keep learning.

Boys & Girls Clubs of America: Helping feed kids participating in its clubs and is providing virtual academic support.

Free Wheelchair Mission: Provides children and adults with disabilities and their caregivers with critical medical supplies and mobility aids.

Blessings in a Backpack: This organization helps feeds school children across the US, and is partnering with districts that have summer feeding programs to extend services while schools are shut down.

Save the Children: Providing children in America’s poorest communities with nutritious meals, books and other learning resources during the outbreak closures.

United Way: They are using their COVID-19 Community Response and Recovery Fund to stock food banks with essential staples to help feed children who rely on schools for meals.

UNICEF USA: Delivering medical supplies to health workers around the world. They are also providing hygiene and medical kits to schools and health clinics to help keep children safe. 

World Vision: Providing children in low-income families and schools with emergency kits of food and cleaning supplies and supporting health care workers on the front lines by distributing protective equipment in the US and abroad.

The National Domestic Violence Hotline: The Hotline is the only national, full-service hotline that answers the call for both victims and survivors, along with concerned friends, family, co-workers and others seeking information and guidance on how to help someone they know. The Hotline provides confidential, one-on-one support to each caller/chatter/texter, offering crisis intervention, options for next steps, and direct connection to sources for immediate safety. 

RAINN: Now, more than ever, it’s crucial that survivors can get help. Many people are staying at home in an effort to slow the spread of COVID-19. Those experiencing intimate partner violence or child sexual abuse are at particular risk. For example, children have lost critical social support structures due to school closings and isolation from adults who regularly look for signs of abuse and exploitation. Mandated reports of child abuse across the country have been dropping as schools, daycare centers, after school programs, and other places where children would interact with adults who may spot the signs of abuse have closed due to the virus. Having a place to turn is critical and, for the first time ever, minors accounted for the majority of visitors to RAINN’s online hotline in the month of March.

COVID-19: How The Health of Children Is at Stake

| April 11, 2020 |

Children may not be dying in the same number as adults or senior citizens due to COVID-19, but their health is at risk and so are the lives of their parents and grandparents. While children are often more susceptible to certain diseases and environmental toxins, they are also often more responsive to medical treatment and have a better ability to bounce back and heal from health issues.

The latter appears to be the case with COVID-19, but it should not lead to an utter dismissal of their unique health care needs or their special circumstances by politicians.

There is a reason we have experts in the care and treatment of children and the creation of the field of pediatric medicine that includes pediatricians, pediatric nurses, and children’s hospitals. Children have unique health care needs due to the fact that disease, stress and trauma, and health interventions are almost always different for kids than adults. In some ways, it can be far more complicated.

When you think about a child, they need protection. They’re not fully formed or fully mature. Their organs are not what they’re going to be. But at the same time, that immaturity allows so much bounce back and so much healing and so much ability. So you have to take both those things into mind as you take care of a child.

Dr. Kurt Newman, President and CEO of Children’s National

Kids are hospitalized are lower rates than adults and so the majority of expenses are in adult care and medicine. Attention follows the money, but money also follows attention.

In his book Healing ChildrenDr. Newman points out:

Adult diseases win more investment; adult doctors are better paid; adult medicine dominates the news cycle. As a society, we prioritize end-of-life and palliative care, while children’s medicine is painfully undervalued and underfunded. In the United States there are 35 independent children’s hospitals and more than 200 operating as part of a larger integrated health system, but nearly 5,000 hospitals focused primarily on adult care. This in a country with 75 million children under the age of eighteen.

Unfortunately, rather than addressing the unique needs of children, health care systems and policymakers often treat children as an afterthought.

We are seeing that again in the COVID-19 response. Other infectious diseases often more heavily impact children, but for reasons yet to be fully understood, children are less likely to die from this virus. That does not mean they do not have special concerns or needs at this moment in time. Every facet of the lives of children is being disrupted by both COVID-19 and the economic crisis. Children are, as UNICEF points out, the “hidden victims.”

Children Are Not Immune or Invincible

The impact on children from COVID-19 is immense. It is also variable and complicated. The impact is different based on age, gender, income, disability and health status, geography, and family circumstance.

In comparison to adults, children need different endotracheal tubs, resuscitation bags, laryngoscopes, suction catheters, intravenous catheters, needles, chest tubes, blood pressure cuffs, and medications. Children need more intensive and specialized pediatric nursing care, as children cannot be given instructions for self-care or left unattended in the same way adults are. Hospitals that care for kids must have expertise in child abuse and maltreatment. Children that have certain medical procedures, such as orthopedic and cardiology, sometimes have to repeat them as they grow and develop.

Unfortunately, in policy discussions, children are often ignored or invisible to policymakers so much of this nuance is ignored. Sometimes policymakers are downright clueless.

It is happening again. On April 8, Florida Gov. Ron DeSantis said he was considering the reopening of public schools in the midst of a statewide stay-at-home directive by claiming:

This particular epidemic is one where, I don’t think nationwide there’s been a single fatality under 25. For whatever reason it just doesn’t seem to threaten, you know, kids.

Gov. DeSantis needs to understand four critical issues related to COVID-19 and child health:

(1) Children and families are getting sick and dying from COVID-19 (recent data from the CDC and South Korea indicates that prior reports from China and Italy significantly understated the impact on children because the data was and still is predominately driven by who is getting tested, which have been older adults);

(2) Like anybody, young people also can carry the virus and infect teachers, coaches, bus drivers, counselors, teacher aides, janitors, school administrators, etc. and their own parents;

(3) Child health is heavily impacted by family and ensuring the protection of the health of parents and teachers is critical to children; and,

(4) More than 16,000 people in Florida have tested positive and tens of thousands of others likely have the virus and 354 people have already died in Florida.

Even though children are not dying at the same rate as senior citizens from coronavirus, it is wrong to assume that children are not being heavily impacted. Elon Musk also made a similar false leap when he tweeted that kids are “essentially immune” from COVID-19. Simply put, they are not.

The fact is that the coronavirus is impacting every aspect of the lives of children, including their health.

Children are neither immune nor invincible. The impact on them is just different. Again, children are not little adults.

According to the Centers for Disease Control and Prevention (CDC), 2,572 of laboratory-confirmed COVID-19 cases in the U.S. between February 12 and April 2 were in children. The median age for children infected in the U.S. for that period was 11 years. Although coronavirus cases in children tend to be less severe than in adults, there are some serious cases and even deaths among children. The CDC is finding that hospitalizations are more frequent for infants than other age groups of children. Data also indicated the underlying medical conditions among children that have been hospitalized are most reported for those with chronic lung disease (including asthma), cardiovascular disease, and immunosuppression.

The CDC concludes:

Whereas most COVID-19 cases in children are not severe, serious COVID-19 illness resulting in hospitalization still occurs in this age group. Social distancing and everyday preventive behaviors remain important for all age groups as patients with less serious illness and those without symptoms likely play an important role in disease transmission.

Children’s Physical and Mental Health Are Linked to Family Well-Being

Policymakers must also recognize the health of children is also greatly influenced by the overall health and well-being of their families. As Dr. Jack Shonkoff at Harvard University’s Center on the Developing Child explains:

The immediate effects and long-term impacts of this rapidly changing situation will not be evenly distributed. The stresses of caregiving (for children as well as for adults at greater risk) are rising for everyone.

Dr. Shonkoff adds:

For the millions of parents who were already struggling with low-wage work, lack of affordable childcare, and meeting their family’s basic needs from paycheck to paycheck, the stresses are increasing exponentially. When unstable housing, food insecurity, social isolation, limited access to medical care, the burdens of racism, and fears related to immigration status are added, the toxic overload of adversities can also lead to increasing rates of substance abuse, family violence, and untreated mental health problems. We cannot lose sight of the massive consequences of these threats to the health and development of our most vulnerable children and their families — now and for years to come.

Our failure to fully support families with children whose schools and child care centers have been closed could be catastrophic in the long-term. The education, housing, nutrition, and poverty of children will all, to varying degrees, be negatively impacted by the COVID-19 and economic crises. President Trump, Congress, the governors, state legislatures, and local governments must all do more to address these problems on a holistic basis.

For example, in the CARES Act that just passed Congress, the U.S. government will treat children as worth just 41.7 percent of that of adults ($500 for children and $1,200 for adults in the COVID/stimulus package). Consequently, a single mother caring for her two children will receive less support than two adults with no kids. That is one of a number of things that should be considered and fixed.

Cambridge University’s child and adolescent psychologist Paul Ramchandani points out that we should also be addressing the specific mental health needs of children and their caregivers. Ramchandani writes:

First, the very youngest children (including those yet to be born) are potentially the most vulnerable to family stress and anxiety. Effects on them may not be immediately apparent, but there is a large body of research showing that depression and anxiety in either parent is linked to a greater risk of mental health problems in children. This isn’t set in stone, so intervention and support now, such as psychological therapies for parents, would be transformative for many families.

Crisis Creates Expanded Threats to Maternal and Infant Mortality

In addition, at a time when people are being asked to shelter in place, maintain social distancing, and do not have child care, a whole array of problems are facing children. For example, mothers with newborns are being released from hospitals more quickly than normal, and parents are having trouble getting children to appointments for checkups, developmental screenings, and immunizations. This threatens the health and development of children.

We have an on-going crisis with respect to maternal and infant mortality across the world and we should take proactive steps to ensure that COVID-19 does not exacerbate those problems. Although we have made significant progress, The World Health Organization (WHO) points out that “[c]omplications during pregnancy and childbirth are the leading cause of death for 15–19-year-old girls globally.”

There are special circumstances and challenges related to the health of mothers and their babies when it comes to this health crisis, particularly as to how it impacts mothers and infants, the current uncertainty of how COVID-19 may or may not be transmitted, and how to keep mothers and babies safe and healthy.

Furthermore, with schools and child care centers closed, parents with health concerns are finding it difficult to address their own needs and problems while simultaneously attempting to care for their children. Pediatrician Dorothy Novack highlights the threat of “children “being stranded should their parents fall ill.” Novack explains:

For those who are single parenting, COVID-19 infection is already particularly harrowing. They are sick and quarantined away from anyone who can care for them. The only help they are able to receive comes in packages delivered to their stoops. They have no choice but to care for their children while they themselves are weak, feverish and exhausted. And the issue of child care adds insurmountable fear. They are constantly assessing their own breathing, wondering if they should call 911, hoping they can hold out and stay home, knowing their children have nowhere to go.

Beyond the enormous health challenges that COVID-19 has created, the stress it has on children and families must be addressed or there will be long-term consequences.

Crisis Will Create Other Threats to Child Health

The COVID-19 pandemic is also straining hospitals and health systems, leading to the reallocation of personnel and resources, and creating shortages of medical supplies and disruptions to routine health care services, such as pediatric developmental screenings and immunizations. Before this public health pandemic, through the crisis, related to the crisis (e.g., increases in emergencies caused by child abuse and unintentional poisonings), and well after, children have health concerns that must be addressed.

This is a critically important and on-going issue across the world. As UNICEF reports:

We are particularly concerned about countries that are battling measles, cholera or polio outbreaks while responding to COVID-19 cases, such as Afghanistan, the Democratic Republic of Congo, Somalia, the Philippines, Syria and South Sudan. Not only would such outbreaks tax already stretched health services, they could also lead to additional loss of lives and suffering. At a time like this, these countries can ill-afford to face additional outbreaks of vaccine-preventable diseases.

The message is clear: We must not allow lifesaving health interventions to fall victim to our efforts to address COVID-19.

In the U.S., immunization rates were already dropping before the coronavirus pandemic and communicable diseases like measles were on the rise in 2019 and have not gone away. We must ensure that steps are taken to maintain access to immunizations through this crisis and to take further action to improve immunization rates after the COVID-19 crisis passes, particularly among those that are behind on immunizations and the poorest and most vulnerable children.

In my last blog, the impact that the closing of schools is having on child nutrition was highlighted and there is a new story out emphasizing how Congress’s initial efforts on nutrition are not getting to children.

The Trump Administration and Congress must immediately address and fix this problem to ensure children are receiving the food and nutrition they need.

Policymakers must also consider ways to improve access to health care services for those children that rely upon school-based and school-linked services “for primary care and often mental health care, social services, oral health care, reproductive health, nutrition education, vision services, and health promotion.” Access to this health care is particularly important as students from poorer communities often have higher rates of asthma, substance use, poor nutrition, obesity, anxiety, and depression than other children.

There are also particular threats to the health of children in group home settings, homeless children, kids in the juvenile justice system, and those in immigration detention centers, who are in contact with workers that do not have the training, resources, or equipment to deal with this crisis. These children are far more susceptible to being exposed and contracting COVID-19 and are in settings without adequate medical services or resources.

Children are not little adults. They have special or unique health care needs across age, gender, disability, income, and circumstance. There are numerous challenges that children face when it comes to COVID-19. So again, kids are not “essentially immune.” Quite the contrary.

Furthermore, threats to the health and well-being of children go well beyond this health care crisis, as the economic downturn and recession will have long-lasting implications for children. Research on the impact that Hurricane Katrina and other natural, public health, and economic disasters highlight this challenge.

After Katrina, a National Commission on Children and Disasters was created to address the unique challenges facing children in crisis or disasters. According to a follow-up report by Save the Children five years later, only 21 percent of the recommendations had been fully implemented. Now is the time to pay full attention to the needs of children — both their health care challenges but also every aspect of their lives that is being disrupted.

Children in the U.S. need a coordinated and comprehensive approach to addressing the myriad of challenges impacted every aspect of the lives of children to deal with COVID-19 and the economic downturn. They need what children have in over 60 countries across the world: an independent Children’s Commissioner.

Our national and state leaders must pay special attention and focus to the needs of children and get it right. Our future depends on it.

The 2020 Census is make-or-break for children’s health

| April 7, 2020 |

The coronavirus crisis has canceled or postponed thousands of events worldwide, but one major event is still on track: The 2020 United States Census. Every ten years, the United States sets out to count each and every person living in the country. Knowing how many of us there are informs our national identity and provides data to effectively design and fund life-saving programs across the country. Medicaid and the Children’s Health Insurance Program (CHIP) are two of the most important.

Between them, these two programs offer health care coverage 46 million children over the course of a year. They provide coverage to kids in low-income families or whose working parents lack affordable employer-sponsored coverage. Medicaid is the largest insurer of children in the country and nearly 50% of its recipients are kids. In 2018, CHIP covered almost ten million children, along with several hundred thousand pregnant women.

The Census Bureau has extended the response window to August 14. If everyone responds — and remembers to #CountAllKids —states will receive the federal funding they need for their kids.

For these programs, the Census is make-or-break. Why? Federal funding for Medicaid and CHIP is based on a formula known as the Federal Medical Assistance Percentage (FMAP), which is determined in part by a state’s population. The higher the population, the fewer dollars the FMAP requires states to contribute from their own budgets. When the Census undercounts the population – and children under the age of five are the most likely to be missed – states lose billions of dollars in federal funding.

As co-leader of the Count All Kids campaign, First Focus on Children is working to make sure that the 2020 Census captures those hard-to-reach children and families, ensuring that Medicaid and CHIP receive their fair share of federal dollars.

Under the state-federal partnership that funds Medicaid and CHIP, the federal government covers at least 50% of program costs. The states contribute the balance. The federal government, however, can provide as much as 83% of the funding, with the state partner contributing just 17%. The FMAP determines what percentage a state must contribute.

The FMAP is based on a state’s per capita income. The U.S. Bureau of Economic Analysis calculates per capita income by dividing the aggregate income of all state residents by the state’s total population as determined by the census. When the census undercounts residents, the state’s per capita income is calculated as inaccurately high. The higher the state’s per capita income, the higher its required contribution according to the FMAP. In fiscal year 2015, the loss of federal dollars per person missed by the 2010 Census ranged from $533 for Utah to $2,309 for Vermont.

Over the course of a year, Medicaid covers around 36 million children; CHIP covers close to 10 million. These programs are especially critical for kids in times of economic crisis like the one created by COVID-19. When unemployment rises, families lose employer-sponsored health care coverage along with their jobs. During the 2008 recession, every 1% increase in the unemployment rate meant an additional 600,000 children became eligible for Medicaid and CHIP.

Medicaid and CHIP also serve as primary sources of coverage for many children of color. Together, the programs cover almost one-third of White (31%) children, one-quarter of Asian (28%) children, and more than half of Hispanic (56%) and Black children (58%), who are more likely to live in low-income families than White children.

Ensuring that Medicaid and CHIP are fully funded means better health care access and health outcomes for children. To make sure states receive their rightful share of federal financing through the 2020s, all people need to be counted. Undercounts in states create under-funding and stretched programs that can’t meet the needs of all eligible children.

The COVID-19 Crisis Is Catastrophic for Children Too

| April 4, 2020 |

This is likely a once-in-a-generation disaster, and it will affect every domain of human life. It will be traumatic. And trauma always falls hardest on the youngest among us. . . All the evidence suggests that children — and poor children especially — will bear an incredible burden during the coronavirus pandemic and the attendant economic shocks. But that evidence has trouble breaking into a national conversation dominated by mortality rates and work-from-home strategies.

Vann R. Newkirk II, “The Kids Aren’t All Right,” The Atlantic

On a daily basis, we are witnessing an ever-changing response to the spread of COVID-19 across the entire nation. Unlike natural disasters like hurricanes, tornadoes, fires, flooding, or man-made disasters like 9/11 that impact the entire nation but have devastating consequences that are more consequential to a specific and defined geographic area, the COVID-19 challenge is that it is a worldwide catastrophe and is creating both health and economic crises simultaneously.

While it is critically important to concentrate on protecting the health care of certain populations like people with special health care needs and senior citizens, the needs of health care providers to do their jobs and be safe themselves, the adoption of public health measures, the growing economic crisis and help for businesses, the needs for state and local governments to remain solvent and be responsive to their communications, and the transformation of work to temporary at-home strategies, policymakers and society must also think about how the most vulnerable in our society and the non-profit sector that cares for them are being impacted.

Federal, state, and local governments have responded with rapidly changing strategies to respond to a woefully under-resourced public health care system, and thereby, an unprepared health care infrastructure. While some have stepped up to the task at hand, others have failed to address the immense challenges that the combined health and economic crises have wrought.

If we learn nothing else from this: policy and policymakers matter. There are important reasons why some countries and some states are doing much better in response to the crisis than others.

Some of the measures being adopted, such as social distancing and sheltering in place, are being used for the purpose of flattening the curve of the epidemic, protecting the health of the most vulnerable, and mitigating the impact on an unprepared and overly stressed health care system. This has included closing schools, limiting the operations of nonessential businesses, urging or requiring people to work from home and avoid social gatherings. This has society-wide ramifications and causes a radically disparate impact on people, including children.

Many low-income individuals and families face significant challenges that prevent them from protecting themselves and others from COVID-19. Many lack the disposable income, flexible work schedules, and ability to do paid work from home. Nor do they have paid leave required to take care of children whose schools are closed and whose education attainment and social development may be set back for months. Others may be able to stay home, but their housing security may be at risk because they’ve lost their jobs or had hours cut back as a result of the pandemic.

Emily Benfer and Lindsay Wiley,Health Affairs

Every Facet of a Child’s Life Is Being Disrupted

Every facet of the lives of children and families are being disrupted. Unfortunately, both the short-term and long-term consequences and challenges are not being fully considered or discussed. This crisis is severe and will last for months or even years to come. Moreover, the health and trauma, impact on education and child development, and economic consequences of this calamity will last well beyond the coronavirus itself.

Alice Forthergill, the author of the Children of Katrina, explains, “Disasters last a really long time in the lives of children.” In fact, Forthergill’s research indicates there were profound long-term impacts on children of New Orleans from Hurricane Katrina 15 years ago and that children have “unique experiences and distinct perspectives” in crises that must be considered and addressed.

At the conclusion of her research on Katrina’s impact on children, Forthergill explains, “…it is certain at this point that more attention needs to be paid to the welfare of children in disasters if we are going to reduce their vulnerability and lessen the impacts on them. . . .”

Sadly, far too often, those distinct needs or concerns are often ignored or dismissed even though children have very little control over their lives during a disaster. Kids don’t issue warnings or make either evacuation or shelter in place decisions for themselves or their families. Adults and policymakers make those decisions, and yet, often forget about the needs and lives of the children they are impacting. As Forthergill concludes:

Children are often thought of as hyper-resilient, like rubber balls that can bounce right back after disasters. It is true that children can endure tremendous challenges, yet without proper support, their odds of experiencing many negative health, educational, and behavioral outcomes increase. Our research demonstrated that how children fared after Katrina was not simply a matter of their individual traits, but also a result of social inequality and social structural constraints. Many of the children suffered immensely, had enormous losses, and struggled to find a balance as they and their families faced years of temporary homes and uncertainty.

Children Are Not Simply Small Adults

Policy solutions for children require varied responses for children adjusted for age, income, disability status, etc. The response cannot be monolithic.

Children are not simply small adults. Throughout this report, the Commission notes children’s unique vulnerabilities in disasters that must be addressed in disaster management activities and policies.

National Commission on Children and Disasters report, 2010

Unfortunately, as a nation, we have been unprepared. Across different areas, including disaster relief and recovery, mental health, physical health and trauma, emergency medical services, disaster case management, child care and early education, elementary and secondary education, child welfare and juvenile justice, sheltering standards, services, and supplies, and housing, Save the Children found that only 21 percent of the National Commission on Children and Disasters’ recommendations of importance to children had been fully adopted years after its recommendations had been set to Congress.

It is important that all those that formulate policy should be compelled to consider the impact their policies have on children.

The Moral Status of Children,Michael Freeman

Unfortunately, children are often an afterthought in policy debates. We have witnessed the failure to do so time and time again. Freeman adds:

All too rarely is consideration given to what policies. . .do to children. This is all the more the case where the immediate focus of the policy is not children. But even in children’s legislation the unintended or indirect effects of changes are not given the critical attention they demand. . .

But where the policy is not “headlined” children. . ., the impact on the lives of children is all too readily glossed over.

In the current health and economic emergency, the needs of children are being, once again, either ignored or discounted in a number of ways.

Failure to Fully Address the Needs of Children in “Stimulus” Checks

First and foremost, in the checks that individuals are getting across the country ($1,200 for individual adults, $2,400 per married couple, and $500 for each “qualifying child”), the first issue is that it treats children as if they are worth two-fifth of that of adults. The needs of a child — their shelter, their food, their care, their educational supports, etc. — are not 41.7 percent of the needs of an adult. And yet, that is what Congress deemed children and their needs were worth in the “Coronavirus Aid, Relief and Economic Security (CARES) Act.”

The consequence is that a single mom with two children ($2,200) will get less than two adults with no kids ($2,400). In light of the problems that parents are having due to school closures, the lack of paid leave policies in this country, job disruptions, and the lack of child care funding and support, the needs of families with children are greater now than ever. People all across this country are rediscovering the fact that schools (education, nutrition, community resource, the safety and protection of children, etc.), along with their hospitals, are one of the most important institutions serving our communities.

Beyond the much lower stimulus payments for dependent children, additional problems arise for children in a number of ways and at both ends of the age spectrum. For example, some babies born in 2019 (if the IRS uses a 2018 tax return for the family) and all babies born this year are not included until they file their 2020 tax returns in 2021. The needs of families with newborns are an immediate or “now” issue.

Furthermore, since children are only eligible for the Child Tax Credit up to age 17, young people who are 17- and 18-years-old or who are college students and dependent upon their parents for the majority of their income are set to receive nothing.

College students are rightfully quite upset by the oversight or purposeful denial.

Fortunately, legislation by Rep. Angie Craig (D-MN) entitled the “All Dependent Children Count Act” (H.R. 6420) has been introduced to correct that inequity.

In addition, U.S. citizen children are being denied funding provided for by the “CARES Act” simply because of the citizenship status of one or more of their parents. This is a critical problem, as 1 in 4 children in this country has an immigrant parent. The coronavirus doesn’t care about the citizenship status of its victims and the closure of schools and other disruptions that have impacted children do not fall upon children differently based upon the citizenship status of kids or their parents.

We are all in this together.

Unfortunately, it is unclear whether Congress will provide an opportunity to fix these tragic inequities, as some Members of Congress are claiming there “may be no need for another round of government relief.”

While the COVID-19 pandemic response was initiated with a focus on protecting the health and well-being of more vulnerable populations, such as senior citizens and people with disabilities who are a greater health risk than children, many politicians are completely unaware or unconcerned about the plight of millions of children and young adults across this country.

To reiterate, every facet of the lives of children is being disrupted right now.

What Children and College Students Need:

  • All children should be fully and equitably treated by the government, which includes the need for them to receive comparable and equitable “stimulus” payments for children to those of adults and to ensure newborns, teenagers, college students, and children regardless of their or their parents’ immigration status qualify for the full amount.

Child Poverty Will Rise and Children Will Disproportionately Bear That Burden

It is undeniable that the economic recession will have a number of long-term, negative ramifications on millions of our nation’s children. With millions of people losing jobs and families with children likely disproportionately among those, the rapidly growing crisis is that of child poverty.

Children begin this recession with a poverty rate that is already 54.4 percent greater than that for adults, but if past recessions are an indicator, economic downturns are often deeper and longer for kids.

landmark study by the National Academy of Sciences, Engineering, and Medicine (NASEM) entitled A Roadmap to Reducing Child Poverty explains:

. . .studies show significant associations between poverty and poor child outcomes, such as harmful childhood experiences, including maltreatment, material hardship, impaired physical health, low birthweight, structural changes in brain development, and mental health problems. Studies also show significant associations between child poverty and lower educational attainment, difficulty obtaining steady, well-paying employment in adulthood, and a greater likelihood of risky behaviors, delinquency, and criminal behavior in adolescence and adulthood.

In a 2012 review of the impact of the last recession on children, the Urban Institute reported, “There has been a nearly four-fold increase in the number of children with long-term unemployed parents and a 77 percent increase in SNAP caseloads over the past five years.” For children and families, economic recovery is often lengthy and slow.

Other comparable nations are doing far better for their children. New York Times reporter Jason DeParle writes:

About 17.2 percent of American children live on less than half the median income, said Timothy Smeeding, an economist at the University of Wisconsin, citing data from Luxembourg Income Study. That compares to 11.9 percent in Canada, 10.2 percent in the United Kingdom, and 9.4 percent in Ireland. The United States also spends less on needy families as a share of its economy.

Even before coronavirus and the accompanying economic crisis, we were failing millions of children living in poverty. To prevent rising child poverty leading to longer-term negative consequences for the next generation, we need urgent action to do more in support of struggling families and their children.

It is in all of our interest to address child poverty now and for our future. As the NASEM report explains, the negative impact of child poverty on the economy was costing the nation between $800 billion and $1.1 trillion annually before the recession. That will worsen if we fail to act.

What Children Need:

  • Congress should adopt the recommendations of the landmark NASEM report to implement a Child Poverty Target and policies that would convert the Child Tax Credit to a Child Allowance, such as the legislation by Sens. Michael Bennet (D-CO) and Sherrod Brown (D-OH) and Reps. Rosa DeLauro (D-CT) and Suzan DelBene (D-WA), expand the Supplemental Nutrition Assistance Program (SNAP), and other policy changes that would significantly cut child poverty in this country.

Ensure Access to Food for Infants and Children

As Benfer and Wiley point out:

About 22 million free and reduced-price lunches and 12.5 million breakfasts are served in school each day. More than 34 million households rely on the Supplemental Nutrition Assistance Program (SNAP), and 6.4 million rely on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Schools are closed. A number of school districts are working to either school meals dropped off or picked up, but the reality is that the vast majority of children are not going to get meals through this or other initiatives like the collaboration between McLane Global, the Baylor Collaborative on Poverty and Hunger, and Pepsi to children in rural areas. These initiatives are important and should be applauded but are not enough to reach all the children in crisis.

Although the “Families First Coronavirus Response Act” includes $1.2 billion for food and nutrition programs and was an important step, food insecurity remains a top concern and issue among the nation’s most vulnerable citizens.

This leads to the need for further enhancements to SNAP and WIC. In the case of SNAP, it is a program that targets the most vulnerable citizens during this crisis, as more than 90 percent of SNAP benefits reach households at or below the poverty line and almost half of SNAP recipients are children and other 20 percent are senior citizens or people with disabilities. Unfortunately, the resources are inadequate as the average amount is just $1.40 per meal, and families typically run out of assistance in the first few weeks every month. Monthly resources for SNAP, particularly for families with children because of school closures, must be increased.

It is also important to recognize and address the special challenges that parents with infants and toddlers are facing at this moment in time. We know that around half of all babies in the U.S. access WIC services and that we ensure that they have access to the food and formula that they need to get through this crisis.

What Children Need:

  • As was done in the last recession, we urge an increase in the SNAP monthly benefit of at least 15 percent per household and an added 20 percent for families with children throughout this crisis that includes the economic recession. Furthermore, although WIC received $500 million in additional funding in the first stimulus package, we believe additional resources are necessary to deal with both COVID-19 and the economic downturn.

Ensure Children Access to Housing and Shelter

With respect to housing and shelter, there are numerous and unique challenges for families with children who are homeless. The system already defines homelessness in a way that treats these families and children as if they are invisible and precludes them from qualifying for assistance. Even worse, the ways that homeless families typically cope without a home is to double-up with other family members or friends, sleeping in cars, living temporarily in motels, etc., which were already terribly difficult, are all the more challenging due to school closures and sheltering in place demands from government.

The Department of Housing and Urban Development (HUD) was failing children before, but now things are worse. As Mihir Zaveri of the New York Times writes:

The coronavirus outbreak has only amplified those challenges, as it has for homeless people nationwide. People living in crowded shelters or doubled up with other families are more likely to contract the virus. They are less likely to have access to health care. Many who work low-wage jobs are likely to be laid off.

COVID-19 and the economic downturn will simultaneously increase the number of homeless families across the country but also increase the anxiety and potential risks to children and caregivers already homeless. School closures are particularly difficult, as it leaves homeless families and children without a key institution that provides education, meals, health services, and therapy, safety and protection, respite, and child care.

In contrast to Canada, which has doubled the amount of funding to combat homelessness in its “stimulus” package, little has been done in the first three coronavirus packages to address the housing needs of children and families.

What Children Need:

  • Funding for homeless children and families, such as through the McKinney-Vento Education for Homeless Children and Youth (EHCY), Runaway and Homeless Youth, Service Connect for Youth on the Streets, the Legal Services Corporation, and other related programs should be increased and action to block evictions and utility shutoffs should be included.

The Loss of Education in the Short- and Long-Term

The closing of schools all across the country has impacted every aspect of the lives of children and highlight the importance that our nation’s public schools play for families and our society. This is another lesson that should last well beyond this crisis and put an end to the constant attacks upon public schools and teachers.

Although parents are doing their best through this crisis, some elementary school children will have trouble learning to read or add, subtract, multiple, or divide, others will fail to learn the basics of science, junior high school kids are missing out on prerequisite coursework to prepare them for high school, and high school kids are missing out on courses, college visits, prom, and even graduation.

The important role that schools play for parents of children with disabilities or that are homeless cannot be understated. Schools help narrow the technology gap in society. Education and learning are challenging, at best, or completely lost at this moment in time.

Parents and businesses all across this country have reached a rapid understanding of the important role that schools and parents play — some with desperation and others with humor. Savannah and Jenna talk challenges of being at home with the kids Savannah Guthrie and Jenna Bush Hager exchange stories about getting frustrated with the kids while at home all day in…

While we work through this crisis, there is a longer-term funding threat due to the economic downturn that will likely negatively impact schools for years unless we take action to address that problem.

Derek Black, a law professor at the University of South Carolina School of Law, writes:

Now is the time to learn from mistakes of the past, not repeat them.

Public schools have long consumed the lion’s share of states’ revenues, and for good reason. Public education, as the Supreme Court wrote, is “the most important function of state and local governments.” It serves as the “foundation of good citizenship” and “democratic society.”

Yet, when the economy faltered in 2008, states made little, if any, attempt to shield schools. Several states even targeted education for cuts. Wisconsin waged a “war” on teacher benefits. North Carolina and Florida cut education spending from about $10,000 per pupil to $7,000 in just three years. States across the country incentivized students to leave public schools for cheaper alternatives: charter schools and voucher programs.

States then refused to replenish education funding even after the economy rebounded. The latest available data from the Center for Budget and Policy Priorities shows that as late as the 2016–17 school year, education funding remained below pre-recession levels in real dollar terms in most states — sometimes up to 30 percent lower.

Students paid the price.

What Children Need:

  • Congress should take additional action to support funding for schools and teachers and to end problems related to the “homework gap” for families without broadband access and educational needs of children with special needs in the interim. Moreover, Congress must make a long-term commitment to providing on-going fiscal relief to state and local governments in the long-term to keep them from cutting funding to schools throughout the fiscal crisis. Children will already be behind due to school closures this year and keeping schools fully funded should protect their future success.

At All Costs, Children Should Be Protected From Harm

The children that are the responsibility of society, including children that have been abandoned, abused, or neglected by their parents, kids in the juvenile justice system, and immigrant kids in detention centers are at particular risk.

We are seeing numerous reports and evidence that child abuse and domestic abuse is increasing right now, but that state systems, departments, and courts are closed down or minimally operating.

Newkirk writes:

Child neglect and abuse tend to track with greater traumatic events, economic instability, and stress. Sadly, they might be tracking already. Reportedly, a single hospital in Fort Worth, Texas, has treated six children with severe physical-abuse-related injuries. Doctors believe the cases are related to parents’ stress over the pandemic.

For workers in child protective services, group homes for foster kids, the juvenile justice system, and in the immigration system that are overseeing the well-being of children, they do not have training or resources that are critical to protecting both the children and the workers. This all is deeply concerning and these kids are, by definition, our responsibility and are still being neglected or ignored.

What Children Need:

  • By definition, children in government custody rely upon the government to help them with every aspect of their lives, including their health and well-being. Every precaution and safety must be taken to protect vulnerable children, particularly those in group settings. At-risk children need extra protection and attention rather than less.

Children Need a Children’s Commissioner to Coordinate and Better Serve Children

When a child cries out for help, whether it is a sick child, a child seeking an education, an abused child, a hungry child, a homeless child, or a child fleeing violence and in search of refuge, adults should listen and most Americans do.

Unfortunately, our nation’s policymakers often treat children as merely an afterthought. They have powerful interest groups that are constantly demanding and receiving their full attention, and so children are often ignored. There is a reason that children represent nearly one-quarter of the population but just 7.21 percent of the federal budget.

Across the board, children desperately need a special advocate in the government to hear their unique needs, raise their concerns, and help better coordinate services across the government. This is particularly true during a national crisis. Children desperately need an independent Children’s Commissioner.

Children are exceptionally vulnerable. The fact is that violence, abuse, injustice, and discrimination against children in families, schools, prisons, and institutions can best be eliminated if children are enabled and encouraged to tell their stories and be heard by people with the authority to take action. The consequence of the silencing or dismissal of the voices of children and the harm they experience has the effect of protecting the abusers rather than the children.

A Children’s Commissioner could examine policy choices, issue reports, and make recommendations to Congress and federal agencies on ways to coordinate their efforts and build on best practices, research, and lessons learned with respect to the impact of proposed policies on children. This is in the best interest of our nation, as the cost of failing children is enormous in both human and socio-economic terms in the long term.

What Children Need:

  • Children need an independent Children’s Commissioner to listen to, raise, protect, and coordinate services for children.

Children Must Be Treated as a Priority and Not as an Afterthought

We will come out on the other side of COVID-19 and the economic downturn, but we should do so in a manner where the lives of children are protected to the best extent that we can and that we make sure they have the opportunity to live the “American dream” as have past generations.

Jamie Margolin, a climate justice activist, made the intergenerational point:

My generation is giving up our youth — our schooling, our fun and our freedom — so that you can see next year. When this is over, you may have to keep giving something up so that we can see the next century.

The issue of climate change is a perfect example of how issues of importance to kids are often brushed aside or ignored by other generations. This is the sad reality for children and young adults.

Newkirk concludes:

. . .the most likely outcome is that this pandemic, like most others in history, will again uncover our most basic inequities. For children and their parents, that might mean that mortality rates are only the beginning of the story.

COVID-19 and the economic recession are just two more crises that compound the underlying health, education, social, and political problems that children have been facing before the current calamity.

That must change. Our children deserve nothing less.

Make Sure Every Child Is Counted Today

| April 1, 2020 |

On April 1, tell people to count all children at their address who have no permanent residence.

As the spread of the Coronavirus has increased, the vulnerabilities within our system have become clear. Children and families living in poverty and experiencing homelessness already lack the financial stability to access nutritious food, stable housing, healthcare, and all of the resources needed to support a child’s healthy development consistently. A public health crisis – when resources are scarce for everyone – only exacerbates these needs.

While we are all busy urging decision-makers to take action and fund resources to support children and families hit hardest by this outbreak, we must also remember that we cannot show the true needs of all of our nation’s children and families without an accurate 2020 Census count.

This Wednesday, April 1st is Census Day, the official start to the 2020 decennial census which now – due to the Coronavirus – runs from April 1st to August 14th. Notices about responding to the Census have already gone out to many homes, and as of Sunday, March 29th, 33.1 percent of households nationwide have already responded to the Census via online, phone, or mail.

While this is a good start, we know there are many households that are unlikely to self-respond on their own or may leave children off the form when responding.  In 2010, two million children were missed in the Census and those most at risk of being undercounted include young children in families and unaccompanied youth living in very transient situations who are experiencing homelessness or housing instability.

We already know that these children and youth represent a sizable population. According to data from the Department of Education, public schools identified more than 1.5 million homeless students in the 2017-2018 school year, a 10 percent increase since the previous school year. In addition, the landmark 2017 study, Missed Opportunities: Youth Homelessness in America, from Chapin Hall at the University of Chicago found that 4.2 million young people experienced homelessness on their own over a 12-month period.

The majority of these children and youth are in “doubled-up situations” meaning they are living with others because they have nowhere else to go.  These are often overcrowded, unstable and very temporary situations that put children at high risk of predation, trafficking, and abuse.

The recent Coronavirus outbreak only serves to put more children and youth at risk of homelessness or housing instability. As businesses close or reduce hours, and consumers stay home, low-income household budgets are being stretched even thinner, with less money for rent and utilities.  Children and youth already experiencing homelessness are being put into even more perilous situations. They may be kicked out of doubled-up situations or be stuck in overcrowded and stressful environments all day due to school and childcare closures that make social distancing, quarantining and remote learning nearly impossible.

Children experiencing homelessness and housing instability have poorer educational and health outcomes than their stably housed peers. This has consequences for their future success, as well as our country’s economic future. Yet these same children and youth most in need of resources such as healthcare and educational support are the ones at high risk of being missed during the 2020 Census. If they are missed, they risk not being taken into consideration when communities receive and allocate resources based on census data.

The U.S. Census Bureau guidelines are clear that if people are staying in your home on April 1, including babies and young children, and they have no permanent home elsewhere, you should count them on your Census form. This includes temporary residents — whether related or unrelated — unless you know they are being counted elsewhere. So even if a family is staying at an address and not paying rent, all members of that family, including young children, should be included on the census form for that address. Grandparents, foster parents, or legal guardians who are caring for young children or babies should include them on the census form for that address as well.

If families with children or unaccompanied youth are not sure if they are being included on the census form at the address where they are temporarily staying, then they should self-report to the U.S. Census Bureau on their own to ensure they are counted. They can use the online or phone response system, and just use the address they are staying at on April 1.

The Count All Kids committee, a group of national, state and local children’s organizations dedicated to ensuring our nation’s children are counted in the 2020 Census, has a toolkit of materials to help with outreach to the millions of children in families or unaccompanied youth experiencing homelessness or housing instability. These materials use tested messaging that stress the importance of a full count to help determine how much money communities get for vital resources for children as well as stressing that the Census has the strongest confidentiality guarantees in the federal government. They also have resources saying explicitly to count everyone at that address on April 1 with no permanent residence.

While we are all rightfully focused on the current Coronavirus outbreak, we must also remember that an accurate 2020 Census has implications for the next 10 years – the span of a full childhood – and can help ensure that children and youth most impacted by Coronavirus get all of the resources they need to be healthy, safe and successful.

For more information on the undercount of children in the Census and how to take action, visit and follow Count All Kids on Twitter at @CountAllKids.

Coronavirus confirms why we need a national commitment to address child poverty and homelessness in the United States

| March 13, 2020 |

There is real momentum towards addressing the high rate of child poverty in the United States and the Coronavirus outbreak has only served to confirm that action to reduce child poverty and support family economic security is more necessary than ever. Congress has held three separate committee hearings on child poverty in the past six weeks, all which have highlighted that we know what is needed to address the problem, now there just has to be the political will to act.

In 2019, the National Academy of Sciences released A Roadmap to Reducing Child Poverty, a non-partisan, evidence-based study that models a set of policy and program changes, that if implemented, would cut our child poverty rate in half within a decade. The policies in this roadmap, such as establishing a national monthly child allowance program, increasing SNAP benefits, housing vouchers, and other proven solutions would ensure that families have the resources needed to support their children’s healthy development and support their long-term success.

As the spread of the Coronavirus has grown, the vulnerabilities within our system have become clear. Children and families living in poverty already lack the financial stability to consistently access nutritious food, stable housing, healthcare, and all of the resources needed to support a child’s healthy development. A public health crisis only exacerbates these needs when resources are scarce for everyone.

As schools close, businesses close or reduce hours, consumers stay home, and events are canceled, low-income household budgets are being stretched even thinner and children’s healthy development is at risk as children miss meals and other resources usually provided in school, and parents miss paychecks due to reduced work hours or lack of childcare.

For children, youth, and families also experiencing homelessness, there are additional safety concerns. The majority of children and youth experiencing homelessness in the United States are not in shelters but moving between different temporary situations that include living doubled-up with others or run-down motels. When schools close, children and youth are in these overcrowded and stressful environments all day without many resources. This not only makes quarantining nearly impossible, but these unstable situations also put children and youth at increased risk of predation, trafficking, and abuse.

There is already an unacceptable downward trend on the federal share of spending on children. In fact, our Children Budget 2019 publication shows that the share of spending on children declined to an all-time low of just 7.21 percent. And, just last month, the President released the FY2021 budget request that would dramatically cut spending on critical programs benefitting children, such as Medicaid, the Children’s Health Insurance Program, and the Temporary Assistance for Needy Families program, and eliminate or block grant over 50 other programs including, preschool block grants, the Low Income Home Energy Assistance Program, the Social Services Block Grant, the Community Development Block Grant and creating block grants for 29 education programs, foster youth programs, and Centers for Disease Control and Prevention. This signals that we have a steep, uphill battle to reverse the downward spending trend for children’s programs and services.

Undoubtedly, the Coronavirus outbreak requires increased investment in many of these same, underfunded programs that benefit low-income families, children, and vulnerable populations in order to solve it. Congress must act swiftly to support struggling children and families through investments that provide immediate economic relief in the form of nutrition assistance, paid sick leave, housing assistance, education support, child care assistance, and direct cash transfers that provide families with some financial stability to help weather times of uncertainty. As Congress acts to address this public health emergency, it is our expectation that our nation’s children will figure prominently in the decision-making process before us.

We cannot make progress to reduce child poverty and homelessness without holding ourselves accountable and making it a priority. This is why First Focus, along with 25 other national organizations, launched the End Child Poverty US campaign to call for a national commitment to cut child poverty in half within a decade.

This current crisis makes clear that anti-poverty strategies are public health strategies. We hope you will join us to ensure that no child or family experiences poverty or homelessness in the United States.

You can learn more at

What does the President’s budget say about how we value children?

| February 11, 2020 |

Yesterday, President Trump released a $4.8 trillion budget proposal that would impose massive cuts to critical programs that children and families rely on every day.

The proposal calls for $200 billion in cuts to programs that combat childhood poverty like SNAP and TANF, eliminated 29 programs from the Department of Education — including specific funding that helps homeless (McKinney-Vento Act) and low-income students (Title I), not to mention a $920 billion cut to Medicaid and CHIP which provide vital care that keep kids healthy.

“The budget is a moral document,” First Focus on Children president Bruce Lesley said in a statement yesterday. “Although we fully expect both Democrats and Republicans in Congress to reject these cuts as they have in the past, we are dismayed that the president places so little value on our nation’s children.”

The President’s budget — which Congressional leaders have already blasted as “devastating” and a “double-cross” — proposes a $1.5 trillion cut over 10 years to non-defense discretionary spending, which takes aim specifically at children. As we noted last year, 82% of all programs that benefit children fall into this category — from health to education to financial security to nutrition and others.

Last year, the President unsuccessfully tried to eliminate more than 40 children’s programs and make cuts to hundreds more. And while this budget proposal is once again unlikely to pass, it does speak to the Administration’s priorities. In recent weeks, we’ve seen efforts that put children in harm’s way by allowing states to arbitrarily cap Medicaid, unfairly target the children of immigrants, place undue burdens on the families of children with disabilities, not to mention a two-day hearing on a multitude of policies — on child poverty, housing, hunger, and health — being pursued by this Administration that would threaten children.

As Bruce Lesley noted in our annual Children’s Budget report last year, “Children are often an afterthought among federal policymakers in this process. Time and time again, children’s policy issues are ignored or neglected by Congress.” Our report found that the share of federal spending dedicated to children would have been just 6.45% if President Trump’s budget was enacted completely in FY20 — a $20 billion cut since FY 2015. And, for the first time in U.S. history, we are spending more to service the national debt than we are on the children who will inherit it.

If a budget documents our values and priorities — what does this year’s budget say about how we value children?