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Despite Strong Economy, Census Data Shows That Child Poverty Remains High

| September 13, 2018 |

Despite continual reports over steady growth and declining unemployment in our economy, yesterday the U.S. Census Bureau reported that 17.5 percent of children in the U.S. were living in poverty in 2017 (the official poverty line for a family of four with two children is $24,858).

We know that economic gains are not reaching low-income households with children. Recent data from the Urban Institute shows that 40 percent of non-elderly households had trouble meeting at least one basic need for food, healthcare, housing or utilities in 2017. This hardship increased for households with children, especially those headed by a single parent.

Our child poverty rate remains stubbornly high when compared with other industrialized countries, and children continue to experience the highest rates of poverty in the U.S. While children make up 22.7 percent of the U.S. population, they account for 32.3 percent of the population living in poverty.

Due to our country’s long history of structural racism and discrimination, children of color continue to experience poverty at nearly three times the rate of white children, and the 18 million children who live in a family with at least one immigrant parent face unique cultural and systemic barriers to obtaining economic security. Fear of deportation, family separation, and the threat of the expansion of the public charge rule drives immigrant children and families away from accessing critical benefits.

Yet the good news is that the U.S. Census Bureau data also tells us that the child poverty rate would be much higher without effective anti-poverty programs such as refundable tax credits and the Supplemental Nutrition Assistance Program (SNAP). Nearly 4.5 million children were lifted out of poverty by refundable tax credits alone in 2017 – the child poverty rate would be 39 percent higher without the Earned Income Tax Credit and Child Tax Credit.

This data confirms what we know to be true – increasing access to resources such as income supports, nutrition assistance, housing assistance, early childhood education, health care, and quality K-12 education reduces child poverty and promotes healthy development which has long-term positive benefits for a child’s life.

While reducing child poverty is not an easy task, we know that it is possible if there is political will.

The Child Poverty Reduction Act (S. 1630/H.R. 3381) would establish a national target to cut the child poverty rate in half within a decade and eliminate it within 20 years as well as mandate that the federal government create a national plan to meet these targets. A national target would provide a tool for advocates, the media, and the public to hold the government accountable for identifying and implementing effective interventions to reduce child poverty.

Be on the lookout for additional analysis of the 2017 Census poverty data from First Focus and the U.S. Child Poverty Action Group in the days to come.

Additional resources:

More Must Be Done to Address the Crisis of Maternal and Infant Mortality

| September 10, 2018 |


The United States continues to be plagued by the tragic effects of maternal and infant mortality, particularly among African-American women and children. According to recent data however, one state has shown that there are interventions that can work. Access to quality health care has shown to be a key component to helping women and children.

According to the UN Inter-agency Group for Child Mortality, the United States has made strides in reducing its infant mortality rate. Between 1996 and 2016, the infant mortality rate per 1,000 births, reduced from 7.7 percent to 5.6 percent, a 27 percent decrease. Unfortunately, 5.6 percent is still significantly high, and much more can, and should, be done.

According to recent reports, Louisiana, which has historically dealt with a difficult record in dealing with its maternal and infant mortality rate, has acted. Central Louisiana, commonly referred to as Region 6, faced challenges in tackling the infant mortality rate with children born with low birth weight, premature birth, or exposure to second hand smoke.

According to the Louisiana Department of Health, between 2013 and 2015, 16.6 percent of African-American infants were classified as being born at a low birth weight (during the same time period 10.7 percent of all infants in the state were born at a low birth weight). When officials in Region 6 decided to resolve the problem, they concluded that the communities most affected need more access to care.

Officials provided better education on contraception, and increased the involvement of the Nurse Family Partnership among other interventions. The investment paid off, within two years, the infant mortality rate in Region 6 was cut in half. The rate went down to 4.7 deaths per 1,000 live births in 2015, the lowest of the state’s nine public health regions.

Unfortunately, overall the number of American women who are dying from pregnancy complications compared to women in other nations, is still significantly higher. In fact only in the United States has the rate of women who die due to pregnancy related complications has been rising. In the 48 contiguous States and Washington D.C. the maternal mortality rate has increased from 18.8 percent in 2000 to 23.8 percent in 2014, and then to 26.6 percent in 2018.

While the Louisiana example of local intervention can be important to reducing the overall rate of infant and maternal mortality, more must be done, particularly in the African-American community. Structural racism continues to be a problem that must be addressed. African-American women are three to four times more likely to suffer fatal complications than white women. Between 2011 and 2014, the ratio among white women was 12.4 deaths per 100,000 live births and 40 deaths for black women, according to the Centers for Disease Control.

The United States can and should do more to help vulnerable women and infants. First Focus will continue to advocate on behalf of at-risk women and children to address this crisis.


Food Insecurity Data Underscores Importance of Farm Bill for Children

| September 5, 2018 |

New data from the US Department of Agriculture (USDA) shows that the nation’s children continue to experience food insecurity at higher rates than the general population. 12.5 million children—or 17 percent—lived in food insecure households in 2017, meaning they lacked consistent access to enough healthy food to lead productive lives. Just 11 percent of adults, on the other hand, experienced food insecurity in 2017.

Food insecurity takes a costly toll on children. Not only does it increase the likelihood of poor nutrition and hunger, it also impacts their health, school performance, and behavior. The harmful effects of child food insecurity can reverberate into adulthood.

The fact that one in six children are still food insecure should be a chief concern for the lawmakers currently serving on the Farm Bill conference committee. The Farm Bill authorizes the Supplemental Nutrition Assistance Program (SNAP), which is a critical tool for combatting food insecurity. SNAP provides low-income families with additional funds to spend exclusively on groceries. As of 2016, 19.2 million children relied on SNAP to help put food on the table at home. Many of these children also receive eligibility for free school meals thanks to their participation in the program. Unsurprisingly, research shows that SNAP participation is associated with reduced rates of food insecurity in children; we also know that SNAP keeps children from falling into poverty.

In many respects, SNAP is the first line of defense against food insecurity, even though benefits are often modest and do not always last through the entire month. The Farm Bill thus represents an important opportunity to strengthen SNAP—or, at the very least, protect it from harmful changes. The Conference Committee is tasked with reconciling two widely divergent nutrition titles. Unlike the Senate measure (S. 3042), the House farm bill (H.R. 2) would drastically harm SNAP by imposing burdensome work and documentation requirements on parents of school-aged children and changing eligibility standards. Child advocates are rightly opposed to these sweeping measures, which would result in an estimated 400,000 households losing SNAP and 265,000 children losing access to free school meals.

The Senate nutrition title, on the other hand, maintains access to SNAP for the many vulnerable families struggling to make ends meet. It makes improvements in program operations and makes it easier for elderly and disabled individuals to stay on the program, an especially helpful change given the skyrocketing number of children living with their grandparents due to the opioid crisis. Unsurprisingly, the overwhelming majority of the Senate voted in favor of those provisions.

With 12.5 million children still experiencing food insecurity, maintaining their access to SNAP is as important as ever. By rejecting the House nutrition title in favor of the Senate’s, Farm Bill conferees have the opportunity to do just that.

Reading the News is a Constant Reminder of Why We Need a National Children’s Commissioner

| August 24, 2018 |

I felt uneasy as I was doing my usual scroll through the daily news last week and read about child sexual abuse, child abuse in government facilities, and the failure of government agencies to accept responsibility for children in their care. However, my uneasiness did not stem from the fact this was happening, but that I was not even surprised by it any more.

Children are the nation’s most vulnerable population. With no proper representation in the government, they have a heightened chance to be subject to abuse, exploitation, and neglect. The rate of news coming out these days regarding the abuse of children is astonishing, and there is no end in sight as long as children remain underrepresented, shortchanged, and forgotten. Just look at last week, for example, when three major instances of abuse against children surfaced.

First, a grand jury in Pennsylvania issued an explosive report last Tuesday showing that hundreds of Bishops and leaders in the Roman Catholic Church of Pennsylvania perpetrated and covered up the sexual abuse of around 1,000 children over a period of 70 years. The scope of these abuses and the subsequent cover-ups are staggering, and the Roman Catholic Church was left free to run its own phony investigations and allow abusers to remain employed at the church. The lack of a proper investigation by both the church and outside officials allowed the church to prioritize its own self-image and the reputation of its establishment over the interests of abused and traumatized children. Worst of all, the disregard for the well-being of children under their care allowed the problem to fester until the cases were too old to prosecute, leaving countless children traumatized for life.

Also on Tuesday of last week, the Virginia Department of Juvenile Justice released a report regarding the alleged abuse of immigrant children at the Shenandoah Valley Juvenile Center. Governor Ralph Northam ordered this review in June after the Associated Press published accounts of children as young as 14 who said facility officials handcuffed, shackled and beat them. However, the investigation did not even look into those past abuses—investigators only inquired about the 22 children currently housed there. On top of this, the facility would not allow state investigators to interview the children without a staff member present and barred them from copying or making notes on case files, medical records, and other documents. The report confirms that the facility restrained immigrant children by strapping them to chairs and placing mesh bags over their heads, but, shockingly, concludes that this is not child abuse.

Lastly, the Senate Homeland Security and Government Affairs subcommittee on investigations continued their probe into the treatment and care of unaccompanied immigrant children in a report issued last Wednesday. The report states that the Department of Health and Human Services (HHS) has not taken proper responsibility for tracking unaccompanied children once they are out of government care and in the custody of sponsors. The Department of Homeland Security is responsible for processing unaccompanied children at the border, after which HHS is charged with housing them in shelters and screening adult sponsors to care for them as they await immigration court proceedings. However, once children are with sponsors, HHS does not take any measures to ensure their well-being besides a one-time phone call, which often goes unanswered. Thanks to this lack of follow-up, HHS could not account for nearly 1,500 children who left its custody this past year. This is worrisome given the 2015 finding that HHS released eight immigrant children into the custody of sponsors who forced the children to work twelve-hour days on a farm in horrible working conditions. It took an exhaustive committee investigation to even unearth these shortcomings, and, as of now, there has still been no noticeable improvement.

These examples of child abuse and neglect, as well as the lack of government oversight and action in response, seem shocking—and this is just one week’s worth of news. The true scope of the plight of children in our country is much larger, of which these stories are just a small sample. One thing is becoming clear: our country desperately needs a national Children’s Commissioner that advocates for and protects the well-being of children. When adults are tasked with conducting internal investigations, they almost always ignore what’s best for the children. These instances, along with many others, prove that adults can and do exploit the vulnerability of children to further their own image and interests. The only way to even the playing field for children is to install an independent Commissioner with an unbiased, vested interest in protecting children—something the federal government currently lacks.

The concept of a Children’s Commissioner is not new. More than 40 U.N. countries have created Commissioner positions or similar bodies since 1990. England, Ireland, and New Zealand are just a few examples of Children’s Commissioner making a difference for children in their country. In the U.S., Tennessee and Connecticut, among others, have established robust Commissions of their own on a state level. An independent Children’s Commissioner would have the power to investigate matters like the stories above, and the role’s exclusive focus on children would spur action far sooner with more impactful outcomes.

The United States should follow in the footsteps of other countries and states that have given kids the attention they deserve from the government and have established children’s commissioners to do just that.

Low-Income Children Need Access to Oral Health Care

| August 23, 2018 |

Many children face limited access to our nation’s health care system. On top of that, access to oral health care is even more scarce, particularly for low-income children.

This May, the Center for Medicare and Medicaid Services reported that tooth decay is one of the most prevalent chronic diseases in children, “despite the abundance of scientific evidence demonstrating that it can be prevented.”

It has been 11 years since Deamonte Driver passed away from preventable tooth decay when he was 12-year old. Why is it, then, that in the last 11 years we have not done much to reduce the effects of tooth decay for our most vulnerable children?

According to the American Academy of Pediatric Dentistry, 80 percent of all tooth decay, within the entire U.S. population, occurs in 20-25 percent of children, most of whom live in poor or low-income households. The U.S. Surgeon General estimated that nearly 5 million children need acute dental care, but public programs for children have not reached many of them. These children are more likely to live in low-income families and do not have resources to pay for oral health services.

The problem of inadequate oral health care for low-income kids has two roots: Medicaid and CHIP offer limited coverage for these health care services, and most dentists do not accept these types of insurance. The dental community and Congress need to ensure that all children have access to quality dental services.

Medicaid Work Requirements For Parents Will Harm Children

| August 22, 2018 |

This week, First Focus submitted comments to Health and Human Services Secretary Azar about the Medicaid waivers from Mississippi and Kentucky. Both states proposed adding work requirements to their adult Medicaid program, while Kentucky included premiums and a lockout period of up to six months. First Focus urged the secretary to reject both waiver proposals.

In Mississippi the waiver request is particularly punishing since Mississippi did not expand Medicaid to uninsured adults as allowed under the Affordable Care Act. The adults who receive Medicaid coverage in Mississippi live in extreme poverty and get by on $467/month for a family of three, under 27% of the Federal Poverty Level. The states’ own budget neutrality estimates project that around 5,000 parents will lose Medicaid coverage in the first year if this waiver is approved. In fact, the waiver is designed for that to happen; if a parent meets the 20 hour/week work requirement at a minimum wage job, they will make too much money, $580/month, disqualifying them for Medicaid. Literally, they are damned if they do and damned if they don’t.

In Kentucky the premiums for Medicaid and lockout periods associated with work requirement reporting will result in otherwise eligible adults and parents losing coverage. As in other states, we know that Medicaid losses for parents put their children’s coverage at risk. It’s well-proven that when parents lose their coverage, children’s coverage drops, even when those kids remain eligible for Medicaid or CHIP.

First Focus opposes work requirements for programs like Medicaid, SNAP, housing supports, and TANF. Actions to limit household access to health care and effective anti-poverty programs will result in a future generation of children whose physical, mental health, nutritional, and educational outcomes are weakened. Instead, we should build on what works and promote policies that ensure that every child has access to health care, proper nutrition, stable housing, and enough resources to support their healthy development.

TANF at 22

| August 22, 2018 |

This week marks the 22nd anniversary of the Temporary Assistance for Needy Families (TANF) program, the only federal program that provides cash assistance to families.

Cash assistance is critical to reducing child poverty and improving child well-being. Numerous studies show that when families receive an influx of money, it has positive effects for healthy child development, including academic achievement and educational attainment.

While the overwhelming majority of TANF recipients are children, the effectiveness of TANF in reducing child poverty has been diminishing over time. Just under 25 percent of all poor families with children receive cash assistance today.

Due to its nature as a fixed block grant, TANF is not able to be effective in responding during times of increased need and the block grant has fallen in value by over 30 percent due to inflation since 1996.

In addition, most TANF funds no longer actually go towards cash assistance. In fact, states overwhelmingly use TANF funds for a number of other priorities other than its original intent: reducing child poverty and getting families back to work. For the funds that are allocated towards cash assistance, monthly amounts are often not enough to lift children out of poverty, and states have placed harsh restrictions on these small amounts, such as strict work requirements and time-limits that severely limit access to these funds.

TANF is long overdue for reauthorization. Earlier this summer, the House Ways and Means Committee passed the Jobs and Opportunity with Benefits and Services (JOBS) for Success Act (H.R. 5861), which would reauthorize the program for five years and make some significant changes.

One change is the addition of child poverty reduction as an explicit goal of TANF. While this is a positive step in the right direction, the provisions included in the bill would not actually significantly strengthen TANF’s ability to reduce child poverty. The bill fails to provide an increase in funding for the block grant or improve upon the responsiveness of TANF during times of increased need. Without improvements to these aspects of the program, TANF’s ability to reduce child poverty remains limited.

Members of the Child Poverty Action Group, a partnership of organizations dedicated to reducing child poverty, urged the House Ways and Means Committee to strengthen TANF’s ability to reduce child poverty through establishing a national goal of cutting child poverty in half within a decade and eliminating it within 20 years. This would be a significant step towards holding federal, state, and local governments accountable to reducing child poverty in the U.S. through TANF and other programs.

In addition, the U.S. Child Poverty Action group recently released Our Kids, Our Future, a compendium of more than 20 policy papers with solutions to addressing child poverty in the U.S. Two of these papers provide recommendations for improving TANF through increasing funding, requiring states to spend funds on cash assistance and other core purposes, and more.

Reaching economic security is a long road for many families. While parents and caregivers are working towards upward mobility, we need to ensure that every family is provided with enough cash assistance to provide sufficient resources for children while their brains are undergoing critical stages of development.

For more information on TANF reform from the U.S. Child Poverty Action Group:

Children Living in Poverty Need TANF Reform

A Child Focused Approach to TANF Reform

Reducing Child Poverty Through Income Supports

New data from CDC reveals increasing rate of pregnant women with opioid use disorder

| August 16, 2018 |

According to the Centers for Disease Control and Prevention (CDC), the number of pregnant women with opioid use disorder (OUD) has more than quadrupled between 1999 and 2014. The data revealed this month from the CDC’s Morbidity and Mortality Weekly Report found that rates significantly increased in all of the 28 states that can provide 3 years of data.

It is important to note that the rate of OUD increase varies — for instance, in Maine, New Mexico, Vermont, and West Virginia, the rate exceeded 2.5 per 1,000 deliveries per year. In 2014 specifically, rates ranged from 0.7 in Washington, DC to 48.6 in Vermont.

This increasing trend, according to the CDC, may “represent actual increases in prevalence or improved screening and diagnosis”. The report clarified that diagnostic procedures differ by state, however “states with enhanced procedures for identifying infants with neonatal abstinence syndrome might ascertain more cases of maternal opioid use disorder.”

CDC Director Robert Redfield, argued “Untreated opioid use disorder during pregnancy can lead to heartbreaking results. Each case represents a mother, a child, and a family in need of continued treatment and support.”

According to the CDC’s 2016 Guideline for Prescribing Opioids for Chronic Pain:

  • States should enhance their prescription drug monitoring programs
  • Women should receive a substance use screening at their first prenatal visit
  • Women should receive access to addiction counseling services as well as medication-assisted therapy, and adequate patient-centered postpartum care that includes mental health and substance use treatment.

In 2016, the CDC expanded the Pregnancy Risk Assessment Monitoring System in a number of states to assess substance use before and during pregnancy.

First Focus is committed to advocating on behalf of pregnant women and children. The growing rate of pregnant women with OUD is an alarming trend. More states should enhance their prescription drug monitoring programs and improve screening.



How a new rule on short-term health care plans jeopardizes the health of children and families

| August 1, 2018 |

Remember the relief and happiness so many Americans felt when the Affordable Care Act (ACA) passed because finally their health insurance would cover their pre-existing conditions, like asthma and cerebral palsy and cancer? Covering pre-existing conditions became the norm, and many thought we could never go back to the way it was before, when insurance companies could decide what illnesses and parts of our bodies we could treat.

But today the Trump administration approved a rule allowing insurance companies to sell short-term plans beginning in October this year, before the ACA Marketplaces open for enrollments in November. Consumers may well be confused about this new option. Premiums for these plans will factor in age, gender, and health status. They will not include “essential benefits” that consumers receive under the ACA, such as mental health, prescription drug, and maternity coverage.

This rule will allow short-term plans to be sold for a year at a time and renewed up to 36 months, instead of just three months as it was before the ACA. Families could get locked into one of these plans for a long period of time and, upon facing a new and serious illness, face high deductibles and out of pocket costs.

The rule itself puts it pretty clearly:

“For example, short-term, limited-duration insurance is not subject to the requirement to provide essential health benefits and it is not subject to the prohibitions on preexisting condition exclusions or lifetime and annual dollar limits. It is also not subject to requirements regarding guaranteed availability and guaranteed renewability.”

And this is the “warning” consumers will see when they purchase one of these plans for a child or adult family member:

“This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage. Also, this coverage is not ‘minimum essential coverage.’”

Families need to read that warning carefully and fully understand what they are buying. Otherwise, they could be left in a very expensive and sad situation if their child gets sick and needs to see multiple specialist to diagnose a condition. They could go broke. Their child could miss out on services and treatments. There could be a delay in even getting an appropriate diagnosis if no provider takes the short-term plan. In essence, these plans are a recipe for disaster for families.

Though the vast majority of commenters to the proposed rule raised concerns about the plans, the rule was approved anyway. Now, the options to protect families will fall to state regulators, as Sarah Lueck at the Center on Budget and Policy Priorities explains in this blog post.

I hope families will tell their state insurance regulator, governor, and state legislatures to regulate or bar these plans.

Deadline Looms for Reuniting Separated Families

| July 25, 2018 |

While family reunification efforts due to the Trump administration’s family separation policy are underway, more than one thousand families still face significant hurdles to being reunited with their children.

In June, U.S. District Judge Dana Sabraw ordered that all children separated from their parents and are eligible for reunification should be reunited by Thursday, July 26.

Despite the urgency of the order, government agencies are struggling to reunite families in a timely manner.

As of Friday, July 20 there were approximately 1,900 children waiting reunification. While U.S. Immigration and Customs Enforcement (ICE) has cleared more than 1,000 parents for reunification with their children, their families face additional hurdles to reunification—one such barrier asks them to present documents to the Office of Refugee Resettlement (ORR) that were taken from them while they were in the custody of Customs and Border Patrol.

In many cases parents must also travel long distances to reach their child, and some parents were asked to pay for the transportation costs. The American Civil Liberties Union (ACLU) argued this is a concept that doesn’t make any sense for parents who were victims of this cruel practice. In agreement, Judge Sabraw ordered the Trump administration to pay for all costs of reuniting families. Additionally, documents related to the court-ordered reunifications show that the Trump administration stated that 463 parents are no longer in the U.S.

This is a nightmare scenario for children and families. While the administration states that these parents waived their rights to reunification, it is impossible to know under what circumstances these parents were given—or forced into—this choice. In one report, attorneys spoke with mothers who were told if they continued to fight for asylum they would continue to be detained and separated from their children. One mother stated that more than once an ICE agent pressured her by asking, “Don’t you want to see your daughter?” For families fleeing the Northern Triangle, it is cruel to expect them to choose between taking their children back to the dangerous conditions from which they escaped or giving up their right to ever see their children again.

The reunification of these families is only the beginning of another arduous journey, as more than 900 parents are facing deportation orders. Children and families who have been traumatized by the horrific practice of being forcibly separated will experience yet another traumatizing event.

The videos of children being reunited with their parents show a mix of emotions as they see each other for the first time in months. Parents are reportedly seeing significant changes in their child’s demeanor due to the trauma that was inflicted by the separation and prolonged detention. According to Dylan Gee, assistant professor of psychology at Yale University, traumatizing experiences that happen in early childhood have lasting effects. Forcibly separating a child from their parent produces toxic stress that will have profound psychological and neurobiological consequences.

First Focus will be monitoring this issue as the deadline closes–stay tuned for the latest policy and status updates.