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Maternal and Infant Mortality: What Does the Data Tell Us and What Can We Do?

| November 18, 2019 |

The United States has some of the highest maternal and infant mortality rates in the developed world and they continue to rise.

African-American women are at especially high risk and are three times more likely to die from maternal health issues than their white counterparts. African-American babies are more than twice as likely as white babies to die within their first year of life, and American Indian and Alaskan Native babies are nearly twice as likely.  

Four experts in maternal and infant mortality outlined this crisis for members of Congress and their staff during a standing-room-only briefing on November 19 on Capitol Hill. Reps. Alma S. Adams, Ph.D, (D-NC) and Lauren Underwood (D-IL), co-chairs of the Black Maternal Health Caucus, hosted the event along with First Focus on Children and the March of Dimes.

Our four expert speakers discussed the role of structural racism in the racial disparities in maternal and infant mortality rates; trends at the national and state levels; the importance of federal health care coverage policies in combating maternal and infant mortality; and steps that are being taken in states such as Illinois and Texas to improve care and outcomes for women and babies. 

Panelists included:

Below are some of the materials shared at the briefing:

A recording of the briefing and all slides can be found below:

Maternal and Infant Mortality: What Does the Data Tell Us and What Can We Do?

Congressional Briefing Live from Capitol Hill — Maternal and Infant Mortality: What Does the Data Tell Us and What Can We Do?

Posted by First Focus on Children on Tuesday, November 19, 2019

New principles for child care define vision for high-quality, affordable care

| October 10, 2019 |

Child care is one of the greatest multi-taskers that exists – it simultaneously provides both early care and education for our youngest citizens, enables parents to work and attend school, provides an economic driver for business that ensures a stable workforce, and employs more than one million workers. Each of us, whether we have children or not, has a stake in the success of child care in this country. First Focus on Children is proud to be a co-signer of Principles for Child Care: A Vision for Investing in High-Quality, Affordable Child Care. Signed by more than 25 advocacy organizations, this document lays out the core principles any comprehensive child care proposal must have. Combining high-quality, access, affordability, and a well-supported workforce will improve our child care system to provide the care, education and economic stability we need for the success of our children and the national economy.

Our current child care system has many challenges and areas for improvement:

Most American families cannot afford child care. For one infant, a two-income household spends more than 10.6 percent of its income on child care. A single-parent household spends 37 percent of its income on child care. The cost of child care for two children exceeds mortgage costs for homeowners in 35 states and the District of Columbia. And child care fees for two children in a child care center exceeds annual median rent payments in each and every state[1].

Insufficient child care hurts our economy. The annual cost of lost productivity, earnings and revenue to our economy due to child care problems tops $57 billion[2].

Our early childhood professionals are grossly underpaid. In 2017, child care workers earned less than two-thirds of the median wage for all occupations in their states[3]. Child care workers in 21 states and Washington, D.C. would have to spend more than half of their income to pay for center-based care for their own infants. Forty-six percent of early childhood professionals rely on one or more public support programs annually[4].

And yet, our youngest children’s brains are making more neural connections than at any other time in their lives, making it a critical time for learning and development. The settings that our children spend their days in matter for improved outcomes in health, well-being, education, economic stability and reduced involvement in the criminal justice system[5]. We must do better for our children, their families, the professionals who care for them every day and our economy.

As outlined in these Principles for Child Care, First Focus on Children believes that all children should receive high-quality child care; that families should be able to access the high-quality child care setting that best meets their needs; should get the financial support they need to afford high-quality child care; and that early childhood professionals in all settings should receive the support, resource, and compensation they need to provide high-quality care and to support their own families.

This is an investment that is worth making and that we must make.


[1]The U.S. and the High Cost of Child Care,”Childcare Aware, 2018

[2]Want to grow the economy? Fix the child care crisis,” Ready Nation, 2019

[3]Early Childhood Workforce Index, 2018,” Center for the Study of Child Care Employment

[4]Child care workers aren’t paid enough to make ends meet,” Economic Policy Institute, November 2015

[5]Research Summary: The Lifecycle Benefits of an Influential Early Childhood Program,” Heckman.


Tennessee Proposes to Block Grant Medicaid and Ration Care for its Children

| September 25, 2019 |

When it comes to making public policy related to children, the vast majority of Americans support the notion that public policy and government should act in the “best interest of the child” or, at the very least, “do no harm” to children.

Unfortunately, far too often, children are either an afterthought or worse. In the case of Tennessee Gov. Bill Lee’s proposal to convert Medicaid into a block grant or per capita capped program, it is disturbing — but sadly not surprising — that children are actually targeted and disproportionately placed in harm’s way.

A Medicaid block grant or per capita cap is simply an arbitrary financial limit that a state would receive from the federal government to provide health care. According to a recent analysis of the potential impact of recent proposals to cap Medicaid, Avalere Health estimates for a potential loss of federal funding to states, specifically for children, of $93 to $163 billion for FY 2020–2029 nationally. As Avalere explains:

A reduction in federal Medicaid funding would require states to reduce spending in Medicaid or in other areas of their budget. In particular, states may reduce eligibility for coverage, limit access to covered benefits or services, increase beneficiary cost sharing or decrease payment for care. . .

The Tennessee concept paper to radically, and likely illegally, (more on that later) transform the Medicaid program by Gov. Lee’s administration would likely seek a waiver from the Medicaid law from the U.S. Department of Health and Human Services (HHS) later this fall after three public hearings between October 1–3 in Nashville, Knoxville and Jackson, respectively.

Arbitrarily capping the Medicaid program, whether block grants or per capita caps, has been shown to create enormous shortfalls in funding to provide health coverage to low-income senior citizens, people with disabilities, children and adults that receive health coverage. In a review of legislative proposals to impose Medicaid per capita caps in Congress and to address likely significant shortfalls in funding, the Congressional Budget Office (CBO) wrote:

. . .enrollees could face more significant effects if a state reduced providers’ payment rates or payments to managed care plans, cut covered services, or curtailed eligibility — either in keeping with current law or to a greater extent, if given the flexibility. If states reduced payment rates, fewer providers might be willing to accept Medicaid patients, especially given that, in many cases, Medicaid’s rates are already significantly below those of Medicare or private insurance for some of the same services. If states reduced payments to Medicaid managed care plans, some plans might shrink their provider networks, curtail quality assurance, or drop out of the program altogether. If states reduced covered services, some enrollees might decide either to pay out of pocket or to forgo those services entirely. And if states narrowed their categories of eligibility (including the optional expansion under the ACA), some of those enrollees would lose access to Medicaid coverage. . . .

This proposal comes at a time when the nation’s uninsured rate is heading in the wrong direction. According to the U.S. Census Bureau, the uninsured rate across the country increased from 25.6 million to 27.5 million between 2017 to 2018 or from 7.9 to 8.5 percent.

For children, the Census Bureau finds that the uninsured rate rose from 5.0 to 5.5 percent from 2017 to 2018, which represents an 11 percent increase, and that the overall number of uninsured children rose by 425,000 to 4.3 million.

We should not be heading backward. Every person in this country should have access to high-quality health insurance coverage. Instead of setting arbitrary caps and putting in place the bureaucracy to enforce cuts and limits to care, we should be looking for ways to increase the number of insured Americans, including children, and improving access to health care.

Even worse, Tennessee is proposing to disproportionately threaten the health of children. As Figure 2 in the concept paper shows, children would represent a vast majority of those placed in harm’s way by Gov. Lee’s unique hybrid of a Medicaid block grant and per capita cap (i.e., the 62 percent of children in this chart and another percentage share of people with disabilities subjected to the caps).

Arbitrary Medicaid caps or limits are particularly threatening for children with special health care needs, including infants, kids with cancer, asthma, heart conditions, and children in foster care, because the cost of their care and coverage would, by definition, exceed the average per capita limit included in the proposal for the federal share.

To meet the arbitrary caps, Tennessee and its Medicaid managed care plans would have an incentive to impose bureaucratic barriers to care, paperwork denials, limits and other forms of rationing for Tennessee’s vulnerable and fragile children.

This is particularly disturbing because Tennessee has already demonstrated a desire and ability to use such mechanisms to limit care and services to children. Just a few months ago, a study by the Tennessean found that the state had used a number of mechanisms to limit and ration coverage for its children over the past few years. The investigative report explains:

At least 220,000 Tennessee children were cut, or were slated to be cut, from state health insurance in recent years in an unwieldy TennCare system that was dependent on hard-copy forms and postal mail. . . The majority of these kids likely lost their coverage because of late, incomplete or unreturned eligibility forms.

In an analysis titled The Return of Churn: State Paperwork Barriers Caused More than 1.5 Million People to Lose Their Medicaid Coverage in 2018, Families USA’sEliot Fishman and Emmet Ruff found:

In 2016, [Tennessee] began making manual eligibility redeterminations after still not having an online system to do so. Because redeterminations could not be processed online, the state mailed a 98-page renewal packet to beneficiaries to renew their eligibility. The Tennessee Justice Center, an advocacy organization that has helped Tennesseans and their families to renew their TennCare eligibility, reports that in many cases the state mailed renewal packets to the wrong addresses, and as a result, beneficiaries lost coverage for failing to return renewal packets that they never received. In other cases, the state never processed beneficiaries’ renewal packets despite receiving them (as documented by beneficiaries’ proof of receipt).

Also contrary to federal law, the state failed to screen children for eligibility under other Medicaid categories before disenrolling them, resulting in children losing coverage despite qualifying under another category. Additionally, because the state did not apply the same eligibility information to all members of the same family, parents and caregivers were required to submit separate packets for each of their children, and the state made separate eligibility determinations for each member of a family.

None of this is about striving to improve the health of children and families. At a budget hearing earlier this year, Tennessee State Sen. Jeff Yarbro pushed agency officials about how Tennessee had the highest decline in covered children across the country in 2018. Sen. Yarbro said:

This is utterly broken to the point of where it appears to be more by design than accident. You have to conclude that this is a management decision to trim the rolls or at least let them shrink by relying on people either not receiving, or not completing, the gargantuan applications.

Tennessee was rationing care to children through bureaucratic red tape.

Tennessee’s Proposed Arbitrary Medicaid Cap Targets Kids

Although Tennessee has finally revamped its eligibility process this year, it is disturbing that the state is creating new barriers to the health of children by proposing the vast majority of those that would be subjected to the newly proposed Medicaid caps would be kids [MK1] (Figure 2 above).

Under current law, the federal government and states have a shared partnership (65.21 percent federal and 34.79 percent state)to cover any increase in Medicaid’s costs due to either enrollment or inflation.

This would no longer be the case if Tennessee’s proposed Medicaid cap were approved. According to the proposal:

. . .the financing of Tennessee’s Medicaid program will no longer operate under the traditional Medicaid financing model. Instead of drawing down federal dollars based on a fixed percentage, the federal government will provide a block grant of federal funds to the state for the operation of its Medicaid program.

In short, federal funding would no longer be guaranteed to cover its full share of costs under the program.

Recognizing the potential for significant harm, the Governor specifically exempts most senior citizens (“expenditures on behalf of individuals who are enrolled in Medicare”), outpatient prescription drugs, and Tennessee’s own administrative expenses from the caps in his proposal. In other words, the health of children would be put at grave risk but not administrative costs and bureaucracy.

Consequently, under the draft proposal, federal funding would be allocated to the state in the first year in the form of a block grant and future federal contributions would be limited in the form of per capita payments above a base block grant amount.

According to the concept paper:

Once calculated, the block grant amount will be trended forward from 2018 to the first year of the demonstration using an inflation factor based on CBO projections for growth in Medicaid spending.

First, CBO is often way off in its projections and inflation rates often vary wildly from year-to-year, depending on a number of factors. For example, in the case of natural disasters or some public health crises, Tennessee’s Medicaid would find itself shortchanged at the very moment when it is in need of additional federal support.

Much like the Tennessee proposal, U.S. Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana proposed a Medicaid cap that was supported by President Donald Trump in his FY 2020 budget submission to do much the same but at an inflation rate that would be below the expected medical inflation rate. According to an analysis by Avalere Health, the Graham-Cassidy language would have cut Medicaid payments to children by an astounding 31 percent over a 10-year period.

Tennessee Proposes to End Its Future Commitment to Its Citizens

Even worse than the federal caps, Gov. Lee’s radical proposal also would end Tennessee’s commitment to its share of health costs of citizens covered by Medicaid to what it spends in fiscal year (FY) 2019. According to the concept paper:

. . .the state commits to maintenance of effort with regard to the non-federal share of TennCare funding based on state expenditures on TennCare during state Fiscal Year 2019, trended forward each year the block grant is in effect.

Limiting the state Medicaid contribution to just what was spent in FY 2019 would create significant shortfalls over time. This is particularly true in cases where enrollment and costs increase due to demographic changes, economic downturns, natural disasters, a public health crisis, the discovery of a medical breakthrough or cure, or medical inflation.

The state’s proposal to no longer pay its share of the costs of its citizens in the future is the most disturbing aspect of the proposed Medicaid waiver. Although it is bad enough that the federal government’s commitment or share to the health care costs of those in Medicaid would be arbitrary capped, even worse, Tennessee would no longer cover a dime of any additional future expenses.

This quickly becomes a significant problem since Tennessee currently pays for more than one-third (34.79 percent in FY 2020) of the costs of Medicaid coverage. Under Gov. Lee’s proposal, it is difficult to see how Medicaid would cover newly enrolled infants, foster children, children with cancer, people with disabilities, or people who would need Medicaid coverage in the wake of an economic downturn or natural disaster.

To address the subsequent shortfall, Tennessee assumes federal officials would be willing to give the state “flexibility” to use their “block grant” to:

  • Withhold certain medical benefits, such as mental health, dental coverage, or new treatments (Tennessee is asking to waive amount, scope, and duration benefit requirements and to limit access to Food and Drug Administration approved prescription drugs under current Medicaid law);
  • Slash payment rates to hospitals, clinics, doctors, dentists, and pharmacies; and,
  • Cut children, pregnant women, people with disabilities, or low-income senior citizens off of coverage.

Despite the strange allure to some state officials of the word “flexibility,” block grants and per capita caps do not come with some sort of magic wand. “Flexibility” does not make children, senior citizens and people with disabilities mysteriously less expensive to cover without significant cuts to benefits, services or provider payment rates.

This is one of many reasons Medicaid block grants are such terrible public policy.

Tennessee’s Proposal is Likely Not Legal

Tennessee’s proposal to cap both the federal and state payments in Medicaid would likely be found to be illegal if challenged in the courts. According to a Health Affairs analysis by Rachel Sachs and Nicole Huberfeld entitled “The Problematic Law and Policy of Medicaid Block Grants,” Medicaid law allows Section 1115 demonstration waivers “to allow states to experiment with certain aspects of the Medicaid program to improve beneficiary coverage or care.”

However, Tennessee’s waiver proposal does nothing to improve beneficiary coverage or care and it does nothing to further the intent and objectives of Medicaid law.

Moreover, as Sachs and Huberfeld explain:

Medicaid spells out federal payment within Section 1903, which states that the HHS secretary “shall pay to each State…the [federal match] of the total amount expended…as medical assistance under the State plan….” This language is not waivable under Section 1115, which explicitly permits waivers of Section 1902 but not Section 1903. (HHS can approve more spending than Section 1903 contemplates to match a state’s expansion of Medicaid coverage, but it cannot waive Section 1903.) As a result, HHS cannot cap the Medicaid funds it disburses to states, either per person or programmatically, because it must pay the federal match for the “total amount” of a state’s spending.

Nicholas Bagley confirms this point in a blog titled “Tennessee wants to block grant Medicaid. Is that legal?” for The Incidental Economist. He writes:

You can’t use section 1115 to waive section 1903. To the contrary, section 1903 is pointedly omitted from the list of statutory provisions that HHS is empowered to waive.

So you can’t use Medicaid waivers to change Medicaid’s financing structure. And that’s exactly what Tennessee is proposing to do.

Conclusion

Tennessee was once considered a national leader in health care policy. In 1994, Tennessee launched TennCare by using savings from the use of Medicaid managed care to expand health care coverage to the uninsured. Mandy Pelligrin of the nonpartisan Sycamore Institute explains, “This was considered the most expansive Medicaid eligibility in the country at the time.”

Unfortunately, rather than seeking innovative ways to expand and improve health coverage of its citizens, now Gov. Bill Lee and the Tennessee legislature are moving in the opposite direction and proposing an arbitrary cap on both the federal and state shares of Medicaid. This would lead to limits and the rationing of health care services for low-income children, some senior citizens, people with disabilities and adults.

Our elected officials should protect children rather than putting them in harm’s way. When it comes to policies that impact children, the “best interest of the child” should be the standard.

Unfortunately, placing arbitrary fiscal limits on the health of kids does nothing to improve their care. In fact, it threatens their health and well-being, and for that reason, should be soundly rejected.

Children deserve much better.


Census says: Tax credits, SNAP and other benefit programs work. So let’s make them stronger.

| September 20, 2019 |

The U.S. Census Bureau released annual data on child poverty in the United States on September 10 that shows benefit programs are particularly effective at reducing poverty for children.

The U.S. Census Bureau calculates the Supplemental Poverty Measure (SPM) as an alternate measure to the Official Poverty Measure. Unlike the Official Poverty Measure, which uses an income threshold solely based on the cost of food, the SPM incorporates the cost of food, clothing, shelter and utilities. It also adjusts for family size and geographic differences in housing costs. The SPM further considers cash income (including child support) and non-cash benefits, subtracts taxes (or adds tax credits), work expenses, out-of-pocket medical expenses, and child support paid to another household.

When taking all of these factors into account, the SPM rate for children in 2018 was 13.7 percent, compared to 16.2 percent when using the Official Poverty Measure. The nearly two-point drop in poverty illustrates that benefit programs are particularly effective for children and must not only be protected, but strengthened so they can reach many more children still living in poverty.

This year’s data shows that tax credits continue to be the strongest anti-poverty tool we have. Together, the Earned Income Tax Credit and the Child Tax Credit lifted 4.7 million children out of poverty in 2018.

The Supplemental Nutrition Assistance Program (SNAP) continued to be another powerful anti-poverty program for children in 2018. SNAP provides low-income households with monthly funds intended for grocery purchases, and while benefits under the program are modest (corresponding to roughly $1.40 per person per meal), they play a critical role in freeing up household resources and helping struggling families place food on the table. Given that more than 18 million children participate in SNAP—representing 44 percent of its beneficiaries—it is unsurprising that it kept almost 1.4 million children from falling into poverty last year. This data further underscores the importance of protecting children from proposed cuts to SNAP.

How Do These Programs Lift Children Out of Poverty?

A recent landmark study from the National Academy of Sciences, A Roadmap to Reducing Child Poverty, confirms that the negative outcomes associated with child poverty directly result from a lack of income.

Studies show that when parents and guardians receive cash assistance, they use it to provide resources for their children such as nutritious food, stable housing and educational supports that improve children’s healthy development. Increased income also relieves parental stress, giving them increased time and mental energy for their children.

More resources in a household in the short-term also improves children’s outcomes for the long-term. Studies show that children in households that received an increase in income through programs such as EITC or SNAP were healthier and earned more as adults, thereby helping to break the cycle of generational poverty.

A Roadmap to Reducing Child Poverty puts forward a set of policy and program options that, if implemented together, could cut our national child poverty rate in half within a decade.  Within these options, they find that establishing a $3,000 annual child allowance would have the biggest impact of any single policy in reducing child poverty, and by itself could cut deep child poverty (children in households with incomes below half of the poverty line) in half within a decade. It would also address racial and ethnic disparities by having the biggest impact in reducing poverty for Black and Hispanic children.

The bottom line is that money matters to reducing child poverty. We could do more to reduce child poverty by:

  1. Establishing a national child poverty target. Child poverty is a solvable problem if there is the political will to take action. Establishing a national child poverty target – similar to ones in the United KingdomCanada and New Zealand as well as here in the United States – would be the first step toward holding lawmakers accountable to making child poverty a priority and implementing solutions. Bicameral legislation introduced in past sessions of Congress established a target and we hope to see this legislation reintroduced soon.
  • Strengthening family tax credits. Currently 26 million children are unable to benefit from the full Child Tax Credit, and the 2017 tax law also widened income and racial disparities and neglected to expand the EITC and the Child and Dependent Care Tax Credit (CDCTC). Congress should alter that course and ensure that any legislation to extend tax breaks for businesses also include improvements for low-wage families with children. 
  • Creating a national child allowance – The American Family Act (S.690/H.R. 1560), the Working Families Tax Relief Act (S.1138/H.R. 3157), and the Economic Mobility Act (H.R, 3300) would establish child allowance programs.  If signed into law, these proposals would implement one of the most effective policy changes to reduce child poverty identified in the NASEM study and currently adopted by numerous industrialized nations, such as Canada, Australia and nearly every European country  — already proving the success of cash-transfer programs to struggling families and children.

For more recommendations on how to reduce child poverty in America, see First Focus Campaign for Children’s Proactive Kids Agenda for the 116th Congress and Children’s Budget 2019. For more information on the newly released Census data, see: Alarming 2018 Census Data Spurs New Call for National Poverty Targets.


Shortchanging Our Children Harms the Nation

| September 16, 2019 |

The future of any society, by definition, depends on its ability to boost the health and well-being of the next generation. When we devote the resources necessary to support families and improve the services and programs that help all children be healthy, get a good education, and contribute to our nation’s future success, we all benefit.

Instead, we are shortchanging and failing our children. The Washington Post’s Catherine Rampell refers to the current situation as a “War on Children” and the Post’s Petula Dvorak writes how, on issue after issue, the country is “failing its children.”

The Post’s Colby Itkowitz adds:

The mistreatment or disregard of American and foreign children at the hands of the United States is not a new problem. . . When issues from guns to immigration to health care to foreign affairs are viewed through the lens of how they affect children, it becomes clear the young are an afterthought when it comes to public policy.

This is underscored by what is happening to children in the federal budget. In the Children’s Budget 2019 report we released at the National Press Club last week, we found that the share of all federal spending dedicated to children dropped from 7.98 percent in fiscal year (FY) 2015 to 7.21 percent in FY 2019 — a 9.7 percent reduction over the period.

Even worse, President Trump’s proposed FY 2020 budget would cause the share of federal spending on children to drop to just 6.45 percent — a real cut of $20 billion. His budget submission would eliminate 44 separate children’s programs and make cuts to far more.

One might speculate that the president’s budget attempts to reduce the deficit, but it is important to highlight that children are disproportionately targeted for the cuts. As our report highlights, Trump’s budget targets children for 17 percent of the cuts in domestic discretionary spending.

Moreover, we can also be pretty certain that the President’s proposed cuts on the mandatory side on the budget would also look to target children with greater harm. For example, according to the President’s FY 2020 budget narrative, the Administration supports “enactment of legislation modeled after the Graham-Cassidy-Heller-Johnson bill proposed in September 2017.”

That proposal would have established a Medicaid per capita cap and subjected children to much lower inflation rates and much higher cuts on a per capita cap basis. In fact, according to analysis by Avalere Health, Medicaid spending on children would have been cut by 31 percent compared to less than 2 percent for senior citizens.

In Children’s Budget 2019, we also estimate that interest on the federal deficit began exceeding all federal spending on children combined this year.

Under current law, things will only get worse over the next decade. The Urban Institute’s Kids’ Share 2018 report projects that the downward trend will continue well into the future. As the author’s explain:

Children’s programs are projected to receive just 1 cent of every dollar of the projected increase in federal spending over the next decade, compared to 61cents for [the adult portion of] Social Security, Medicaid, and Medicaid, and 29 cents for interest on the debt.

These facts all point to a growing crisis for children and our nation’s future. Unless dramatic changes are made to the federal budget process, and we begin to prioritize children in our society:

1) Investments in children will be a rapidly declining share of all federal spending;

2) The burden of the fast growing federal debt will be passed on to our children by adults who have favored cutting taxes and increasing defense spending over investment in children and reducing the federal deficit;

3) The rapidly growing share of Medicare and Social Security costs due to the retirement of Baby Boomers will be assumed by the next generation;

4) At some point, fiscal austerity measures will fall disproportionately upon our children and their children.

Economist Eugene Steuerle believes that the budget crisis is already upon us. In a Washington Post Op-Ed, Steuerle writes:

The costs are being incurred now; they’re not waiting for some fiscal blowup. The evidence is abundant: Education spending and other federal investments in children, as a share of gross domestic product, will fall by about one-eighth in about a decade. Programs that might promote economic mobility and opportunity for everyone make up an ever-smaller portion of the federal budget. Support for working families declines. College students get stuck with huge debts. Anyone visiting from abroad finds our airports and other transportation infrastructure second-rate. . . . These stories all relate to the decline of fiscal democracy.

In other words, even if Congress finds political will to make much needed investments in children, doing so will be difficult because the federal budget process is heavily stacked against kids.

A recent Committee for a Responsible Federal Budget (CRFB) report, Budgeting for the Next Generation: Does the Budget Process Prioritize Children?, finds that the budget process systemically disadvantages and shortchanges our nation’s children.

CRFB’s analysis concludes:

  • While much of spending on adults is mandatory, spending on children is disproportionately discretionary and thus must be reviewed and renewed with other appropriations.
  • Spending on children is disproportionately temporary, and it requires far more regular reauthorization and appropriation than programs for adults.
  • Spending on adults is rarely limited while spending on children is often capped, constraining what can be spent for most major children’s programs.
  • Most programs for children lack built-in growth, leading spending on children to erode relative to spending on adults and relative to the economy.
  • Programs for children lack dedicated revenue and thus lack the political advantage and protection of programs for seniors that enjoy this benefit.
  • Growing spending on adults is burdening younger generations by driving up debt and thus reducing future income and increasing costs.

As CRFB explains, “These features of the current budget process are increasingly leading spending on children to be crowded out, as the burden we place on children rises.”

Advocates seeking increased investments in children face serious political and structural barriers. As Children’s Budget 2019 and the reports by the Urban Institute and CRFB illustrate, children are not faring well — not at all.

However, according to a study entitled “A Unified Welfare Analysis of Government Policies” by Nathaniel Hendren and Ben Sprung-Keyser and published by Harvard’s Opportunity Insights, found:

  • Direct investments in the health and education of low-income children have historically yielded the highest returns.
  • Opportunities for high-return investments have persisted throughout childhood.
  • Many direct investments in low-income children’s health and education have paid for themselves.

Hendren concludes:

The policies that have historically invested in kids tend to be the ones that have the biggest bang for the buck. Because, oftentimes when you put in a dollar when a kid is young, it can have impact that then pays us back when those kids grow up.

Money matters. As Connecticut Rep. Rosa DeLauro (D-CT) points out:

The targeted investments and interventions we make now will make a lifetime of difference for the children they reach.

In an effort to achieve better investments and outcomes for children, more than 80 organizations have come together across all policy areas to form the Children’s Budget Coalition. Through this Coalition, child advocates have committed to work together to raise attention as to how the federal budget is shortchanging our children, both overall and within individual programs.

First Focus Campaign for Children, Save the Children Action Network, and other partners are also supportive of S. 1780, the “Focus on Children Act,” by Sen. Kamala Harris (D-CA) and S. 1776, the “Children’s Budget Act,” by Sen. Bob Menendez (D-NJ).

These two bills would direct the Congressional Budget Office (CBO) and the Office of Management and Budget (OMB), respectively, to provide reports to Congress on spending levels related to annual appropriations bills and the President’s budget with respect to spending on children.

The status quo of shortchanging our children is unacceptable. It leaves children worse off in both the short- and long-term. We can and must do better by our children, who are the future of our country.


We Know We Can Cut Child Poverty in Half, So Why Aren’t We?

| September 10, 2019 |

Today, the U.S. Census Bureau released its annual national data on poverty in America and it paints the picture that we know all too well: Our child poverty rate remains stubbornly high despite the fact that we have the solutions to address it.

The Numbers

According to the Census Bureau’s Official Poverty Measure (OPM), 16.2 percent of children (11.9 million) were living in poverty in 2018.  (The official poverty line for a family of four with two children is $25,465 a year.)

The new figure represents a 1.2 percent decrease from 2017.  While we are encouraged to see this small decrease in the child poverty rate, we know that children still have a 54.4 percent higher chance of living in poverty than adults and that the United States continues to have a significantly higher rate of child poverty than most of our peer countries.

And due to the continual racism and discrimination ingrained in our country’s institutions, children of color continue to experience rates of poverty three times that of white children.  29.5 percent of Black children and 23.7 percent of Hispanic children were living in poverty in 2018 compared to 8.9 percent of white children.

The figures also show a modest decrease in children living in deep poverty, with 6.9 percent of children living in deep poverty in 2018 ($12,732 a year for a family of four with two children).  This number remains particularly worrisome, since households living in deep poverty lack the income to meet their children’s basic needs. 

Despite the vulnerability of children living in households of deep poverty, they often lack access to assistance. Many anti-poverty programs are contingent on a household having some income, yet families in deep poverty have little to no earnings due to barriers such as disability, substance abuse, mental health or other complex and persistent issues that prevent them from working full time or at all.

The good news is that we are making more progress than the OPM indicates. The Supplemental Poverty Measure, also released today, tells us that when we take anti-poverty programs such as the Earned Income Tax Credit (EITC), Child Tax Credit (CTC), the Supplemental Nutrition Assistance Program (SNAP), housing assistance and other programs into account (as well as other factors) the child poverty rate drops to 13.7 percent.

We Know How To End Child Poverty

However, no matter what measure you use to indicate child poverty in the United States, our rate remains high – an inexcusable trend considering that findings of a landmark study released earlier this year from the nonpartisan National Academy of Sciences show that we know how to make progress. A Roadmap to Reducing Child Povertyputs forward a set of policy and program changes that, if implemented, would cut our national child poverty rate in half within a decade. While the study committee finds that no single policy can cut our child poverty rate in half within a decade, establishing a $3,000 annual child allowance would have the biggest impact by far and would cut our deep child poverty rate in half within a decade. Structural improvements and funding increases to the EITC, SNAP and housing vouchers would also make a serious dent.

The study committee also finds that implementing these changes are cost-effective. Poverty costs our country upwards of $1 trillion a year due to reduced economic activity and output, yet cutting our child poverty rate in half within a decade would cost less than $110 billion a year.

Yet our country is going in the opposite direction. Today First Focus on Children released our annual Children’s Budget Book, which reports that the share of spending on children in the United States declined to an all-time low of just 7.21% in FY2019.

And recently, we have also seen a slew of harmful regulations from the Trump Administration that if implemented, would further increase our child poverty rate by restricting access to critical resources for millions of children.

For this reason, First Focus on Children, with our partners at the U.S. Child Poverty Action Group, launched the End Child Poverty campaign earlier this year and is calling upon the United States to establish a national target to cut our child poverty rate in half within a decade. Setting a target would provide advocates, the media and other stakeholders with a tool to hold our lawmakers accountable for reducing child poverty.  We have seen evidence of the effectiveness of targets in the United Kingdom, Canada and New Zealand as well as here in the United States. Bicameral legislation introduced in past sessions of Congress established a target and we hope to see this legislation reintroduced soon.

Please join us in this effort! You can start by participating in our upcoming Twitterstorm on Tuesday, September 24th at 2pm EST using the hashtag #EndChildPoverty. Please also attend our webinar on Wednesday, September 25th at 3pm EST. For additional details, sign-up for our listserv here and follow us on Twitter at @CPAG_USA.

For more information:

End Child Poverty Press Statement

Top Takeaways from A Roadmap to Reducing Child Poverty

Implementing a Roadmap to Reducing Child Poverty


New USDA Data shows that Children Cannot Afford to Lose SNAP Benefits

| September 5, 2019 |

The U.S. Department of Agriculture (USDA) released new data Sept. 4 showing a continued decline in food insecurity (uncertain access to enough healthy food.) Unfortunately, even with this progress, food insecurity continues to disproportionately impact households with children. In fact, as of 2018, 11.2 million children (nearly 1 in 7) lived in a household struggling to put food on the table.

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

If we truly want to eradicate childhood food insecurity, we must drastically strengthen the assistance programs that help children access the food they need to thrive. Unfortunately, rather than investing in the Supplemental Nutrition Assistance Program (SNAP), which serves as the first line of defense against child food insecurity, the Trump administration has taken actions to cut SNAP benefits and discourage vulnerable families from enrolling in the program. These measures include a proposed rule that would restrict state eligibility options for SNAP, causing 3.1 million individuals to lose their benefits — of whom 1.9 million are either living with children or are children themselves. Worse still, 500,000 impacted children would also lose access to free school meals. This “Categorical Eligibility” proposal comes on the heels of a separate proposed rule that sought to limit access to SNAP benefits for adults struggling to access employment, which would create harmful spillover effects for several groups of children and youth.

The Trump administration also recently issued a final rule that imposes sweeping changes on long-standing, bipartisan immigration policy by allowing government officials to consider the use of an applicant’s broad range of services — including SNAP — when determining eligibility for green cards and/or lawful admission to the United States. Individuals who are eligible for SNAP will now be punished for using those benefits, meaning parents and children will likely disenroll from the program in order to avoid a public charge determination.

The USDA’s food insecurity data serves as a stark reminder that our children cannot afford the Trump administration’s proposed cuts to SNAP. Congress must fight these proposals as well as take proactive steps to invest in complementary child nutrition programs so that more children can access the food they need to thrive.

Take Action: The Administration’s Proposed Rule for the Revision of Categorical Eligibility in the Supplemental Nutrition Assistance Program is open for comments until September 23rd. We encourage partner child advocacy organizations to submit comments by customizing our model comment template. Individuals may submit a personalized comment using Feeding America’s comment portal.


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

| August 16, 2019 |

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

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

Children are not exempt from the rule.

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

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

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

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

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

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

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

The impact will reach beyond the intended targets

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

The rule disproportionately affects family-based immigration.

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

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


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

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

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

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

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


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

| July 24, 2019 |

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

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

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

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

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

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

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

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


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

| July 23, 2019 |

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

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

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

See our full issue brief.