Dr. DreyerOver the years, Washington has (justifiably) gained a reputation for being mired in partisan gridlock. In 2015, however, old-fashioned bipartisan negotiations in the 114th Congress led to compromise and important legislation that is really good for children.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the fiscal year 2016 omnibus appropriations and tax cut packages are major wins for kids — especially those from poor or low-income families.
Before elaborating on this legislation, I’d like to reflect on how vital government programs are to protecting children and enhancing their futures. Safety net programs that provide cash and in-kind financial aid reduce the extent and depth of poverty in families with children: The Supplemental Food Assistance Program (SNAP, aka food stamps); refundable tax credits (the Earned Income Tax Credit and the Child Tax Credit); and federal rent subsidies lifted almost 8 million children out of poverty in 2012.
Other nutrition programs like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and school lunches as well as Supplemental Security Income also are important. And federal housing assistance protects 4 million children from homelessness, frequent moves, crowded living and inadequate housing. Without programs like these, 30% of children would have been counted as poor in 2012; with these programs, the number of children counted as poor dropped to 18%.
Perhaps even more important, growing scientific evidence shows these government programs improve newborn, child and adolescent health; school achievement; high school graduation rates and college completion — and even lead to higher earnings as adults. These impressive long-term benefits literally change the life trajectories of many children.
As pediatricians, we know firsthand how important public health insurance like Medicaid and the Children’s Health Insurance Program (CHIP) are for children and pediatricians. Almost 40% of all U.S. children are enrolled in these programs. Because of CHIP and expansions in Medicaid coverage, only 6% of U.S. children are uninsured today — the lowest rate we’ve ever had in this country. The impact on poor children has been even more dramatic. In 1990, over 30% of poor children were uninsured, but today that number is down to 6%.
Programs like CHIP are important to children because their benefits match children’s needs, and low out-of-pocket expenses mean parents can afford to access the health care their children require. These programs also substantially reduce financial burdens of families — especially those with children who have chronic illness — leading to lower rates of poverty in low-income families. Receipt of public health insurance also influences children’s long-term health and economic outcomes as they grow to be adults.
Which brings us back to 2015 legislation. MACRA was a major victory. It ensures two more years of funding for CHIP, increases federal matching for the CHIP block grant by 23% and includes $20 million in pediatric quality improvement funding as well as funding for home visiting programs and community health centers.
The 2016 appropriations and tax packages also were wonderful wins. Among the provisions that will help children are:
- funding WIC at levels consistent with estimates of present need;
- making permanent the improvements and increases in the Earned Income Tax Credit and the Child Tax Credit put into place by the American Recovery and Reinvestment Act of 2009, which lifted so many children out of poverty;
- increasing funding for Head Start, child care, special education, preschool and K-12 education, family planning and National Institutes of Health research, and
- maintaining funding for SNAP, Pell Grants for college education and the Low Income Home Energy Assistance Program.
Your membership in our Academy, the AAP Department of Federal Affairs and your personal advocacy made this happen for children!
Of course, more work is needed to decrease child poverty, help immigrants and those deep in poverty, and protect all children from the danger of gun violence. But let’s take a deep breath and be thankful that government actually worked last year — and worked very much in favor of children. And let’s celebrate the important role pediatricians and your AAP played in making this happen. Kudos to all!