Children in Peril: The Urgent Need for an Affirmative Agenda to Child Health
Our children are not alright.
For example, earlier this year, a report in JAMA found that pediatric mortality rates – largely driven by increases in child homicide and suicide rates – are rising.
Furthermore, infant mortality is on the rise for the first time in decades.
These disturbing and tragic consequences deserve greater attention, expressions of outrage, and a demand for a national response to improving child health coverage and access to care.
Instead, many of our nation’s policymakers are heading in the wrong direction.
First, states across the country have disenrolled over 3 million children from Medicaid in what is referred to as “unwinding,” which is the process of redetermining people’s eligibility for Medicaid after the COVID-19 public health emergency expired. If you are at all concerned about the health and well-being of children, this is catastrophic. While some level of reduction might be expected in an “unwinding” process, this level of decrease is outrageous and often in error.
As Bryce Covert writes in the New York Times:
One driver of the big losses is technical: States are required to use data they already have — from, say, a family’s food stamps application or wage information — to determine whether people are eligible. But as part of that process, 30 states and Washington, D.C., have examined eligibility only for the head of the household and then cut the entire family off, even though children are far more likely to be eligible than their parents.
To put this in perspective, our infants, children, and youth are dying at increasing rates, and somehow our national response by federal and state policymakers is to disenroll millions of children – the equivalent of filling every single seat in NRG Stadium, which is the site of Monday’s 2024 College Football Playoff National Championship, an astounding 42 times – from health care coverage.
Instead, we should be striving to cover all kids rather than increasing the uninsured rate among children.
We should also commit to protecting the health coverage of millions of children in the Children’s Health Insurance Program (CHIP) by making the program permanent by passing H.R. 4771, the Children’s Health Insurance Program Permanency (CHIPP) Act by Rep. Nancy Barragán (D-CA). This is critically important to protect the health coverage of millions of children who have repeatedly been subjected to the whims and threats of politicians, who have endangered CHIP’s survival far too many times in the past, including funding shortfalls and cliffs, outright expirations due to congressional inaction, two horrific vetoes of extension bills, intention and unintentional repeal votes in the House, and the unfortunate uses of CHIP as a “bargaining chip” for some unrelated political cause.
(As additional examples, see THIS from Dec. 2007, THIS from Mar. 2010, THIS from Mar. 2013, THIS from Sep. 2013, THIS from May 2014, THIS from Aug. 2014, THIS from Dec. 2014, THIS from Mar. 2015, THIS from Dec. 2017, THIS from May 2018, THIS from Jan. 2018, and THIS from Sept. 2018).
These threats to CHIP have all occurred despite overwhelming support for making CHIP permanent.
Source: Lake Research Partners poll, May 2022
And let’s be clear, politicians would never subject their own health insurance coverage or the health coverage of senior citizens on Medicare to such repeated threats and nor should they do it repeatedly to millions of children.
In addition to cutting and threatening to cut children off of health coverage, the House of Representatives is responding to the current crisis of rising death rates in infants and children by proposing significant cuts in funding to address the challenges of maternal child health, suicide prevention, gun safety, and child nutrition.
The bill eliminates funding for Healthy Start (which seeks to reduce infant mortality), the Teen Pregnancy Prevention program, Title X Family Planning, Tobacco Prevention and Control, and Firearm Prevention and Mortality Prevention Research. Moreover, the legislation cuts funding for the Maternal and Child Health (MCH) Block Grant. In the midst of rising maternal, infant, and child mortality rates in this country, we should be investing in these programs, not eliminating or cutting them.
Overall, the bill slashed $1.6 billion out of the Center for Disease Control and Prevention (CDC).
Furthermore, at a time of a mental health crisis and increases in substance abuse overdoses in children and youth, the bill cuts the Substance Abuse and Mental Health Services Administration (SAMHSA) by $234 million.
In a Speaking of Kids podcast released yesterday, we also talk to the National WIC Association’s Nell Manefee-Libey about the dangers posed to infants and pregnant women if Congress fails to fully fund WIC for the first time this century.
Again, we should be investing in our children, not eliminating, cutting, or shortchanging them.
And again, the American people strongly agree.
Source: Lake Research Partners poll, May 2022
In addition to higher child death rates and the loss of child health care coverage, children are also seeing declining vaccination rates due to what Dr. Rhea Boyd, Alexandra Quinn, and I referred to in a STAT article as a “dangerous combination of pandemic fatigue, waning health literacy, and the unmitigated spread of health misinformation and disinformation.”
Unless our nation’s leaders take action, we will see increasing numbers of outbreaks of preventable diseases like measles, mumps, and rubella in the near future. According to the CDC, the percentage of kindergartners whose parents opted them out of state-required childhood vaccinations rose to the highest level in years during the most recent school year.
Dr. Boyd, Quinn, and I explain:
A crisis is brewing that will disproportionately harm America’s children and follow them into adulthood. They are neither immune to nor invincible from preventable infectious diseases, and it is a travesty that we would allow the health and safety of children to be threatened by harms that are easily preventable.
It’s time for a coordinated effort across government, public health, and health care organizations to do more to support childhood vaccination. Ensuring access to vaccination, health care, and health information must be immediate and top priorities.
Unfortunately, rather than striving to cover all kids and ensure they are protected from preventable diseases like measles, mumps, and rubella, a number of states have expanded vaccine exemptions, which increases the likelihood of outbreaks of preventable diseases in children.
Compounding the problem, we now have several presidential candidates, including Ron DeSantis, Vivek Ramaswamy, Nikki Haley, and Robert Kennedy, Jr., pushing radical anti-vaccine claims or agendas that have undoubtedly contributed to declining vaccine rates among our nation’s children.
Once again, wrong direction.
Our nation’s children and the health care system are also being challenged by a pediatric mental health crisis that is caused by increasing need and reduced health system capacity. Our nation’s children’s hospitals are leading a campaign they call “Sound the Alarm for Kids” outlining the urgency needed to promote the well-being of our nation’s children. Moreover, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association have declared a National State of Emergency in Children’s Mental Health.
Such a campaign requires increasing children’s health coverage, access to care, and an expansion of health system infrastructure and workforce capacity and services. Unfortunately, rather than committing to the needs and challenges of children and health systems, too many politicians at the national and state levels are heading in the opposite direction.
Rather than supporting children at disproportionate risk, states are considering a raft of disturbing bills that, for example, target LGBTQ kids and their families (see Erin Reed’s chart and analysis).
And instead of supporting children’s hospitals, Rep. Dan Crenshaw (R-TX) has stalled the pediatric graduate medical education (GME) bill that provides funding to children’s hospitals across the country for the education, training, and research of the next generation of pediatricians. Rather than providing much-needed support and improvements to child health, Rep. Crenshaw has held up the bill with the purpose of prohibiting children’s hospitals from providing gender-affirming care to transgender youth.
As First Focus Campaign for Children points out:
…pediatric cancer remains a leading cause of death among children in this country. Therefore, we must continue to invest in the search for a cure for cancer, and that must include maintaining support for children’s hospitals graduate medical education programs. Moreover, this support is needed to continue progress on addressing a full array of diseases and conditions from which children suffer and that children’s hospitals have taken a leadership role. We must also confront crises, as they arise. For example, we are in the midst of a rise in pediatric mortality rates in this country and that is fueled in part by a growing children’s mental health crisis and gun violence. We should be supporting our children and the needs and concerns of kids and their families in these areas.
In order to do so, we urge the House Energy and Commerce Committee to focus on making progress with respect to: (1) children’s health coverage; (2) primary and preventive care; (3) medical research; (4) graduate medical education; and, (5) public health.
Specifically, in the case of transgender children, a large percentage of these kids have attempted suicide. Transgender kids need of support and care – not marginalization and attacks. And the pediatricians and children’s hospitals who are serving them and their needs should not be targeted for harm, as H.R. 3887 by Rep. Crenshaw does. Alarmingly, H.R. 3887 would seek to force children’s hospitals to deny transgender children affirming care with the threat of the loss of medical education dollars that are unrelated to that care. Consequently, we must strongly oppose the damaging policy that threatens the essential care children’s hospitals provide nationwide today and for generations to come.
Texas Attorney General Ken Paxton is also targeting transgender youth by demanding their health records from children’s hospitals – a violation of their privacy and care – as far away as Seattle.
These attacks are from political leaders in Texas, which leads the entire nation in the percentage of uninsured children. This exacerbates the fact that the Lone Star State has compounded the problem by recently disenrolling hundreds of thousands of children from Medicaid.
Source: Ben Sargent cartoon in the Texas Observer
The children of Texas face profound shortcomings in their child health, education, and child welfare systems and lead the nation in school shootings, and yet, their political leaders are spending the bulk of their time banning books, seeking to privatize public schools, and attacking LGBTQ youth. Consequently, Texas ranks a dismal 44th on measures of child well-being.
Source: Annie E. Casey Foundation, 2023 KIDS COUNT Data Book
Meanwhile, the “parental rights” movement has, at times, threatened the health, education, safety, and well-being of children.
Again, this is all about priorities and how, far too many, politicians are targeting children for harm rather than addressing their needs and well-being.
Therefore, we urge a profoundly different health care agenda for our nation’s children. Let’s demand that our political leaders adopt a child health agenda that:
Protects and expands children’s access to health care coverage;
Removes barriers and obstacles to health care coverage;
Makes CHIP permanent so the coverage of millions of children is no longer subjected to repeated threats of expiration;
Commits to addressing deficiencies in maternal child health and children’s mental health;
Provides timely access to quality, pediatric-focused care;
Strengthens the pediatric health care infrastructure and workforce so that all children have access to physical, oral, and mental health care services;
Improves the pediatric-focused capacity and services in our nation’s emergency rooms;
Protects the privacy, confidentiality, and agency of young people concerning their own health care; and,
Expands the Child Tax Credit to dramatically cut child poverty.
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If you are someone concerned about helping to ensure that children and their needs, concerns, and best interests are no longer ignored by policymakers, please join First Focus on Children as an “Ambassador for Children” or consider becoming a paid subscriber to help First Focus on Children and Texas Kids Can’t Wait continue our work on behalf of children.