Giving a Hand Up with a Hand Out: Part 2
(Christopher Smith/The New York Times)
In the first article of this two-part series centered around child poverty, I suggested policies focused on no-strings attached cash and updating food assistance. Here in the second installment, there will be a focus on policies providing housing vouchers and health insurance consistently and broadly.
Introduction
The U.S. has one of the highest child poverty rates in the developed world, and children have the highest poverty rate among any age group in America. Our country is more than wealthy enough to resolve this issue — the continued existence of child poverty is a policy choice. How does a country that prides itself on its exceptionalism, reckon with the fact that so many of its youth sleep hungry or on the street?
Current programs for housing and health insurance suffer from exclusion and complicated rules. By expanding and reforming current programs, the United States can make monumental reductions in child poverty. The cost of child poverty is estimated at around $1 trillion a year. It is both unsustainable and a moral failure that a child, through no control of their own, lives a life constrained by hardship.
Stable Housing
Nearly a fifth of all homeless people in the United States are under the age of 18. In 2019, prior to the Covid-19 pandemic, 8 million children lived in “extremely cost burdened” households that paid over half of their monthly income in rent. These households are at higher risk of homelessness: all it takes is one unexpected bill for a family to be living on the street. The consequences of this are far-reaching. Housing insecurity has been widely documented as increasing the likelihood of mental health issues, substance abuse, and various other detrimental outcomes.
A Solution — Expand Housing Choice Vouchers
One of the most immediate and substantial actions that Congress should take: make Housing Choice Vouchers (HCVs) available to all who qualify. Currently, these housing vouchers are limited by the amount of funding apportioned, leaving out 70% of eligible low-income Americans. This is a critical shortcoming considering HCVs are the primary source of aid for households to pay for rent. The limited existing support from HCVs have already lifted nearly nearly a million children out of poverty.
A study from Columbia University finds expanding housing vouchers to be universal — meaning available to anyone who qualifies — would lift 9.3 million out of poverty. Over a third of them would be children (3.4 million).
In addition to poverty reduction, recipients of HCV have lower instances of food insecurity, child separations, and a lower likelihood of becoming single parents. Children in these households also have higher college attendance rates and incomes later in life. Most notably, housing vouchers drastically reduce homlessness and overcrowding in homes. It is essential to ensure housing security for children's development, and we have a moral responsibility as a society to prevent a child from experiencing homelessness.
Ensuring Health Insurance for Kids
The uninsurance rate of children has continued to increase, with over 4 million now without coverage. This is in part due to regulatory barriers that make it difficult to re-enroll in Medicaid and CHIP (Children’s Health Insurance Program). These programs combined cover nearly half of all children in America. Consequently, we must pursue the policy prescriptions that have been proven to cover uninsured children.
Eligibility Issues
Of the 4 million that are uninsured, 2.3 million are eligible for Medicaid or CHIP, but not enrolled. This is because these programs target the lowest income groups, excluding Americans with slightly higher incomes who still cannot afford insurance.
Many states have refused to expand Medicaid and CHIP in accordance with the broader income ranges created by the Affordable Care Act (ACA). Over half of our country’s uninsured children are concentrated in these very states.
By expanding Medicaid and CHIP to higher income thresholds set by the ACA, we can drastically increase insurance coverage. This would allow more parents and children to have access to basic medical care by closing the insurance gap.
Infant Healthcare
In addition to expanding coverage, we must work to provide healthcare from the earliest stages. Newborns should not leave the hospital uninsured. Oklahoma, for instance, enrolls newborns in Medicaid right at the hospital. This simple program should also include the mothers, and their coverage should be effective immediately.
Regulations and Renewal Processes
Regulatory and renewal processes should be as limited as possible so that newborns and young children do not mistakenly lose coverage. For instance, over 40% of babies eligible for Medicaid lose insurance on their first birthday because of failure to renew the coverage. For mothers on Medicaid, over half experience a loss of coverage soon after delivery.
Additionally, low and middle income families experience high volatility in their income. This can often disenroll them from Medicaid or CHIP if they surpass a certain threshold — even though they cannot afford private insurance.
Kelly Whitener, an Associate Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, explained to me, “...continuous enrollment [in health insurance] allows for fluctuations in income...for families — especially when you think about working hourly jobs where you have more shifts one week than another.”
In states without continuous enrollment, Professor Whitener describes, “...families four, five, six times a year where they have to reassert their eligibility showing paystubs...and it gets more complicated when you get a notice in the mail…[and a family] has 10 days to respond, which is a very tight turnaround.”
In order to ensure optimal child development, the solution is for states to provide continuous coverage for at least twelve months to reduce coverage gaps. But when the time comes to re-enroll, the process should be made as simple as possible. Policies such as Express Lane Eligibility (ELE) would allow Medicaid agencies to use eligibility for other public programs such as SNAP, to renew the child’s enrollment. Over 89% of children on SNAP are also on Medicaid, meaning children can be re-enrolled simultaneously for multiple programs quickly and seamlessly.
Gaps in coverage can be harmful to young children who require many doctor visits early on to ensure they are developing properly. With consistent access to insurance, families report fewer difficulties accessing care, less hospital visits, and better management of conditions that require prescriptions.
A recent paper finds that “...childhood Medicaid eligibility reduces mortality and disability, increases employment…” while saving money and lives in the long-run when these children become healthy working adults non-dependent on government assistance.
Much of children’s healthcare entails preventative measures (vaccines, check-ups, etc.) to avoid future treatments, which in the long-run, become particularly cost-effective. Preventing children from losing coverage when they would not otherwise, requires simple changes to how the current system operates, with the benefit of having a more healthy youth.
Conclusion
Poverty is not only a moral concern: it is expensive. Additional healthcare costs because of poor nutrition, higher crime, and less productive adults, not only hurt those in poverty, but society as whole. To address poverty among children, we must start at the core of the problem. We must provide cash to provide flexibility to cover the variety of expenses. Food assistance for adequate nutrition. Housing to provide stability, safety, and security. Health insurance for mundane, everyday care, and as a potential safeguard against financial ruin in case of an emergency. Together, these create a safety net that is practical and pragmatic. We must build around universal values of health and happiness to create a society that cares for its youngest, because its future relies on them.