As we face an election in a year unlike any other, we lack a national policy agenda that will improve the health and well-being of children and families, particularly those most in need.
The COVID-19 pandemic has magnified stark fault lines of inequities for children and families, brought on by years of declining public investment in the programs that support them.
Here are four pillars of a policy platform that we believe would meaningfully deliver for the nation’s children and families.
Policies that support working families
Child care is an essential service and a labor force issue. Inadequate access to child care costs families more than $8 billion in lost wages. Conversely, access to high-quality early-learning programs has been shown to improve long-term educational attainment and health. Yet, the child-care industry is in crisis, with the pandemic forcing many centers to close.
Child-care subsidies make this service more affordable, and parents who receive subsidies are more likely to work and stay employed. However, state child-care subsidy programs are woefully underfunded, and almost none meet federally recommended levels of payment, signaling a clear need for renewed commitments. Policymakers must also look to improve the quality of and expand access to high-quality options for child care, particularly for infants and toddlers. Only 43% of child-care capacity in Pennsylvania currently meets high-quality standards.
Paid leave is also essential to health equity and public health. In addition to the physical and mental-health benefits of paid maternity leave for women, families with access to paid sick leave are more likely to bring their children in for necessary medical care. It is critical that the absence of consistent paid leave policies undermines efforts to allow for safe school and child care reopening and functioning during the COVID-19 pandemic.
Investments in public education systems
Education is associated with better long-term health outcomes for children, well into adulthood. Moreover, schools provide critical student health, nutrition, and social services, playing an essential role made clearer with the recent shift to virtual learning.
Yet investments in public education have declined for years, particularly in larger, urban school districts. For example, the School District of Philadelphia spends half as much per student as neighboring affluent suburban districts. Across the country, support staff, nursing and counseling services have been gutted. This had already left us unprepared to meet the needs of children, and has now undermined the safe reopening of schools during the pandemic.
There are also issues of aging physical infrastructure — reflected in building disrepair, asbestos risk, lead in drinking water, and inadequate ventilation — which leave schools unable to meet guidance to mitigate COVID-19. Any national infrastructure effort must consider our aging public schools and include plans to update them to meet this and future challenges.
A behavioral health system that meets youths’ needs
The COVID-19 pandemic will have long-term repercussions for the mental health of children and teens, and layers on an already growing youth mental-health crisis. A recent Centers for Disease Control and Prevention (CDC) survey found that almost 1 in 4 young people (ages 18-24) seriously considered suicide in the previous 30 days.
The pandemic is also exacerbating long-standing issues around access to and payment for pediatric behavioral and mental-health services. Our colleagues recently reviewed this complicated issue, and called out issues and solutions for fragmented insurance markets, incomplete benefits, provider workforce shortages, and delayed access to care, particularly for racial and ethnic minorities.
Further, improving behavioral health for youth requires a focus on evidence-based interventions and prevention. We need care delivery models and payment for early screening and prevention services to keep more youth from reaching crisis levels.
Comprehensive and affordable health insurance coverage
Achieving universal health coverage for children is an attainable goal, and one that was within our grasp when the children’s uninsurance rate historically dipped below 5% in 2016. However, it has been on the rise since then, and new data show this worrying trend is intensifying. This increase has disproportionately impacted Latino children, most of whom are U.S. citizens but may be in mixed-status families wary of the “public charge” rule. We proudly joined our organization, Children’s Hospital of Philadelphia, in endorsing DreamCare in PA, which would expand public insurance benefits to undocumented children throughout the commonwealth.
Health insurance provides access to health care, financial protection, and has been linked to improved life outcomes. Medicaid and the Children’s Health Insurance Program (CHIP) insured nearly 40% of all children before the pandemic, and were increasingly important for working families who could no longer afford the out-of-pocket costs of their employer plans. Mounting job losses in the current economic crisis bring greater urgency to pursue solutions now.
Ensuring the well-being of families should be a priority for recovery from the pandemic, and will require a political commitment and investment to ensure our country fulfills that promise.
Rebecka Rosenquist is the health policy director at PolicyLab at Children’s Hospital of Philadelphia (CHOP). David Rubin is the director of PolicyLab at CHOP.