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Today, the House voted to pass the American Health Care Act (AHCA) – including an amendment crafted by Representatives Mark Meadows (R - NC) and Tom MacArthur (R - NJ) – representing continued efforts to dismantle the current structure of providing health care to Americans. The AHCA is a significant step back and jeopardizes recent gains made in health care coverage, which is a foundation for healthy development and well-being. The AHCA’s changes will reduce individuals’ and families’ access to health care services, weakening coverage or making it less affordable. Its changes to Medicaid will also devastate state budgets, reducing child welfare, juvenile justice and education spending and services – all of which now effectively leverage Medicaid dollars to promote healthy development and well-being for children and youth. Specifically, the AHCA:

  • Ends federal match funding for all who qualify for Medicaid – effectively converting Medicaid from an open-ended entitlement program to a block grant or per-capita cap;
  • Does not allow states to expand Medicaid coverage to uninsured adults after 2018;
  • Allows states to determine what qualifies as an “essential health benefit;" and 
  • Increases premiums for individuals based on breaks in coverage. 

Based on the Congressional Budget Office report on the initial version of the AHCA, provisions included will lead to the loss of coverage for approximately 24 million people and disproportionately impact children and families of color, low-income children and families and those facing significant barriers to coverage such as those with pre-existing conditions and those who use mental health services or are in need of substance use treatment. 

In order to garner the necessary votes, the AHCA now includes the Meadows-MacArthur amendment, which builds on an already harmful bill by allowing states to request waivers of essential health benefits and of “community rating” requirements. These waivers would enable insurance providers to:

  • roll back nationwide standards that require plans to cover services like emergency services, mental health and substance use treatment
  • discriminate against individuals based on their medical history by increasing their insurance premiums;
  • charge women more than men for health coverage as they would have to pay more for plans that include maternity coverage; and
  • re-impose annual and lifetime limits on coverage.

While the AHCA now includes $8 billion in federal funding to help cover those who fall into a high-risk pool and requires states to set up their own funding for these individuals, it falls significantly short of eliminating the bill’s funding deficits, or solving the other problems it creates for people with pre-existing conditions. 

Currently, ninety-five percent of children in the United States have health coverage – a historic high – thanks in large part to the Affordable Care Act (ACA), Medicaid and the Children’s Health Insurance Program (CHIP). More than 11 million low income adults in 31 states and the District of Columbia are also benefitting from expanded Medicaid under the ACA. When parents are able to access health care coverage and treatment, it not only strengthens their capacity to promote their child’s development, but increases rates of coverage and treatment services for their children. The AHCA now goes to the Senate where it could face barriers to passage. 

For more information on how the current structure of Medicaid promotes well-being and healthy outcomes for children and families and the dangers of altering the funding structure of the program, download and read recent CSSP briefs:

Today’s vote in the House along with the Executive Order Promoting Free Speech and Religious Liberty, which addresses amending regulations to allow for organizations to not provide preventive care based on a religious objection, marks a significant step backward in health care coverage for all Americans. We will continue to issue policy briefs, statements and blogs in response to attacks on equity, basic rights and well-being. These are continually evolving issues, and our analysis and specific recommendations will change as we learn new information. Please continue to follow us on social media (@CtrSocialPolicy and fb.com/ctrsocialpolicy) and visit our website at www.cssp.org

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Rhiannon Reeves is a policy analyst at CSSP.

Concluding its role as technical assistance provider for the Building Neighborhood Capacity Program (BNCP), the Center for the Study of Social Policy is releasing a four-part series of practice briefs reflecting on program learnings. Highlighting guidance and examples from the four BNCP sites in Flint, MI; Fresno, CA; Memphis, TN; and Milwaukee, WI; the briefs focus on:

Launched in 2012 by the Obama Administration, BNCP aimed to catalyze community-driven change in neighborhoods that have historically faced barriers to revitalization. The program focused on building the capacity of residents, community organizations, and city-level stakeholders to work together to make progress on neighborhood priorities. BNCP was supported by a federal interagency partnership, with funding from the U.S. Departments of Justice, Education, and Housing and Urban Development, and additional partnership from the Department of Health and Human Services.

The first two BNCP practice briefs, originally released in September 2016, discuss the program’s focus on engaging residents and partners to develop local knowledge to inform results-focused revitalization strategies. Exemplifying an action-learning approach to capacity building, sites were encouraged to conduct “learn-by-doing” projects that provided an opportunity for participants to make a difference in the community while developing knowledge, skills, and relationships that could be applied to longer-term planning and revitalization efforts.

The second two practice briefs discuss what it takes to advance community-driven priorities in neighborhoods that have been historically disconnected from resources and power. The briefs underscore that differences in outcomes rooted in place are closely tied to generations of racial and economic segregation that have limited where people can live and work. As described in the third brief, bringing together people to tackle these disparities requires engaging residents and partners to communicate and collaborate across differences in race, class, and power. The fourth brief takes an in-depth look at efforts to transform relationships between neighborhoods and citywide leaders in particular, focusing on how the cities of Fresno and Memphis approached aligning resources, increasing investments, and changing practice or policy to respond effectively to the aspirations of BNCP neighborhoods. 

While federal funding for BNCP has concluded, local teams in each city are working to build on the foundation of progress to date. In doing so, they seek to sustain a focus on working across neighborhood and city boundaries, while engaging residents and partners to apply ongoing capacity gained to propel the long-term efforts and investments needed to create neighborhood of opportunity for everybody.

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Lauren Wechsler is a senior program analyst at CSSP.

Family Stress, Family Strengths and Children's Well-Being

  ·   By Cailin O'Connor,

Recent efforts to cut back on social spending, dismantle existing programs and widen the gaps in the safety net for Americans are concerning on many levels. As a society, we should be doing more – not less – to help families living in or near poverty, families facing racial bias and micro-aggressions on a daily basis and families who feel unsafe in their neighborhoods. When we fail to do so, parents, children and communities all suffer.

We actually know a lot about policy and programmatic strategies that can build on families’ strengths and promote children’s well-being. Unfortunately, many of the proposed policy and regulatory changes at the federal and state level this year threaten to increase stress levels for families who are already overloaded. From a child well-being perspective, there are immediate and obvious consequences of these policies, such as more children going to bed hungry, missing visits to the doctor or facing homelessness. But there are also longer-term and less apparent effects that are of equal concern. We know that children are affected by stress – their own stress and the stress of their parents.

We can’t afford the effects of cutting back on social spending, which will be seen in increased child abuse and neglect, behavioral problems and mental health challenges for today’s children and tomorrow’s adults. Instead, we should be investing in reducing family stress and helping families to build their strengths. We know how.

Among those who work with and on behalf of young children and their families, CSSP’s Strengthening Families protective factors framework provides a common language to describe five characteristics that all families need to support optimal child development and reduce the likelihood of child abuse and neglect. With the universal, research-based Strengthening Families framework, we can recognize how our own family’s strengths and challenges have shaped our lives – and we can see those strengths and challenges in other families, even when their race, culture, family structure or specific needs may be different from ours. The Strengthening Families approach then helps us to look at how various policies, programs, bureaucratic procedures and everyday actions affect families, through the lens of these protective factors.

Concrete support in times of need is the protective factor that tells us the most about the connection between child well-being and policies that affect families’ financial resources or the availability of supports in the community. We define concrete supports as “Access to concrete support and services that address a family’s needs and help minimize stress caused by challenges.” All families need this kind of support to varying degrees at different points in their lives, and these needs can sometimes be met through social networks. A friend who picks your child up from preschool when you have to work late is one form of “concrete support,” as is a family member who lends you money when you unexpectedly need to replace your refrigerator or furnace. (Social connections is another protective factor in our framework, because of the concrete and other forms of support we get from our social networks that help both parents and children thrive.) But many families rely on formal services or programs to meet at least some of their concrete needs, and many rely on benefits like paid sick leave which may or may not be provided by their employers depending on local and state laws. Families are likely to need more of the formal type of concrete supports when they are living in poverty, or living paycheck to paycheck. Families also need these supports to be delivered in a way that is respectful, accessible and culturally appropriate in order to meet their needs and reduce the stress that directly and indirectly affects the children.

Another closely related protective factor in the Strengthening Families framework is parental resilience, defined as “Managing stress and functioning well when faced with challenges, adversity and trauma.” Of course, concrete supports and social connections make it much easier for anyone to continue functioning well under stress, and for parents to continue providing the kind of nurturing care their children need even when times are tough. There is more to resilience than that – the ability to recognize the challenges we are facing and our own emotional responses, a belief in our ability to solve problems and that things will get better – but all of those things are easier to develop and hold on to when we have support for meeting our families’ basic needs. Resilience is also strengthened when parents feel recognized and respected for who they are, which includes celebrating the diversity of families and communities in this country and supporting them to find policy and community solutions that will work for them.

A substantial body of research shows us that a wide range of policies can have a positive or negative effect on the prevalence of child abuse and neglect, an outcome we should all care about and one that reflects how well we are helping families manage stress. The CDC’s recent technical package on Preventing Child Abuse and Neglect highlights policies and strategies that move the needle in the right direction. They include strengthening economic supports to families; changing social norms to support parents and positive parenting; providing quality care and education early in life; enhancing parenting skills to promote healthy child development; and intervening to lessen harms and prevent future risk. In one very concrete example reported by the CDC, the rate of hospitalizations for abusive head trauma (also known as shaken baby syndrome) among infants in California was found to drop following the introduction of paid family leave, while rates in other states without paid family leave rose over the same years. 

The evidence is overwhelming that children fare better when their parents are under less stress and have more support. This is why it is so concerning to hear about rising levels of family stress when I talk with service providers and system leaders around the country these days, and to know that many of the policy changes on the horizon will move us in the wrong direction. Families already stressed are getting fewer concrete supports when we know they need more. Parents’ resilience is being undercut as we make it harder for them to be the parents they want to be. Let’s all work together to find ways to build family strengths, starting with investing in supports for families rather than cutting them back.


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Cailin O'Connor is a senior associate at CSSP.

 

The Ongoing Fight for LGBTQ Youth in Foster Care

  ·   By Amelia Esenstad

The past month we have seen a number of policies, plans and recommendations that, if or when implemented, will have many negative consequences for LGBTQ youth in foster care – reinforcing the need to, now more than ever, actively stand up for and support these youth. While we will continue our efforts at the federal level, we are also committed to highlighting work being done within states. 

Recent CSSP research, which will be featured in a forthcoming paper with Children’s Rights, Inc. and Lambda Legal, looked at state law, policy and licensing regulations across the country in the areas of child welfare, juvenile justice and runaway/homeless systems. Results show that while child welfare systems in 27 states and DC name sexual orientation and gender identity in non-discrimination protections, only four states require that placement decisions of transgender youth be made according to gender identity and only three states include gender identity in their definition of sex or gender. 

Our assessment of every state is documented in the map below, highlighting exemplary states and those with room for improvement. We will further explore the opportunities presented in all states to improve equity and outcomes for LGBTQ children and youth in care.














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Amelia Esenstad is a policy analyst at CSSP.

Promoting the Use of Data to Advance Equity

  ·   By Amelia Esenstad

Data collection and analysis are critical components of – and frequently the first, foundational step within – strategies to advance equity for children and families. However, recent efforts to undermine and eliminate national data tools and mechanisms will restrict the ability of policymakers and communities to fully understand differences among life experiences and impact of policy on promoting well-being and positive outcomes. These data are necessary to ensure sound decision-making and to assess the effectiveness of many policies and programs. Policymakers should not only preserve existing data strategies but should promote additional uses of data as well. 

The issues that policymakers face are often complex, and the data needed to design and implement solutions must match accordingly. Nuanced data looks at multiple data points and considers the intersections between them at different points in time, providing a more accurate picture of children, families and communities to emerge. These details enable jurisdictions to identify points where policy or practice change need to occur and to track and monitor changes and progress over time. Additionally, data should be collected for the purposes of analyzing the impact of policies and programs and should not be linked to individuals. 

Recent conversations highlight the importance of three important bodies of federal data: the Affirmatively Furthering Fair Housing rule, American Community Survey and Supplemental Poverty Measure. 

H.R.482/S.B.103 is designed to dismantle policies that actively combat racial segregation. Section 3 of the proposed legislation specifically prohibits the use of federal funds for the database and is a critical component of this of this proposed legislation. However, even if Section 3 were to be removed from the bill, the remaining language still poses a dire threat to children, families and communities – and the AFFH rule. 

  • H.R.482, The Local Zoning Decisions Protection Act of 2017, would nullify the 2015 Affirmatively Furthering Fair Housing rule and ban federal funds “to design, build, maintain, utilize, or provide access to a Federal database of geospatial information on community racial disparities or disparities in access to affordable housing.” These data are essential to supporting desegregation and community efforts to provide equitable opportunity and access to fair housing, a goal of the Fair Housing Act of 1968. 
     
  • Repeated attempts to eliminate or make voluntary the American Community Survey (ACS) would weaken a key data source for both government and business communities. ACS data informs over $400 billion of federal government funding allocations each year for purposes as varied as education, health care, infrastructure and housing as well as drives business decisions and market research among retailers, entrepreneurs and others. Making the ACS voluntary would reduce quality and accuracy, particularly for communities of color, and would increase annual costs. With the U.S. Government Accountability Office already labeling the 2020 Decennial Census as “high-risk,” the ACS must continue to be recognized as a valuable source of information for policymakers and communities. 
     
  • Calls to eliminate funding for the annual Supplemental Poverty Measure (SPM) report fail to take into account the important data that the SPM provides when examining economic conditions. The SPM was originally developed to address limitations of the official poverty measure, which did not include the value of in-kind benefits or regional differences in cost of living, and to provide a deeper statistical understanding of poverty and anti-poverty programs. The SPM is a vital tool to study and record the positive impact that policies have on reducing poverty, and offers a much-needed complement to data collected through the official poverty measure.

Data plays a central role in shaping policy issues and solutions. The examples given here are only three ways that data can be used to illustrate a more detailed picture of the lives of children and families. Through efforts like these, policymakers can maximize the information available in order to promote equitable opportunities and outcomes for all.

We will continue to issue policy briefs, statements and blogs in response to attacks on equity, basic rights and well-being. These are continually evolving issues, and our analysis and specific recommendations will change as we learn new information. Please continue to follow us on social media (@CtrSocialPolicy and fb.com/ctrsocialpolicy) and visit our website at www.cssp.org.

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Amelia Esenstad is a policy analyst at CSSP.

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