The Center for the Study of Social Policy (CSSP) is excited to welcome Donna Cohen Ross as Associate Director, with responsibility for leading CSSP’s work related to Young Children and their Families. Donna has devoted her career to reducing poverty and improving access to public benefits for low-income children and families.

“Donna brings a wealth of experience and skills to CSSP, with depth in health policy finance, leading national policy campaigns, taking work to scale and bridging the worlds of health, early learning and nutrition,” said Frank Farrow, CSSP’s Director.

“Donna brings a wealth of experience and skills to CSSP, with depth in health policy finance, leading national policy campaigns, taking work to scale and bridging the worlds of health, early learning and nutrition,” said Frank Farrow, CSSP’s Director.

Donna comes to CSSP from Health Management Associates, where she focused on helping children’s programs — including maternal and child home visiting, early literacy and pediatric care programs — obtain support from Medicaid. From 2010 to 2015, Donna served as a Senior Policy Advisor and the Director of Enrollment Initiatives in the Center for Medicaid and CHIP Services (CMCS) at the U.S. Dept. of Health and Human Services. There she crafted guidance that helped jump-start Medicaid enrollment under the Affordable Care Act for individuals participating in the SNAP Program. She also directed Connecting Kids to Coverage, the first-ever federal outreach campaign to find and enroll children eligible for Medicaid and CHIP. Prior to that experience, Donna led the outreach division at the Center for Budget and Policy Priorities for 17 years.

Donna also brings to CSSP a background in other issues of importance to children and families, having worked early in her career with the Association for Children of New Jersey, the Community Food Bank of New Jersey and the Newark Preschool Council.

As Donna joins the Center, Amy Fine, who previously led the Young Children and their Families team, will continue to move CSSP’s work forward as a Senior Fellow based in San Francisco.  She will focus on CSSP’s work in California and on new initiatives across the organization.

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Viet Tran is a communications mananger at CSSP. 

The Congressional Budget Office’s (CBO) report on the House-passed version of the American Health Care Act (AHCA), released on May 24, 2017, highlights the ways in which the bill jeopardizes recent gains made in health care coverage, which is a foundation for healthy development and well-being. As CSSP mentioned in a previous blog post, American Health Care Act (AHCA) Passes the House: A Significant Step-back in Health Care Coverage and Advancement in Health Equity, on May 4, 2017, the House voted along party lines to pass the American Health Care Act (AHCA), by a narrow margin of 217 – 213, before the amended bill had the opportunity to be scored by the Congressional Budget Office (CBO). In order to garner enough votes amongst House Republicans, the bill included an amendment crafted by Representatives Mark Meadows (R - NC) of the conservative Freedom Caucus and Tom MacArthur (R - NJ) of the moderate Tuesday Group allowing states to request waivers of essential health benefits and of “community rating” requirements. These harmful 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. 

The CBO report estimates that the bill would lead to the loss of coverage for approximately 23 million people by 2026 – disproportionately impacting 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.

The CBO report estimates that the bill would lead to the loss of coverage for approximately 23 million people by 2026 – disproportionately impacting 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. The AHCA would also effectively end the Medicaid expansion (currently in effect in 31 states and Washington D.C.) as well as reduce individuals’ and families’ access to health care services, weakening coverage or making it less affordable. As amended, the AHCA would allow insurance providers to exclude basic services such as maternity coverage, substance use or mental health treatment or prescription drugs, leaving many people with pre-existing conditions unable to find the coverage they need at any price. Specifically, the CBO report estimates extremely high premiums for those with pre-existing conditions - essentially creating yet another barrier for these individuals to access necessary health care services. The $8 billion (along with a required state contribution) set aside in the bill to help cover those who fall into a high-risk pool also falls significantly short of eliminating the bill’s funding deficits or solving the other problems it creates for people with pre-existing conditions. 

Changes to Medicaid would also devastate state budgets, forcing them to cover the $834 billion spending gap or make difficult decisions regarding who qualifies for the program – potentially pitting vulnerable groups against each other. These changes will also reduce 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.  

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 are also benefitting from expanded Medicaid under the ACA. This progress is threatened however, by continued attempts to dismantle the current structure of providing health care to Americans through efforts such as the AHCA and President Trump’s FY 2018 budget proposal (released yesterday), which includes an additional $616 billion cut to the Medicaid program and CHIP. 

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. Legislators have the ability to promote positive health and well-being outcomes for children, families and communities in an equitable manner. But by failing to meaningfully invest in policies and programs that have the ability to reduce systemic barriers to success, they instead create disparate outcomes for children, families and communities of color. As the Senate considers this piece of legislation within the coming month, CSSP urges legislators to reject this harmful proposal and any other damaging attempt to dismantle the current structure of providing health care to Americans. 

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: 

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.

As details about the President’s proposed Fiscal Year (FY 2018) budget have emerged, concerns about how the needs of families – particularly those facing the greatest barriers to opportunity – will be met in an equitable and effective manner have intensified. When the President’s proposed “skinny” budget was released in March with limited details, it was clear that the health and well-being of children and families were at-risk. Now, the full version of the proposed budget, “A New Foundation for American Greatness,” makes it even more apparent that the cuts proposed by the President would increase the challenges facing families who experience poverty, food insecurity, homelessness and other forms of compounding disadvantage – disproportionately children and families of color. 

The President’s proposed budget ignores key opportunities to advance equity and instead dramatically cuts – or eliminates entirely – funding for a number of essential safety net programs. All Americans lose in this budget proposal – only a small handful of wealthy households would stand to gain – but the budget is merciless in its treatment of low-income families. Overall, $1.7 trillion would be cut from mandatory domestic spending over 10 years. These devastating cuts are directed at programs that are vital pieces of the social safety net for families with low incomes, including $616 billion from Medicaid and the Children’s Health Insurance Program (CHIP), $21 billion from Temporary Assistance to Needy Families (TANF), $40 billion from the Earned Income Tax Credit (EITC) and Child Tax Credit, $72 billion from programs that support people with disabilities, and $193 billion from the Supplemental Nutrition Assistance Program (SNAP). These programs provide crucial supports to families seeking pathways out of poverty and can mitigate the effects of poverty on children and youth as they grow and develop. The proposed cuts are targeted directly at families experiencing poverty, families of color and immigrant families, moving the budget in a direction that worsens inequities.

The threats posed to families by the President’s dangerous proposals are significant and far-reaching. Specifically, cuts to Medicaid, CHIP and SNAP will negatively impact the health and well-being of children and families and signal l a clear attack by the Administration on children and families, reducing access to and affordability of critical health services, increasing food insecurity and ultimately contributing to poorer outcomes for families. These cuts are particularly significant for children and families of color who, due to compounding effects of disadvantage, face greater threats to their health than white children and families.

Cuts to Medicaid: The President’s devastating proposal to eliminate $610 billion from Medicaid over the next 10 years – in addition to the estimated $800 billion that would be eliminated from the program under the American Health Care Act (AHCA) – would shred an integral piece of America’s health care safety net. Medicaid serves as the primary source of health insurance for Americans with low-incomes, covering nearly 70 million people, over half of whom are children. The Affordable Care Act (ACA) expanded access to Medicaid to nonelderly adults with low-incomes, further improving health care access and affordability for families experiencing poverty in the 31 states and District of Columbia that implemented this option.

Medicaid access has been particularly important for children of color given that it has, in coordination with CHIP, covered 54 percent of black children and 52 percent of Hispanic children in 2014, as well as 25 percent of Asian children and 26 percent of white children. Medicaid has reduced racial and ethnic disparities in access to primary and preventive care, which is crucial to closing gaps in health and developmental outcomes for children of color.

Medicaid has reduced racial and ethnic disparities in access to primary and preventive care, which is crucial to closing gaps in health and developmental outcomes for children of color.

The proposed Medicaid cuts would also be disastrous for children and families involved with child welfare systems, who depend on health care coverage and access to supports and services funded through Medicaid. A strong Medicaid program is critical for these young people as children and youth placed in foster care typically have more complex health care needs than their non-foster care peers.

Cuts to CHIP: The President proposes reducing funding for the Children’s Health Insurance Program (CHIP) – which insures 5.6 million children – by at least 20 percent over the next two fiscal years, directly impacting the health of children across the country. Cuts would be achieved by eliminating an element of the ACA that increased by 23 percent the portion of the program’s costs that is paid for with federal money. This would greatly increase the burden upon states to fund CHIP at the same time that they are also being asked to pick up a greater portion of the costs for SNAP and Medicaid. Currently CHIP and Medicaid work together to ensure that children receive the health care they need, promoting healthy development. CHIP also effectively reduces disparities in coverage and health outcomes for young children of color.

The budget proposal would add additional eligibility restrictions to CHIP, creating a coverage gap for families with slightly higher incomes who nevertheless may not be able to afford health coverage for their children, particularly in high-cost regions. Federal funding would no longer be available to help cover children from families with incomes of more than 250 percent of the federal poverty level. Currently, 18 states and the District of Columbia allow families with incomes higher than 300 percent of the poverty line to access CHIP, according to data from the Kaiser Family Foundation. These families would all be at risk of losing health care coverage for their children, including access to preventive care.

Cuts to SNAP: The President’s proposed $193 billion reduction in spending for SNAP – equal to more than 25 percent of the program’s budget – will lead to higher rates of hunger and food insecurity, and poorer health for children and families. Food insecurity, or a lack of consistent access to enough, nutritious food, is a serious threat to the health and well-being of over 42 million people across the country and disproportionately affects families of color, households headed by a single woman,  households with young children and those who identify as LGBT. SNAP is currently serves one of the nation’s most effective public health and anti-poverty tools, offering nutrition assistance to 42 million families of every description.

The President’s budget would restrict eligibility for the program, impose work requirements beyond those already in place, and requiring states to begin matching 25 percent of the benefits their residents receive by 2023. SNAP has been an effective program for decades because of its flexible structure as a federally-funded entitlement that allows SNAP to respond to sudden changes in need, including spikes in unemployment and natural disasters. Shifting cost burdens to the states will dissuade states from ensuring all families who need SNAP benefits receive them. Furthermore, the U.S. Department of Agriculture reports that only about 14 percent of SNAP participants who are assumed to be able to work are unemployed, making the imposition of additional, redundant work requirements unnecessary, ineffective and burdensome for states to implement. The ultimate impact of these additional restrictions will be to discourage eligible households from participating in SNAP when they experience food insecurity, to the detriment of the health and well-being of children, youth and families across the nation.

SNAP has been an effective program for decades because of its flexible structure as a federally-funded entitlement that allows SNAP to respond to sudden changes in need, including spikes in unemployment and natural disasters.

Nutrition supports are also critical for youth who are seeking to gain stability as they move into adulthood, including youth aging out of foster care, who are significantly more likely to experience poverty, homelessness and food insecurity as they transition into adulthood without the same degree of support from family members that many of their peers have. Food insecurity at these pivotal points can contribute to poorer outcomes in health and education for young children and youth. Because food insecurity disproportionately impacts families of color, reducing federal supports for families experiencing food insecurity will also ultimately deepen inequity across the nation.

Conclusion

The President’s proposed FY 2018 budget is alarming in its disregard for the struggles of our country’s low-income families, and will likely lead to greater disparities for children and families of color. The proposed budget offers important insight into the Administration’s policy priorities signaling a lack of concern with the health and well-being of children and families and a disregard for equity. CSSP is redoubling its commitment to meeting the needs of families facing the most significant barriers, including families of color and others who on a daily basis experience inequitable access to opportunities for health and economic stability.  We will continue to monitor appropriations activities, uplift any negative impacts on children and families, and bring to light the ripple effects federal budget proposals will have in state and local budgets.

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.