Last week was an exciting one for children’s health. After a harrowing few months of uncertainty over the fate of the Children’s Health Insurance Program (CHIP) — the very important federal children’s health insurance program which covers about 9 million children nationwide — Congress agreed to reauthorize CHIP for another six years. You can read about this fantastic news here at NPR.  


We will continue to monitor this big news to examine more closely what this means for children’s health and access in the immediate future. The past few months should have taught us that we should not take the program for granted. After all, the fact that CHIP — an “uncontroversial” program throughout its 20-year history — faced such an existential crisis is an indication of our current political climate. According to NPR, CHIP, which needs to be renewed every few years, was historically a bipartisan priority that legislators worked to renew far in advance. Researchers are still working on finding the impacts of children’s enrollment rates with CHIP within these months of uncertainty.


Some analysts say that extending CHIP for 10 years instead of six would save the federal government much more money, but this deal is still a solid one. Also, one analyst suggested that the national anxiety over CHIP might have brought more attention to it in the long run. More people can now be aware of the program and what it does (and possibly be encouraged to enroll), and more people can communicate to lawmakers about the importance of keeping the program alive. States can also start brainstorming safeguards for future use, just in case we are faced with a similar situation in the future. The role of states is especially important since CHIP is based on an architecture of shared responsibility between the states and the federal government.


CHIP is the sort of program that we may not have heard enough about if not for events such as the most recent budget crisis. It is, however, a very important source of health insurance for many American children. On his show, host Jimmy Kimmel explains a bit more about CHIL and its significance to his family. As we celebrate the most recent news, we should look ahead and start planning for CHIP’s future, so that we don’t repeat history.

A Follow-Up on the Children’s Health Insurance Program

The NYTimes reports that a bill to refinance CHIP, the popular children’s health insurance program we discussed in a previous blog post, has moved from the Senate to the House of Representatives, only to get stuck in the latter. If this bill survives partisan gridlock, then its provisions would set aside more than $100 billion over the next five years for the nearly nine million children enrolled in this program.


Although the main architects of the Senate bill hailed it as a “prime example of what government can accomplish when both parties work together,” there are still many points of contention between Republicans and Democrats when it comes to healthcare spending. The only thing they seem to be able to agree on at the moment is the urgency of the situation.


Federal funding for CHIP expired a few days ago, and apparently, there is no way to predict when a bill might be ready to move on to the White House. Several states have already tapped into emergency federal provisions in order to offset spending while Congress deliberates. Three states are scheduled to run out of CHIP funds at the end of this year, and a total of 30 states will be out of cash by March 2018.

The Public Health Crisis We Aren't Talking About

The Editorial Board of the New York Times wrote a piece last week calling attention to a public health crisis that does not get enough attention: the lethal combination of gun violence and children. According to a report in Pediatrics, cited by the Board, about 7,100 children are killed or sent to the hospital each year with gun-related injuries. That translates to about 25 children who are killed by guns each week. This rate is far beyond that of any other wealthy nation in the world.


The disparities among the pediatric victims are, discouragingly, along geographic and class lines.  African American children are at far greater risk for gun-related injuries, as are boys and children living in the South. At the same time, however, deliberate gun deaths among children are distinctly related to white or American Indian children, according to the study.


Even the most cursory research indicates that this is an American crisis, and one that does not show any signs of improving soon. However, the most striking aspect of this crisis is the inability of federal agencies to conduct meaningful research on guns in the country. The passing of a congressional amendment several years ago “forbid[s] federal money to be used ‘to advocate or promote gun control.’” In other words, the government of the most firearm-dangerous country for children in the world prohibits itself from researching the effects of its laws and policies.


Gun violence is a distinctly American crisis that affects children from all races and socioeconomic classes. In that regard, gun violence is an unparalleled public health crisis - gun violence impacts all facets of American society, and especially its most vulnerable citizens.

Children's Health, Today and Now

The New York Times wrote a piece looking back on the accomplishments and frustrations of Dr. Irwin Redlener, one of the founders of the Children’s Health Fund, who is stepping down from his administrative position this week.


Dr. Redlener’s team began the Children’s Health Fund in 1987 as a response to the poverty he saw in NYC. Today, it has more than 50 mobile pediatric clinics nationwide, and it is an important model for other initiatives in urban areas where poverty and systemic inequality endanger the health of children. Dr. Redlener lived his life to his word when he said, “life and work are based on a simple message: Kids can’t wait.” He points out that the consequences of failing to address a child’s health needs at each stage of development are real and irreversible. For example, failing to treat a child’s ear infection with antibiotics - a relatively simple thing to do - can lead to hearing loss in the long run, which is both a personal disability and a societal cost.


In NYC, the number of children living in city shelters have doubled since 1986. According to the New York Times, there are about 22,000 children living in city shelters today. This statistic has grave implications for children’s health. If these children do not have homes, their nutrition, education, and immunizations are all at risk. Economic factors have worsened the housing situation in NYC for the poor over the past few decades, and society has not come up with sufficient mechanisms to compensate for that.


Instead, at the national level, lawmakers seem determined to chip away at the existing social safety net even further in cuts to Medicaid under the proposed healthcare bill. Dr. Redlener told the New York Times that such cuts would leave children in more danger than ever during his career of over 30 years. He said that politicians have certainly frequently debated the parameters of what Medicaid would cover, but to gut the program as it is now being proposed had never entered the picture.


It is clear that we are at a critical juncture for the future of children’s healthcare, especially for children living in urban areas. Prioritizing the health of children today means preserving the societal health of the future.


To learn more about Dr. Relener and his work, read the full New York Times article. You can also read his upcoming book, "The Future of Us: What the Dreams of Children Mean for Twenty-First-Century America,” which will be published this September.

Feeding Mind and Body: A New Role for Schools

Back in April, we wrote about how American households are not immune to the phenomenon of food insecurity. A recent New York Times piece discusses the importance of school meals in students’ development and learning. The benefits of having ready access to nutritious meals are, according to a research team at the University of California-Berkeley, threefold: “physical development” (e.g. eyesight), “cognition” (concentration and memory), and “behavior” (hyperactivity) are all directly impacted by what a student eats during the crucial formative years between kindergarten and high school.


When Michelle Obama was the first lady, she started health initiatives in school districts nationwide by setting up programs that incentivize schools to invest in healthier options for students. These programs did indeed have an impact: one study found that simply moving the salad bar from the margins to the middle of the serving area increased uptake. However, the current Congress has taken steps to dismantle many of these initiatives. It is surprising that a topic as seemingly uncontroversial as student nutrition could be treated as a partisan issue, especially given the fact that experts from multiple disciplines agree on its importance.


In states that have prioritized school nutrition, the results have been clear. Students at schools that work with healthy lunch vendors score significantly higher on standardized tests than their counterparts at schools without healthy options. Some schools have even ventured into providing breakfast and dinner for students that might otherwise go hungry outside of school hours (e.g. during after school activities.)


Funding is certainly always a factor, as school budgets face real challenges in delivering quality education with limited resources. However, research shows that some of the objections to healthy meals are untrue. If we think of student nutrition as an investment in their academic and personal development, and by extension, an investment in the future of society, prioritizing student health should be a no-brainer. It’s as clear as the very benefits of healthy food.





The Future of Healthcare Coverage for Children

Today we’re shifting gears a bit and talking about what the future of the Affordable Care Act (ACA) means to us and our children moving forward. Its political future has been uncertain ever since election night with no clear signals coming from the Capitol about plans to modify the landmark legislation. The “repeal and replace” rhetoric has largely been replaced with a more muted “repair Obamacare” (according to The New York Times), which doesn’t help the uncertainty we face regarding its future in our daily lives.

NPR recently published an article looking at Arizona as a case study in predicting what would happen to health insurance for children if Obamacare were to be repealed. It looked at the case of Vanessa Ramirez, a young mom of two who is an ovarian cancer survivor. She bought insurance for herself on HealthCare.gov, and her children are covered through Arizona’s KidsCare, the state’s version of the federal Children’s Health Insurance Program. Her experience of being surprised with a cancer diagnosis as an otherwise totally healthy college student is a major influence in her life and the choices she makes for her kids. 

Arizona may differ from other states in that it has one of the highest rates of uninsured children in the country and “more children enrolled in the federal marketplace than almost any other state,” according to NPR. This means that states with a high rate of children enrolled in government health insurance could be severely impacted by a repeal of the ACA. Without a solid plan in place, the number of children affected would be about 130,000 in Arizona alone. As a state, Arizona may be unique but it is not entirely unlike other states: it has a fast growing population with a significant number of people living near the poverty line.

Families like Vanessa’s will be the first to suffer if an ACA replacement does not adequately account for the hundreds of millions of dollars it will take to keep current beneficiaries on Medicaid. The ACA has brought coverage to thousands of children in Arizona in recent years. One could argue that children should be one of the most important priorities for health insurance legislation, since preventive care and annual physicals are indispensable in ensuring that children grow up healthy. Regardless of what state we live in, it is paramount that we provide health access for all children and families.

Voting: A Lifetime Habit

Election Day was already a week ago, but it’s always a good time to think about engaging with children and students about their civic duty. Research shows that voting is as much a habit as it is a privilege or a responsibility. Eligible voters who vote in their first three elections are more likely to remain lifelong voters, according to the New York Times.


The United States is an advanced democracy, and one in which parents have a major influence in forming their children’s voting habits. Partisan leanings aside, the act of going to polling stations with our parents on election day itself (or sending in ballots beforehand) is something that positively influences us as citizens. As an example, Dr. Perri Klass, the author of the New York Times article, said, “In fact, if you look at the American Academy of Pediatrics website for parental advice, you will be told, ‘Children do best when routines are regular, predictable and consistent.’” Voting routines are not necessarily the same thing as annual physical exams or making daily healthy decisions to eat right and getting exercise, but they are a building block for children to make empowering, healthy decisions that will last them a lifetime.


Although American citizens may not be old enough to vote until they are 18 years old, children can still observe how adults in their lives approach national and local elections from a young age. One  good way to teach children about voting at elementary schools where they are often doubled as polling stations every four years. In some of these elementary schools, young children can accompany their parents in these polling booths. Dr. Klass wrote that civic engagement as part of a family’s daily life - talking about politics at dinner or actively participating in student government - cements habits that stay with students as they grow up and become eligible for elections as young adults.


Our most recent election exposed many fault lines in the country, and has been one of the more divisive ones in recent memory. Yet the health of the voting public depends on voters who will return to the polls to vote about the issues that they care about the most, and to pass this behavior to their children. Parents may have mixed feelings about exposing their children to politics at a young age, but there is no denying that parents have a major influence in their children’s future by teaching them to voice their beliefs on the ballots at a young age.