Logic and experience tell us that preventing a problem before it happens is the most effective approach. That is why children use seat belts. And sit in car seats. It’s why we put baby gates at the tops of staircases. We know this approach works for children. To paraphrase Frederick Douglass, “It’s easier to build strong children than to repair broken people.” 

When it comes to early education policy, this “ounce of prevention” approach is also backed by some of the strongest social science data available. Parents, families, and early childhood educators offer glowing personal testimonies to the enriching experiences, life-changing and long-term human connections, and other benefits that early learning gives children. And a rich history of research as well as ongoing studies show that investing in early learning programs produces unprecedented positive impacts for children, families, professionals, and the economy. We have distilled some of this research to highlight the many social and economic advantages that result from this commonsense approach. 

The History of Early Learning Research 

The evidence for positive long-term effects of early learning interventions is among the strongest in economics. In the 1960s and 1970s, multiple field experiments were conducted in which a group of children were randomly assigned to early learning programs, including both classroom education and home visiting that provided support to parents beyond the classroom. They were tracked into adulthood to monitor effects across a broad range of socioeconomic indicators.

This groundbreaking research offers truly rare insights. These studies were randomized control trials (RCTs), meaning that some participants were randomly assigned to the “treatment” and received the early learning intervention, while others were assigned to a “control” group and did not receive access to the early learning programs. RCTs are considered the “gold standard” of evidence in social science because, as in laboratory experiments, randomness of treatment ensures that the treatment and control groups should be roughly statistically equivalent in all characteristics such as health, access to child care, or nutrition that might affect long-term life outcomes. In most circumstances, children enrolled in early learning programs are likely different in many ways from kids who are not — they may come from families with greater financial resources, for example — and it could be these differences rather than early learning itself that drive better socioeconomic outcomes. But, with randomization, the only meaningful difference between the groups is whether they participated in the early learning programs; so we can conclude confidently that the early learning is actually causing any progress observed in the data.

But what was truly special about these experiments was not just that they were randomized, giving us top-notch evidence, it is that these experiments were run more than a half-century ago. RCTs are all the rage in modern economics, but were much rarer in the 1960s and 1970s. Modern RCTs can often only look at short-term outcomes because not enough time has passed to look at persistence of positive effects. But, because these early learning studies were so far ahead of the curve, we have gold standard evidence not just for short-term impacts of early learning on outcomes such as school readiness, but also reliable evidence on long-term impacts well into middle age.

The long-term impacts of these early learning programs were remarkable. These interventions reduced crime, improved educational attainment, boosted cognitive development, increased employment, and improved health. The benefits for taxpayers were just as impressive, with $2.50 of savings for every $1 invested due to less need for support later in life.

Modern Evidence on Head Start and Early Learning

More recent research continues to confirm that Head Start and other early learning programs carry on the legacy of these pioneering early learning experiments. Using cutting-edge empirical methods to evaluate program effects in the real world, Martha J. Bailey, Shuqiao Sun, and Brenden Timpe find that Head Start increased years of schooling attained and both college and high school completion rates, demonstrating persistent educational impacts. Similarly, research on Oklahoma’s universal pre-k program led by Anna Johnson finds that participants have better math skills and self-regulation behaviors into the third grade.

Patrick Kline and Christopher Walters show that children who would not otherwise be able to attend preschool experience the largest positive effects. They further estimate that Head Start delivers benefits for taxpayers that are significantly larger than the cost of funding the program in part because it increases after-tax earnings of participants. Moreover, positive effects on cognitive development and social skills are largest when Head Start centers possess sufficient resources to provide top-quality programming, including full-day instruction and home-visiting services. 

Head Start also complements other investments in K-12 education. Analysis by Rucker C. Johnson and C. Kirabo Jackson shows that both Head Start and higher funding of K-12 education independently increase earnings and educational attainment while reducing poverty and chances of incarceration later in life for children living in poverty. But these benefits are even larger for low-income children who receive both — each program boosts the benefits of the other. Greater support throughout the life cycle is needed rather than cuts in essential programs.

Universal preschool provisions may offer even more gains. Work by Elizabeth Cascio demonstrates the positive effects of preschool more generally, showing that preschool programs have positive effects on test scores for low-income kids, and these effects are actually larger when preschool programs are universal rather than targeted to just low-income kids. A randomized study of a large-scale public preschool program in Boston finds positive impacts on long-term educational attainment as well as decreases in chances of juvenile incarceration and other disciplinary issues. Other research shows that early learning programs improve the economic security and contribution of participating families. Early childhood education boosts work hours for parents of participants and increases family income, demonstrating how a robust public safety net and child investments can increase productive work in the economy. 

But the benefits of early learning programs extend beyond the direct benefits for recipients by boosting local economies and communities. In another study, C. Kirabo Jackson, Julia A. Turner, and Jacob Bastian show that universal pre-k increased employment, hours worked, and labor force participation, leading to higher earnings. On average, “each dollar spent on [universal pre-k] generated between 3 to over 20 dollars in aggregate earnings – enough that tax revenues might fully cover costs,” severely undermining the case that the government cannot afford universal pre-k. A study by Micah W. Rothbart and Taryn W. Morrissey shows that Virginia’s targeted pre-k program for low-income children increased participation in pre-k and kindergarten readiness both for participants and for children more broadly across the community.

Conclusion 

The evidence supporting high-quality early childhood investment is among the strongest in the social sciences. Investing in children during their most formative years is not only one of the smartest financial decisions we can make as a country, it also ensures that children across the country receive the support they need to thrive. Access to high-quality early education should not depend on a family’s income, yet the cost makes it unreachable for many families across the country. When early learning is available to all, it supports working parents and equips children with essential skills that benefit them throughout their lives.

Programs such as Head Start connect families to critical resources such as health care and nutrition support, helping both children and their caregivers succeed. These programs are especially impactful at a time when raising a child is more unaffordable than ever. The average annual cost of raising a child has reached nearly $30,000. For low-income families, these expenses are unsustainable. Child care is among the highest costs for families, costing more than rent across the 100 largest U.S. metro areas. The high cost of raising children is a critical policy failure – having a child should not be a luxury, nor should it force families into poverty. Federally funded child care subsidies are essential to the economic security and well-being of families across the country.

Along with the lack of affordability for families looking to access high-quality early childhood resources, there is a critical shortage of early care educators. Poverty-level pay and a lack of professional development opportunities create difficulty in maintaining early childhood educators, exacerbating child care shortages across the country. The early care and education workforce was found to be compensated at lower rates than 97% of all professions. The low pay and lack of resources can make early childhood careers undesirable and create high turnover. Increased investment in the early care and education workforce is desperately needed. A high-quality early childhood workforce requires specialized training and specific skill sets. It’s important that the pay and benefits of the job match the qualifications needed. 

The evidence behind early childhood investments is clear, and recent policy decisions have resulted in insufficient levels of spending. This lack of investment creates inequitable access to high-quality early childhood education and leaves kids and educators behind. It’s time for our federal government to follow the data and invest in our youngest. 

The post Research Confirms that Early Learning Investments Increase Benefits to Children, Lower Costs to Taxpayers appeared first on First Focus on Children.

While many of the bill’s supporters claim that children and other vulnerable populations will not be harmed by the changes made in reconciliation, this is just not true. It is impossible to achieve the level of funding cuts set forth in the bill without causing direct and indirect impacts to the health and well-being of children and families. 

The House reconciliation bill singles out programs that disproportionately benefit children for cuts. Only 8.87% of total federal spending goes to kids, but the programs targeted by the bill devote a much larger share to children. For example, 20% of Medicaid funding goes to children, 100% of the funding in the Children’s Health Insurance Program (CHIP) goes to children and pregnant women, and 43% of SNAP dollars go to families with children. These three programs rank among the top 10 largest federal investments in children and are targeted for more than $1 trillion in cuts. 

These programs work alongside one another to support our nation’s kids. Any of the individual cuts included in this bill would be considered a loss for children, and when taken together, this bill is a disaster for kids. For example, 14 million children depend on both Medicaid and SNAP. This “double jeopardy” risks their access to both food and health insurance. In addition, enrollment in certain benefit programs makes it easier for children to receive other supports. For instance, SNAP recipients automatically qualify for free school meals and child care subsidies. If children are not enrolled in SNAP or Medicaid, they are also likely to experience reduced participation in these other programs that qualify for automatic eligibility. 

Medicaid, SNAP, and tax policy are essential to keeping kids fed, healthy, and cared for. As the House bill moves to the Senate, Congress still has an opportunity to choose babies over billionaires. First Focus Campaign for Children calls on lawmakers to protect children by stopping this bill. 

Child Health

Every child deserves a healthy start and the opportunity to thrive, but policies that undermine access to essential health care put the well-being, development, and future of millions of children at risk. The proposed budget reconciliation bill includes several provisions that would significantly alter Medicaid and CHIP, jeopardizing health care access for over 37 million children who rely on the programs. 

Moratorium on Rule that Simplifies Enrollment and Eligibility

The House bill would place a moratorium on the Centers for Medicare & Medicaid Services’ (CMS) “Streamlining Medicaid, CHIP, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” rule, which was designed to reduce red tape and make it easier for eligible children to enroll and stay enrolled in Medicaid and CHIP. The rule also included important protections for CHIP by prohibiting states from imposing:

• Waiting periods: This is an outdated mechanism imposed on children after they voluntarily disenroll from a group health insurance plan, such as a parent’s employer-sponsored plan. When CHIP was established in 1997, states were required to make sure that CHIP did not substitute for group health insurance. One method that states used was to impose a period of time a child must remain uninsured before enrolling in CHIP. Many states ended waiting periods after the Affordable Care Act limited them to 90 days. However, as of February 2024, nine states still required children to remain uninsured for a period of time before they could sign on to CHIP. The final rule helped to ensure that no child eligible for CHIP will be forced to go without coverage, preventing critical gaps in their health care.

• Lock-out periods: Under the final rule, states are prohibited from imposing mandatory “lock-out” periods on children whose families cannot keep up with their state’s CHIP premium payments. Prior to the final rule, a dozen states used these lock-out periods to keep children from re-enrolling in CHIP for a certain period of time after they lost coverage due to non-payment of premiums. The child could be forced to go without coverage until the end of the lock-out period, even when the family could afford to pay the overdue premiums.

• Annual/Lifetime Benefit Caps: States have several options for how they implement CHIP. States can choose 1) to expand Medicaid coverage for children (funded with CHIP dollars; a.k.a M-CHIP); 2) design a separate CHIP; or 3) use a combination approach. Most states use a combination approach. For kids enrolled in M-CHIP, a state must follow Medicaid rules. For separate CHIPs, states have greater flexibility in designing benefit packages, a policy that has led some states to limit certain benefits and services, such as dental and mental health care, including imposing annual and lifetime caps. Medicaid does not allow annual or lifetime limits, and the Affordable Care Act extended these protections to other populations. The final rule meant that states could no longer impose these limits on specific benefits that children who are enrolled in separate CHIPs need.

Reducing Retroactive Coverage

Retroactive Medicaid coverage allows medical bills incurred up to 90 days before application approval to be covered. The House bill would reduce this vital coverage from 90 days to 30 days. Retroactive coverage is crucial for newborns, children with sudden illnesses, and families facing emergencies, ensuring they are not left with unaffordable medical debt while their application is processed. Without this protection, families will be forced to delay or forgo crucial medical care for their children due to cost concerns, leading to preventable hospitalizations and worsening chronic conditions.

Penalizing States that Provide Coverage to Immigrants

The reconciliation package would penalize the federal matching rate (FMAP) for adults in Medicaid expansion states, reducing it from 90% to 80%, if the state provides financial assistance or “comprehensive health benefits” to residents ineligible for Medicaid due to immigration status. Currently, 14 states and the District of Columbia have chosen to use state dollars (not federal Medicaid funds) to extend some form of comprehensive health coverage to all children, regardless of immigration status. Two states also provide coverage to pregnant women regardless of immigration status.

This penalty effectively doubles the state’s cost of maintaining Medicaid expansion and also represents an unprecedented federal intrusion into state policy decisions about how to use state-only funds. This provision will force states to choose between maintaining coverage for immigrants, disproportionately children and pregnant women, and preserving federal Medicaid expansion funding. The provision would likely result in thousands of immigrant children losing access to preventive care, chronic disease management, and treatment for acute conditions. This loss of coverage could lead to worsened health outcomes, increased emergency department utilization, and higher long-term health care costs for families and the communities in which they live.

Moratorium on Provider Taxes

A provision to limit states’ flexibility to finance their Medicaid programs through provider taxes would have far-reaching consequences for pediatric care. These taxes on hospitals and other health care providers generate revenue that helps states support their Medicaid programs. Restricting state ability to use this financing mechanism would:

• Force cuts to services, eligibility, or provider payments that directly affect children.
• Create significant financial pressure on children’s hospitals and pediatric specialty providers that depend heavily on Medicaid.
• Threaten school-based health services that rely on support from Medicaid.
• Jeopardize mental health and developmental services for children, which are often financially vulnerable.
• Hit hardest in states with limited tax bases that rely on provider taxes to maintain their programs.

Children’s hospitals, community clinics, and pediatric specialists often operate on thin margins while serving a high proportion of Medicaid patients. Financial instability in these critical institutions would have immediate consequences for children’s access to care, including specialty care, particularly in underserved areas.

Banning Use of Federal Dollars for Gender-Affirming Care

The budget reconciliation bill includes a provision that would prohibit use of federal Medicaid/CHIP funding for gender affirming care for all individuals, including children and youth. This legislative move would have significant negative consequences for the health and well-being of transgender and gender-diverse youth.

Banning federal funding for gender affirming care means that transgender youth in families with low-incomes would lose access to guideline-directed, medically necessary health care interventions. These interventions may include puberty blockers, hormone therapy, and related mental health services, which are recognized by major medical organizations as critical components of care for gender dysphoria in youth. Without coverage, many families would be unable to afford these treatments out-of-pocket.

Research consistently shows that access to gender affirming care is associated with improved mental health, reduced rates of depression and anxiety, and lower risk of suicide among transgender youth. Denying this care can lead to increased psychological distress, feelings of rejection, and a higher incidence of self-harm and suicide attempts. 

Work Requirements

The House bill would require certain adults on Medicaid to work or participate in work-related activities for at least 80 hours per month, with some exemptions for parents and caregivers of small children. Despite these exemptions, imposing work requirements on Medicaid poses significant risks to children’s health. When parents or other adults in a child’s household lose Medicaid coverage due to work requirements — often because of complex paperwork or administrative hurdles — children are less likely to receive the care they need. This is because children’s health and development are closely tied to the health and stability of their parents and caregivers. Loss of coverage for adults can lead to increased family stress, reduced access to health care, and greater financial hardship, all of which negatively affect children’s well-being and development.

Additionally, work requirements create more bureaucratic barriers for families, leading to eligible children losing coverage due to missed paperwork or confusing processes. Past experience, such as in Arkansas, showed that thousands lost coverage for procedural reasons, not because they were actually ineligible. When children lose Medicaid, they lose access to essential services — including preventive care, mental health, and developmental screenings — that are critical for healthy growth, especially for those with special health needs.

Affordable Care Act Marketplace 

More than 2 million children are currently enrolled in Marketplace plans. The reconciliation package includes revisions to Marketplace policies, including special enrollment periods, income verification, auto re-enrollment, and other items that will increase costs for Marketplace enrollees or make it harder to stay covered, which will lead to more uninsured individuals, including children. 

A last-minute change to the House bill will provide funding for special payments called cost-sharing reductions (CSRs), which help lower out-of-pocket costs like deductibles and copays for people with low incomes who buy what are known as Silver plans in the Marketplace. In the past, the government stopped paying these CSRs, but insurers still had to offer the reductions, so they raised the prices of Silver plans to make up the difference—a move known as “Silver Loading.” This actually helped some families get more financial help to pay their premiums for other types of Marketplace plans (e.g., Bronze or Gold). Now that the government will start paying CSRs again, insurers won’t need to “Silver Load,” but this change will have the consequence of raising health insurance premiums for families insured through the Marketplace, making it harder for them to afford coverage and possibly leaving them uninsured.

Potentially even more impactful on Marketplace coverage is what the reconciliation bill fails to do. Under the Affordable Care Act, individuals and families can receive advance premium tax credits (APTCs), based on their income, to help lower their monthly premium cost for purchasing a plan on the Marketplace. The American Rescue Plan Act (ARPA) made “enhancements” to the APTCs, providing even more assistance to lower the cost of premiums. The House bill fails to extend the enhanced APTC levels, which expire at the end of 2025. While the base level of APTCs remain in statute, the additional assistance provided under ARPA significantly improved costs for families enrolling in Marketplace coverage, helping millions more individuals, including children, becoming insured. Since 2020, enrollment in the Marketplace more than doubled from 11 million individuals to over 24 million in 2025. By allowing the enhanced level of APTCs to expire, the Congressional Budget Office estimates that over 4 million people will lose their health insurance.

Nutrition

As the nation’s largest federal food assistance program, the Supplemental Nutrition Assistance Program (SNAP) is the first line of defense against hunger and food insecurity for low-income children. More than 15 million children — representing close to 40% of the program’s participants — rely on SNAP for consistent, healthy meals. In 2023, SNAP lifted more than 1.3 million children out of poverty, and countless studies show that SNAP participation improves food security, health, educational, and long-term economic outcomes for children. First Focus Campaign for Children is deeply concerned that the changes contained in the budget reconciliation bill will increase the number of children who experience hunger or food insecurity. 

Transfer of Cost to States

The federal government has historically fully funded the food benefit costs of SNAP. In this bill, Congress backs away from that commitment and mandates that states cover at least 5% of the food benefit cost. While 5% may seem like a low percentage, this translates to billions of dollars for some states. Moreover, states could be required to pay much more than 5%, with Congress proposing increased responsibility to states based on error rates within the program. In some instances, this provision could lead to states being responsible for up to 25% of the cost. Because error rates are calculated annually, states could fall into different categories of funding responsibility from year-to-year. In addition to the food benefit cost transfer, the budget reconciliation bill also restructures the funding balance so that states will be responsible for 75% of the administrative costs. Currently, the federal and state governments share administrative costs 50%-50%. 

These cost transfers place many states in an unfeasible position. The potential variability of a state’s cost share also makes it extremely difficult for states to plan for program continuation or prepare budgets for future years. Analysts anticipate that, if confirmed, these transfers will force states to reduce benefits, limit eligibility, or, in some cases, even end their SNAP programs. These pressures would lead to a reality where the government assists hungry children in some states and leaves them behind in others. 

Work Requirements

Currently, SNAP exempts households with children from work requirements. The House bill would exempt only families with children under the age of 7. Proponents of the provision reason that children over the age of 7 are in school during the day, allowing guardians to work. This change shows a complete misunderstanding of school schedules, ignoring summer and seasonal breaks and the fact that the hours of a school day are shorter than conventional work hours. It also represents a disregard for the costs and challenges of finding after-school child care. But most concerning, this provision communicates a willingness to risk the health and well-being of children over the age of 7. Adults who care for dependent children with disabilities also are not exempt from work requirements under this bill. Work requirements in SNAP are especially dangerous as they reduce the household’s overall benefits leading to less money for groceries and ultimately diminishing the amount of food the household has for children. Estimates place at least 4 million children living in households at risk of losing some or all of their benefits as a result of the new work requirements. 

Thrifty Food Plan 

The Thrifty Food Plan is the national standard by which the government determines the cost of buying food to maintain a healthy diet and subsequently sets SNAP benefit amounts based on that calculation. The plan was adjusted by the Department of Agriculture (USDA) in 2021 to modernize the standards and take into account the latest nutritional guidelines and food prices. This evaluation led to a slight benefit increase for SNAP recipients, with most households receiving an increase of $12-14 a month. The 2021 adjustment is credited with lifting 1 million children out of poverty. The House budget reconciliation bill would cancel future benefit adjustments, jeopardizing families’ ability to afford the basic necessities and components of a healthy diet. As grocery prices continue to rise, Congress should be taking steps to protect SNAP users from this fluctuation, not jeopardizing child nutrition further by ending future adjustments. 

Cascading Effect onto School Meals

Although the budget reconciliation bill does not specifically mention school meals, its provisions will directly impact the way schools address child hunger. Children who participate in SNAP currently are automatically enrolled in free school meals. If states are forced to limit the number of children covered by SNAP, students could lose their enrollment in free school meals due to administrative burdens, even if they are still qualified. In addition, fewer schools are expected to participate in the Community Eligibility Provision (CEP), which allows them to provide free school meals to the entire student body, if states have to limit their SNAP participation. The two programs are intertwined, with CEP reimbursement rates linked to the percentage of students that a school has enrolled in SNAP. Children cannot afford to lose the nutrition support they receive through schools at any time, but to not have safeguards for school meal enrollment at a time when SNAP cuts are endangering food at home is especially cruel. 

Economic Security

The tax code offers one of the most powerful tools for improving the lives of children, with the Child Tax Credit (CTC) and the Earned Income Tax Credit (EITC) among the top 10 programs contributing to federal investments in kids. In 2023, the CTC and EITC combined lifted 3.4 million children out of poverty. That number would have been even greater — as high as 7 million children — if lawmakers had renewed the historic 2021 improvements to the CTC, according to Columbia University’s Center on Poverty and Social Policy. 

The House reconciliation bill goes in the opposite direction. The bill would make permanent tax cuts benefiting the ultra- wealthy, including a boost to the estate tax exemption and the increase in the business passthrough deduction while also extending the weakened alternative minimum tax. The measure also would revive a trio of business deductions and together all these tax policies account for over 60% of the measure’s overall $3.8 trillion estimate of lost revenue through 2025-2034.

The tax provisions in the reconciliation bill represent a massive giveaway to the richest Americans. Under the bill, in 2026, the bottom 20% of earners (annual income below $27,000) would receive only 1% of tax savings (about $140) while the top 1% of earners (annual income above $900,000) would receive 21% of the tax breaks, amounting to an average tax break of nearly $70,000. The fact that the wealthiest will get permanent tax cuts while families with the lowest incomes will have their taxes increase over time — and will lose access to basic needs programs — threatens the future of millions of kids.

In addition, although the CTC maximum is increased from $2,000 to $2,500, the reconciliation bill simultaneously leaves behind 20 million children whose parents make too little to qualify for the full CTC. It also disqualifies 4.5 million U.S. citizen babies and children because their parents don’t have a Social Security number. Millions of other children will be hurt by changes to the EITC. Despite an overwhelming body of literature documenting that expanding the CTC is one of the best ways to help families with rising costs, this bill sharply limits who can access the credit and how much of it they can claim. 

A more unequal CTC

This budget bill prevents 20 million of the nation’s poorest kids from receiving the full credit — 2.5 million more low-income kids than previously. Right now, 17 million kids — one-in-four — are excluded from the full $2,000 CTC because their family income is too low. Instead of righting this wrong, the reconciliation provisions would increase the maximum CTC from $2,000 to $2,500 but leave in place the inequitable cap on the credit’s refundable portion. Meanwhile, families earning up to $400,000 would qualify for a larger credit. This change will widen the gap between families who are well-off and those who are struggling to provide basic, everyday needs for their children.

Children who will be disproportionately “left behind” by this bill are: babies and toddlers; children in larger families; rural children; children of color; and children in single-parent households. The bill punishes babies and mothers who lose income with a reduced credit when mothers earnings decrease during pregnancy, childbirth, and postpartum, when a child and family are vicitms of a natural disaster, when a child loses a parent due to death, when a parent reduces work to provide caregiving, or when a parent loses a job. For children and families who need the CTC the most, they get the least.

The CTC proposal also strips eligibility from 4.5 million American children because they live in households with mixed immigration status.. The poverty rate among U.S. citizen children in mixed-status families is 31.5% — more than three times that of citizen children in households where all members are citizens. The 2017 Tax Cuts and Jobs Act (TCJA), passed during the first Trump Administration, began denying the CTC to 1 million kids who did not have Social Security numbers.. Under the proposed tax provisions currently being considered, an additional 4.5 million kids, who have social security numbers, are US citizens or lawful permanent residents, and live with a parent without a social security number, would lose access to the credit, forcing many low-income families into, or deeper into, poverty. 

Hurdles to the EITC

The reconciliation bill also erects hurdles to the EITC, which has a long history of bipartisan support and a proven track record of lifting up working families. Research shows that families mostly use the credit to pay for basic needs such as groceries, rent, clothing, and school supplies. In 2023, the EITC kept 4 million people out of poverty as the poverty rate for children jumped to nearly 10 million from 3.8 million in 2021. Evidence has shown that the credit also produces significant lifetime benefits, such as better education outcomes, improved health, and higher lifetime earnings and a more secure retirement. 

Barriers to credit for health care premiums 

The Advance Premium Tax Credit (APTC) is a refundable tax credit available to families purchasing health care through the Affordable Care Act’s health insurance Marketplace, helping lower their monthly premium costs. In 2024, consumers eligible for a tax credit experienced an average yearly premium savings of approximately $700 due to enhanced premium tax credits, yet lawmakers did not extend them in the bill. A record 93% of Marketplace enrollees, or 19.3 million people, receive APTCs. Failure to renew this enhanced tax credit will raise health care costs for many families with children.

Education

Lawmakers have included in the reconciliation bill a version of the “Educational Choice for Children Act,” which would create a federal private school voucher program. School vouchers hurt students and schools by diverting public funds to private schools, discriminating freely against students, and not improving academic outcomes. School voucher programs are disproportionately harmful for students with disabilities. Voters continue to oppose private school voucher schemes: Every time one has come up for a vote, Republican, Democratic, and Independent voters have soundly rejected them.

While legislators claim vouchers help kids, they actually just benefit the wealthy. The bill provides an opportunity to avoid capital gains taxes by allowing donations of “marketable securities.” This provision would allow individuals to donate their appreciated corporate stocks and avoid paying capital gains tax on the appreciation, while also receiving a federal tax credit for the full market value of the donation. According to the Institute on Taxation and Economic Policy, this provision could lead to a “120 percent match or more for upper-income families” and disproportionately benefit wealthy Americans, while decreasing funding in state and federal budgets. In addition to the lost capital gains revenue, this would spend $5 billion a year in taxpayer funds, totaling $20 billion over a four-year period.

Environment

The reconciliation bill would claw back up to $16 million in grants from the Inflation Reduction Act to reduce air pollution and monitor and improve indoor air quality in schools. This provision would disproportionately affect children and schools in low-income, disadvantaged, and tribal communities who routinely report higher instances of asthma, lead poisoning, and obesity. 

Children are uniquely vulnerable to pollutants as they breathe more air in relation to their body weight than adults. A mountain of evidence suggests that properly managing indoor air quality in schools leads to better academic performance and attendance, protects children from airborne illnesses like COVID-19, and makes school buildings last longer while saving money. Estimates show that 57 million people attend or work in schools across the country and the reconciliation bill would put the air they breathe at risk. 

The post How the House-Passed Budget Reconciliation Bill Would Negatively Impact Children appeared first on First Focus on Children.

The Administration’s freeze on foreign assistance earlier this year and the subsequent dismantling of USAID have increased suffering and death among children in low-income countries and diminished U.S. global status as a trusted world leader. 

Lawmakers now are tasked with combining USAID’s humanitarian role and, to a far lesser extent, its development role, with the diplomacy role of the State Department. But fewer than 20% of USAID programs will be folded into the State Department. Key steps must be taken to ensure that children are not left behind in this process. For instance:  

• The State Department’s Function 150 Account for Fiscal Year 2026 must be maintained, at a minimum, at the FY 2025 level of roughly $60 billion, and the Administration must obligate and disburse this funding as directed by Congress 
• USAID programs supporting children must be saved  
• Development programs must be preserved along with humanitarian assistance  
• U.S. humanitarian programs must continue to align with humanitarian principles  
• Senior, empowered leadership reporting directly to the Secretary of State must oversee and lead these development and humanitarian programs  

USAID Programs Supporting Children Must Be Saved 

Worrying signs suggest that the Administration is forgetting children. According to plans shared with Congress, the Administration has terminated a vast swath of child-focused programming, including basic education, Vulnerable Children, and Orphans and Vulnerable Children programs. The Administration passed over these programs because they were not deemed “lifesaving” by the Secretary of State (and therefore given a theoretical waiver) or did not align with the Administration’s goal of using foreign assistance to make America “safer, stronger, and more prosperous.” Before the dismantling of foreign assistance, children were receiving roughly 10% of U.S. foreign assistance resources. Although that amount was far too small given that kids make up 30-50% of the population of many low-income countries, it was far better than the barren landscape that is emerging.  

The State Department Must Retain Orphans & Vulnerable Children Programs  

The Administration has already ended 23 programs for orphans and vulnerable children (OVC) under the President’s Emergency Plan for AIDS Relief (PEPFAR) and has no plans to carry them over to the State Department. Unlike the rest of PEPFAR, which the Administration plans to retain, the OVC program will disappear, leaving vulnerable children and orphans without protection and nurturing care and at dangerous risk of sexual abuse, trafficking, and violence.  

The Administration is operating under the misconception that PEPFAR’s non-clinical support for children, such as Orphans and Vulnerable Children (OVC) programs, is not “lifesaving” and therefore does not need to be preserved. But decades of community-level HIV implementation have shown that barriers to testing, treatment, and adherence to treatment for children living with and orphaned by HIV cannot all be addressed through clinical interventions. Instead, PEPFAR’s OVC programming has been the key to tackling barriers to adherence, such as inadequate nutrition, parenting education for caregivers of children living with HIV, home visits to support testing and adherence to treatment, and lack of financial assets for families to ensure their children reach the clinic and remain on treatment.  

OVC Programs Enjoy Broad Support 

Since Congress passed the first AIDS, TB, and Malaria bill that authorized PEPFAR in 2003, and in every subsequent reauthorization, lawmakers have required that 10% of bilateral HIV resources go to orphans and vulnerable children to keep them fed and protected. The State, Foreign Operations Subcommittee of Appropriations has also included the 10% directive for OVC in recent foreign aid funding bills because Congress felt so strongly that these world-class programs must continue. But now, the United States has turned its back on these children — at last count, 6.6 million children and their caregivers were under the care of these programs. 

PEPFAR’s OVC work historically has enjoyed strong bipartisan support in Congress. The faith community also backs the program. But absent an immediate reversal by the Administration, history tells us that many of the millions of children who were dropped from OVC support will soon be found in hazardous labor, sex trafficking or the grave, instead of in school where they belong.  

Modeling of PEPFAR’s OVC programs in Kenya showed a return on investment (ROI) of 4:1 because of reductions in HIV infections, child marriages, cases of child sex trafficking, and cases of physical violence against children while simultaneously boosting the number of girls in school. Long-term, these programs reduced costs to society and increased labor market productivity by keeping girls safe. In fact, PEPFAR’s adolescent girls’ programs, the majority of which are funded by the OVC set aside, reduced their experiences of sexual violence by 65% in Malawi and 68% in Kenya. 

Development Programs Are an Essential Part of U.S. Strategic Policy 

The Administration plans to slash most development programming and to retain a smaller version of USAID’s humanitarian work at the State Department. But investing in humanitarian assistance without development programs would be inefficient, simply placing the smallest of proverbial Band-Aids on open wounds while ignoring what caused the gashes in the first place. 

Humanitarian assistance focuses on the short-term — the immediate response to crises —by providing food, water, shelter, medical care, and protection to people affected by emergencies. Development assistance, on the other hand, seeks to create lasting change by addressing long-term issues such as the root causes of poverty and food insecurity, and promoting resilience to shocks such as extreme weather. The goal is to make humanitarian assistance less necessary over time. Appropriate international responses require both humanitarian and development assistance, and a smooth transition from humanitarian aid to development is crucial for long-term recovery and sustainability.  

Examples of highly effective development assistance include basic education (especially for girls), caregiver training in positive parenting of toddlers, breastfeeding support that enables moms to exclusively breastfeed babies for the first six months, and improved child nutrition achieved by helping families provide children with protein and vitamins and minerals, often from kitchen gardens. Other examples include training farmers in pest control techniques and water resource management to allow their crops to flourish.  Peacebuilding among warring groups also allows families to safely plant and harvest crops or travel to markets.  

In South Sudan, for instance, a project funded by USAID and implemented by a faith-based organization helped warring tribes build and maintain community water points together. The communal water sources provided families with clean water and reduced the spread of water-borne disease, and also promoted peace between the tribes. With peace came regular planting and harvesting of crops, allowing communities to feed themselves and avoid the need for humanitarian intervention. Simply reacting to emergencies as they break out without a long-term plan to stabilize the area (as seems to be the current plan) will keep the U.S. lurching from one humanitarian situation to another without reducing insecurity or poverty long-term. 

Empowered, senior leaders must head these programs 

The Administration must establish a new position at the State Department, such as Deputy Secretary for Development and Humanitarian Affairs, to oversee all development and humanitarian programs. This position must report directly to the Secretary of State. This position is necessary because the goals and expertise needed to lead, implement, and monitor development and humanitarian assistance are vastly different than the skills needed for diplomacy. The goals of aid and diplomacy must be aligned, but distinct.  

For example, diplomacy seeks to advance American interests abroad. But the core ethical accepted guidelines for humanitarian assistance include humanity, neutrality, impartiality, and independence. Humanitarian aid is given regardless of race, creed, or nationality of the recipients, and without adverse distinction of any kind. It is absolutely critical that the Administration adhere to these global humanitarian principles not only because it is the right thing to do, but also because to do otherwise will endanger the lives of American humanitarian workers. To insist upon “America First” policies in humanitarian work would compromise trust and acceptance within affected communities and would undermine the safety and security of humanitarians. This is no small matter. Last year was the deadliest year on record for aid workers, with 377 humanitarian workers killed and hundreds of others attacked and kidnapped. 

Ideally, Congress would insist that USAID remain an independent, fully staffed, and fully funded agency. Barring that unlikely possibility, lawmakers must mandate the appointment of a Deputy Secretary for Development and Humanitarian Affairs at the State Department who reports directly to the Secretary of State. This person must demonstrate a strong development and humanitarian background and prove capable of leading the following offices and programs: 

• Humanitarian Assistance, including migration, refugees, and emergency relief  
• Development Assistance, including food security and nutrition, water and sanitation, basic education, and economic development  
• Global Health, including Maternal, Newborn & Child Health and Nutrition, Vulnerable Children, Malaria, Tuberculosis, Neglected Tropical Diseases, the President’s Emergency Plan for AIDS Relief (including a strong Orphans & Vulnerable Children component), and the Office for Global Health Security  
• Democracy, Human Rights and Labor (DRL) and Good Governance  
• Office of Foreign Assistance, integrating policy and budget  
• Office to Monitor and Combat Trafficking in Persons (including a strong focus on child protection/anti-trafficking). 

The post Key Ways to Preserve USAID’s Children’s Programs appeared first on First Focus on Children.

As families struggle with high rents, unaffordable child care, and the steep cost of everyday goods such as food and diapers, key assistance programs exist to supplement resources for families struggling to make ends meet. 

Weakening these assistance programs by imposing work requirements, funding cuts, unreasonable time limits, and other unnecessary bureaucratic barriers undermines access to benefits for low-income children and undercuts their opportunities. These actions often hurt children and youth with the greatest need, creating categories of deservedness that negatively impact their well-being and harm their short-term and long-term success.  Holding children back in this way has adverse consequences for our economy and doesn’t reflect the values of our nation. 

Rather than fostering economic mobility, work requirements often prevent parents and caretakers from accessing assistance programs and support, hindering healthy child development and putting additional burdens on struggling families. A 2019 nonpartisan study from the National Academy of Sciences found that “work requirements are at least as likely to increase as to decrease poverty.”2 

There are countless situations where work requirements punish children who live in families that face barriers to financial security or experience a disruption in income through no fault of their own. Just a few examples include children of parents with disabilities or siblings of children with disabilities, whose parents can only work part-time or who are forced to quit to care for their kids. These requirements can also affect children being cared for by grandparents on fixed incomes who are physically unable to work or children who have a parent with cancer or another serious medical condition that prevents them from working. Children in households that lose their home, job, or both due to a natural disaster, such as the recent hurricane in North Carolina or wildfires in California may also lose access. Work requirements also do not account for uncompensated childrearing and caretaking of family members, which is work that produces large benefits to the country as a whole. 

The reality is that the vast majority of households with children (92%) have at least one family member who is working.3 Rather than encouraging employment and upward mobility, work requirements just force families to document their existing employment, which is especially onerous for low-wage workers who often have no control over their schedules and whose hours may vary from week to week.4 Certain employers may be unwilling to provide a letter of employment verification. Furthermore, some parents are self-employed or may not have an employer easily available to verify their employment. 

To meet work requirements, caretakers often must find and pay for child care, which is already unaffordable and difficult to find. In 2023, the cost to a family of child care for two children in a child care center was more than annual mortgage payments in 45 states and the District of Columbia, and that cost was more than rent payments in all 50 states and the District of Columbia. The cost of child care for an infant at a center was more than in-state tuition at a public university in 39 states and D.C..5 Black, Hispanic, and low-income working parents find child care least affordable and accessible.6 

The racist roots of work requirements for benefit programs extend far back into our nation’s history, starting with the slave trade and continuing today, as racist stereotypes persist about the willingness of Black people and other people of color to work.7 For example, policymakers specifically designed the Temporary Assistance for Needy Families (TANF) program, which replaced Aid to Families with Dependent Children (AFDC) in 1996, to limit assistance to Black mothers and children. TANF places extremely arduous administrative burdens on participants, such as strict work requirements, family caps, and time limits, and provides meager cash assistance in many places. Nearly 30 years of evidence show that TANF’s work requirements have failed to improve employment outcomes for program participants, and it should not be a model for other assistance programs.8 

Some members of Congress are once again considering the imposition of work requirements,  funding cuts, and other harmful changes to assistance programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP) that would have significant negative ramifications for children’s health and future success. When parents lose benefits, evidence shows that children do too, making policies such as these harmful to children’s health and development.9 Taking SNAP benefits away from adults results in fewer SNAP benefits for their entire household, meaning less food for children. Even proposals that claim to exempt families with children and only impact “Able-Bodied Adults Without Dependents (ABAWDs)” still harm children, who often depend on pooled resources such as SNAP benefits from family members who do not claim them as dependents.

We already underinvest in our children. As First Focus on Children’s annual Children’s Budget shows, children do not receive their fair share of government funds.10 Despite this inequity, programs that benefit children are at risk of deep cuts in Fiscal Year 2025, which would have grave consequences. For example, cuts to early learning programs would unfairly harm low-income children, who show positive, on-time post-secondary educational outcomes as a result of these programs, as well as improved cognitive development, emotional development, and academic achievement.11,12 As lawmakers negotiate spending levels for the FY 2025 budget, they must protect children’s programs along with those that benefit low-income seniors and adults. 

This document is an update to our 2023 and 2018 briefs, The Harmful Consequences of Work Requirements and Other Obstacles on Families with Children,13 and details the way work requirements would weaken assistance programs by increasing disparities for children in marginalized communities and undermining child health, nutrition, housing stability, economic security, and early childhood development. 

Child Health 

Medicaid and the Children’s Health Insurance Program (CHIP) cover more than 91 million  Americans, including children, pregnant women, seniors, individuals with disabilities, and low-income adults in the United States.14 Children account for more than 41 million Medicaid and CHIP enrollees.15 Imposing work requirements as a condition of receiving Medicaid harms children, pregnant women, and families and creates substantial losses in health coverage and access to care. Past implementation of work requirements has demonstrated that confusing rules, complex reporting systems, and other bureaucratic red tape cause children to lose their health coverage. For example, in Arkansas, 18,000 Medicaid enrollees lost their coverage within the first seven months of the state implementing work requirements before a court order halted the program.16 When parents lose benefits, evidence shows that children do too, making policies such as these harmful to children’s health and development.17 Moreover, the ramifications of losing coverage extend beyond health care to negatively impact financial security, employment, housing, and many other life factors for children. 

Imposing work requirements would exacerbate the loss of coverage that children have already experienced over the last two years as states ended continuous coverage protections established during the COVID-19 pandemic. From March 2020 until April 2023, states had been required to maintain enrollment of children and other individuals covered by Medicaid and CHIP.18 The pandemic-era requirement led to significant health coverage gains for children, driving the uninsurance rate for children down to 5.4%.19 Starting April 1, 2023, states were allowed to begin “unwinding” these protections and disenrolling children from Medicaid and CHIP.20 During the Medicaid unwinding, over 5.5 million children were disenrolled.21 The vast majority of these children were disenrolled for procedural issues — missing renewal forms, confusing notices, materials that are not in preferred languages, and other administrative errors —  rather than for actual determinations of ineligibility.22 Making families jump through additional bureaucratic hoops by imposing work requirements would cause even more eligible children to lose their Medicaid and CHIP coverage. 

When children lose coverage they lose access to critical health services, including Medicaid’s  Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. EPSDT guarantees that children under age 21 have access to a comprehensive set of benefits that ensures they receive appropriate preventive, dental, mental health, developmental, and specialty services. Losing access to EPSDT would be harmful to children, especially those with special health care needs as Medicaid and CHIP serve as the sole source of coverage for more than 47% of such children.23 Losing coverage also impacts long-term outcomes for kids. Children covered by Medicaid during childhood have better health as adults with fewer hospitalizations and emergency room visits,24 are more likely to graduate high school and college,25 have higher wages and pay more in taxes.26 Causing families to lose health coverage by imposing work requirements risks the short-and long-term health and development of our nation’s children. 

Child Food Security and Nutrition

As the nation’s largest federal food assistance program, SNAP is the first line of defense against hunger and food insecurity for low-income children. More than 15 million children —  representing close to 40% of the program’s participants — rely on SNAP for consistent, healthy meals.27 In 2023, SNAP lifted more than 1.3 million children out of poverty,28 and countless studies show that SNAP participation improves food security, health, educational, and long-term economic outcomes for children.29 However, despite its proven effectiveness, SNAP is under threat from legislative proposals that will make it harder for low-income families and families experiencing poverty to put food on the table. 

The upcoming spending bills and Farm Bill negotiations will provide lawmakers an opportunity to impact funding and reauthorize nutrition programs, including SNAP. Some House lawmakers have suggested expanding SNAP’s work requirements to include parents and caretakers with school-age children (age 7-18),30 which could cause 4 million children to see reduced SNAP benefits.31 

Even if children’s SNAP benefits are not directly affected, work requirements could reduce the household’s overall SNAP benefits leading to less money for groceries when prices are on the rise, and ultimately diminishing the amount of food the household has to share with children. Parents and caretakers in some states could also face new restrictions on SNAP time limits,32 which were suspended during the pandemic, a change that will make retaining SNAP even harder for individuals struggling to find adequate employment. 

Proposals to increase SNAP restrictions for ABAWDs also unduly harm children in poverty. Children often depend on pooled resources (including SNAP benefits) from extended family members who do not claim them as dependents, such as a grandparent who watches children after school or a non-custodial parent. Stricter ABAWD time limits would also harm youth aging out of foster care and unaccompanied homeless youth over the age of 18, who already experience high rates of unemployment and poverty and face barriers to accessing public assistance programs.33 

Taking food off the table does not help families achieve economic mobility. Instead, lawmakers should pursue the wide variety of available policies that would strengthen and protect SNAP so that it can more effectively meet the needs of families who don’t have enough to eat. These policies include maintaining the increase in SNAP benefits from the recent update to the Thrifty Food Plan to better reflect modern food costs, making it easier for families to gain SNAP eligibility by limiting burdensome administrative requirements, protecting and replacing SNAP benefits for those who experienced ‘card skimming’, investing in nutrition education for SNAP participants, and ensuring vulnerable youth and young adults have access to food assistance.34 

Child Housing Stability 

Housing vouchers provide proven long-term benefits for children, including an increase in their earnings as adults.35 More than half of nondisabled, working-age households receiving rental assistance have at least one family member who is already working but still struggle to afford the high cost of rent.36 

Yet access to vouchers and other forms of housing assistance remains extremely limited and families with children are a decreasing share of subsidized housing recipients.37 Affordable housing remains one of the main barriers to economic stability for many families. One-third of all U.S. children live in households with a high housing cost burden,38 defined as spending more than 30% of the household’s monthly income on housing.  

Housing instability and homelessness are associated with an increased risk of poor child health,39 and cause trauma with severe negative implications for children’s healthy development. Child and youth homelessness is already high, with more than 1.4 million students identified as homeless by the U.S. Department of Education in the 2022-2023 school year.40 

Project 2025 proposes harmful changes that would further limit housing assistance for families with children, such as work requirements and time limits. Instead, lawmakers should expand access to vouchers for families with children, establish a national renters tax credit, reform federal homelessness assistance, expand access to civil legal services for families facing eviction and other housing disputes, and build upon partnerships between public housing authorities and public school systems designed to improve the educational outcomes of children living in subsidized housing.41 

Temporary Assistance for Needy Families (TANF)

TANF provides critical assistance to millions of children and families, through cash assistance as well as funding for child care, state tax credits, food banks, and other aid. TANF is a children’s program — more than 70% of TANF recipients are children.42 

While TANF cash assistance is a lifeline for struggling households — helping parents and caretakers afford food, rent, diapers, and other staples — it fails to reach many kids in need. Currently, fewer than 2 million children receive TANF basic assistance even though nearly 10 million children in the U.S. are living in poverty.

TANF has not received an increase in federal funding since its creation in 1996. As a fixed block grant, it is not indexed to inflation and therefore its value has decreased over time. TANF funding also does not automatically increase to meet greater need during times of economic crisis. 

House Republicans have proposed43 to further limit access to TANF through significant funding cuts and stricter work requirements. TANF’s rules already allow state officials to set narrow parameters for program eligibility and impose strict work requirements and arduous administrative burdens on program participation. The proposed cuts would eliminate the Contingency Fund, designed to respond during times of economic downturn, which would hurt families when they are in most need of support. In FY 2024, 15 states and the District of Columbia received TANF Contingency funds.44 

Instead, lawmakers should reform the TANF program and increase families’ access to cash assistance.45 Cash assistance has a two-generation effect in promoting economic mobility — in addition to supporting children, the assistance helps adults in the household afford child care, transportation to work, higher education, or job training programs that lead to steady employment and higher-paying jobs.

Child Tax Credit 

Extensive research shows that tax credits and cash transfers influence positive parent-child interactions, improve child development outcomes, and have a bigger impact than any other policy in reducing child poverty.46 The improvements to the Child Tax Credit in 2021 delivered dramatic, positive results, cutting U.S. child poverty nearly in half and narrowing the racial child poverty gap.47 It is hard to overstate the impact of the Child Tax Credit — the payments transformed the lives of tens of millions of children. 

Improvements to the Child Tax Credit greatly increased the amount of the credit, made payments available monthly for half of the year, and made children in families with little or no income eligible for the full credit for the first time. Analysis from Columbia University’s Center on Poverty and Social Policy found that children in the lowest income households who were ineligible for the Child Tax Credit before the 2021 enhancements — mainly Black and Hispanic children, young children, and children in single-parent, rural or large families — all experienced significant declines in child poverty in 2021.48 

Expanding the Child Tax Credit also significantly reduced material hardship and household food  insecurity with “no significant differences in the changes in employment between December  2020 and December 2021 for adults who received the payments and adults who did not receive  the payments.”49 In fact, the Child Tax Credit helps mothers, especially single mothers, increase their labor force participation50 by allowing them to afford child care, transportation, and other necessities that make it possible for them to work. 

With the expiration of the improvements to the Child Tax Credit at the end of 2021, nearly 4 million children immediately fell back into poverty in January 2022.51 By July 2022, the percentage of households with children that reported they could not afford enough food had increased by 25%.52  

The lesson of 2021 tells us that a monthly Child Tax Credit delivered to families without any employment or earnings requirements ensures a steady source of income that offers the best way to help children in need. Creating a fully refundable Child Tax Credit helped cut the child poverty rate in half and achieved a historic low. Congress must build on the success of the 2021 improvements and create a permanent, monthly child allowance program designed to reach all children in households with the greatest barriers to economic stability. 

Stability For Unaccompanied Homeless Youth and Youth Aging Out Of  Foster Care 

The transition to adulthood is always difficult, but it is even harder for unaccompanied homeless youth and youth aging out of the foster care system, who usually have little or no support to help them navigate higher education, housing, and employment.53  

Youth in foster care and unaccompanied homeless youth disproportionately experience significant barriers to obtaining a high school diploma, entering college, obtaining a driver’s license, accessing health insurance, maintaining housing stability, and obtaining steady employment. Surveys have found high rates of homelessness and hunger among college students, especially among community college students,54 and a disproportionate number of these students are former foster youth. Recognizing these barriers, the vast majority of states allow for the extension of foster care through age 21,55 and other states have extended services to support these young people as they age out of care. In addition, states have passed laws to support college students experiencing homelessness,56 but more needs to be done.57 

Medicaid and SNAP help youth obtain critical health care and nutritional support, and access to these and other programs allows foster youth, former foster youth, and unaccompanied homeless youth to continue their education and pursue a path to self-sufficiency and economic mobility. In 2014, the Affordable Care Act extended Medicaid eligibility for youth formerly in the foster care system up to age 26. This extension created parity of coverage between former foster youth and non-foster youth, who are eligible to stay on their parent’s insurance until age 26. Unaccompanied homeless youth have also been able to enroll in health care, including Medicaid, under the ACA. Access to health coverage is vital to young people who have experienced trauma due to abuse and neglect. Due to their experiences, youth in care often have significant physical and mental health care needs.58 

Imposing mandatory Medicaid work requirements on childless adults will hurt foster youth, former foster youth, and unaccompanied homeless youth who already face significant barriers in their transition to adulthood. Students enrolled full-time in higher education classes will be burdened with trying to afford health care in addition to their studies. Imposing work requirements on foster youth and unaccompanied homeless youth for them to continue receiving health care undermines their ability to complete high school and attend college, and to secure housing and other necessities that set them up to succeed in the workforce.

Similarly, SNAP plays a significant role in the health and well-being of youth aging out of care and unaccompanied homeless youth with no support systems. Former foster youth often experience poor nutrition and food insecurity, and SNAP benefits help address this problem and increase the likelihood of healthy adult outcomes. Expanding and increasing work requirements to receive nutrition assistance will undermine the ability of these young people to survive and will exacerbate the unhealthy levels of stress they already feel. 

Policymakers must support these young people by extending the improvements made to the Earned Income Tax Credit (EITC) in 2021, which nearly tripled the amount of the credit for low-income workers and allowed foster and homeless youth to access the EITC starting at age 18 even while they were full-time students. Renewing these improvements would benefit many transition-age youth and prevent millions of low-wage, childless workers from being taxed into poverty. 

Conclusion

Every child should have a fair chance to thrive. Policies such as work requirements that limit access to health care and effective anti-poverty programs will impair the physical and mental health, nutrition, and educational success of the next generation. Policymakers must build on what works and promote policies that ensure that every child has access to health care, proper nutrition, stable housing, child care, and enough resources to support their healthy development. 

For additional information, please contact:  

Cara Baldari, VP of Family Economics, Housing, and Homelessness Policy,Carab@firstfocus.org 

Michelle Dallafior, Senior VP of Budget and Tax Policy, Michelled@firstfocus.org 

Abuko Estrada, VP of Medicaid and Child Health Policy, Abukoe@firstfocus.org Averi Pakulis, VP of Early Childhood and Public Health Policy, Averip@firstfocus.org

Please see the attachment for a full list of citations and endnotes.

The post The Harmful Consequences of Work Requirements and Other Obstacles to Aid for Children  appeared first on First Focus on Children.

Children don’t vote. They don’t have political action committees or lobbying power. They rely on adults to make decisions that safeguard their well-being and invest in their futures. Instead, Congress is targeting cuts and policy changes that limit access to health care, nutrition programs, and basic financial stability for millions of children. Cuts to Medicaid, Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), and other services that help keep children healthy and fed, and reduce child poverty are not just abstract accounting decisions — they’re acts of harm against the children and families who rely on these programs to survive.

Let’s be clear: children’s needs are already woefully underfunded. Despite making up roughly 23% of the U.S. population, children received just 8.87% of the federal budget in Fiscal Year (FY) 2024. This sum marks a significant decrease from the nearly 12% share we invested in children in FY 2021.

Systematic divestment has alarming and real world consequences. Child poverty more than doubled from 5.2% in 2021 to 13.7% in 2023 with the expiration of many critically important provisions included in the American Rescue Plan Act, such as an improved and expanded Child Tax Credit. Furthermore, nearly 5 million children have lost Medicaid coverage under the unwinding of pandemic protections, and the U.S. infant mortality rate increased for the first time in 20 years.

These trends are alarming for children and their future, and proposed federal budget cuts would accelerate them. The proposed Medicaid cuts would undoubtedly strip coverage, benefits, services, and access to care from low-income children, who are more susceptible to preventable illnesses and untreated chronic conditions. Reductions to TANF threaten the ability of struggling families to afford rent or child care. And SNAP cuts will exacerbate food insecurity, leaving children hungry in classrooms where they’re supposed to be learning.

We know better. Research shows that investments in children yield immense returns, not just for their individual well-being but for the nation as a whole. Children who grow up healthy, wellfed, and financially secure are more likely to stay in school, enter the workforce, and contribute meaningfully to society. Yet, Congress is taking a shortsighted approach, trading the future of millions of kids for fleeting fiscal savings.

This is not fiscal responsibility — it’s a failure of responsibility. When we undermine the foundation of childhood, we weaken the entire structure of our society. As we’ve said before: “It’s always cheaper to help children now than to clean up the damage later.”

This analysis will dissect these harmful proposals, explain how they disproportionately harm children, and make the case for a budget that values our youngest citizens. If we truly care about our nation’s future, we must stand against these cuts and demand a budget that prioritizes the health, safety, and potential of every child.

Medicaid Cuts and Their Impact on Children

Medicaid serves as a critical lifeline for millions of children providing essential health care services that support their growth and development. About half of children in the United States are covered by Medicaid or CHIP. However, recent policy proposals threaten to undermine this foundation, disproportionately affecting the most vulnerable members of our society.

Proposed Medicaid Cuts

The House Budget Committee has outlined options to reduce federal spending by up to $5.7 trillion over the next decade, with a large share of those cuts focused on Medicaid. According to KFF, the initially proposed level of cuts would represent nearly one-third of all Medicaid spending over 10 years.Such significant cuts would necessitate substantial changes to Medicaid’s structure and eligibility, including the introduction of arbitrary per capita caps or other limits on Medicaid funding, which have been shown to disproportionately harm children.

• Per Capita Caps: Per capita caps would fundamentally restructure the federal-state Medicaid partnership, allocating a set amount of federal funding for each Medicaid enrollee, regardless of the actual costs of the program.

By capping federal Medicaid funding and tying its growth to an amount that fails to keep up with healthcare cost inflation, per capita caps would shift unmanageable financing burdens to the states. This would leave states vulnerable to unexpected expenses for healthcare from events such as public health emergencies and natural disasters.

Per capita caps ultimately would force states to cut their budgets and ration care to Medicaid enrollees, especially children. This would likely result in a reduction to services and coverage, especially for children with special and complex healthcare needs. It would also lead states to cut healthcare provider rates, increasing provider shortages and potentially causing hospitals to close down with rural areas being hit the hardest.

• Reducing FMAP Floor: This change would shift substantial costs to states including

Colorado, New Jersey, Wyoming, and others that depend on the minimum FMAP rate of 50%. This shift in costs would lead to harsh cuts to Medicaid services and benefits for children and reimbursement to health care providers, such as pediatricians.

• D.C.-Specific FMAP: The District of Columbia’s FMAP is set at 70% due to high Medicaid needs among residents with low incomes. Reducing the District’s FMAP to 50% or lower would hurt the health of D.C.’s children, forcing the District to make significant cuts to eligibility, benefits, and provider payments.
• Imposing Work Requirements: Imposing work requirements as a condition of receiving Medicaid harms children, pregnant women and families and creates substantial losses in health coverage and access to care. Past implementation of work requirements has demonstrated that confusing rules, complex reporting systems and other bureaucratic red tape cause children and families to lose their health coverage. For example, in Arkansas, 18,000 Medicaid enrollees lost their coverage within the first seven months of the state implementing work requirements before a court order halted the program.

When parents lose benefits, evidence shows that children do too, making policies such as these harmful to children’s health and development. Moreover, the ramifications of losing coverage extend beyond health care to negatively impact financial security, employment, housing, and many other life factors for children and families.

• Reducing State Flexibility for Funding Medicaid: States rely on provider taxes as a critical mechanism to help finance their Medicaid programs. Losing this revenue would mean that states would be forced to reduce funding for services including pediatric services, leading to shortages in child-specific care such as neonatal care, pediatric intensive care units, and early intervention services for developmental delays.

The proposed Medicaid cuts pose significant risks to children’s health and well-being. As a society, we must recognize that decisions made in the name of fiscal responsibility should not come at the expense of our children’s future. Protecting and strengthening Medicaid is not only a moral imperative but also a sound investment in the nation’s long-term prosperity.

Health Insurance Marketplace Cuts and Their Impact on Children:

Over 2 million children are covered by health plans in the Health Insurance Marketplace. These children come from families who make too much to qualify for Medicaid or CHIP but who otherwise could not afford employer-sponsored coverage. Reinstating the “Family Glitch” and/or letting the enhanced level of Advanced Premium Tax Credits (APTCs) under the American Rescue Plan expire would result in hundreds of thousands of children losing their health care coverage and remaining uninsured. An estimate by the Urban Institute shows that the expiration of the enhanced APTCs alone would result in 287,000 uninsured children. With gaps in their coverage, these children would suffer severe consequences, including reduced access to necessary medical care, missed preventive services, and delayed developmental screenings, which can lead to poorer health outcomes in both the short and long term. Additionally, the loss of coverage exposes their families to high medical costs and potentially catastrophic medical debt.

TANF Cuts and Their Impact on Children

The TANF program is a federal block grant designed to provide financial assistance and support services to low-income families with children. Established in 1996, TANF aims to promote selfsufficiency through work requirements and time-limited assistance. However, recent policy proposals and longstanding funding issues threaten to undermine the program’s effectiveness, disproportionately affecting children, who constitute nearly 70% of TANF recipients.

Stagnant Funding and Inflation Erosion

Since its inception, the TANF block grant has been set at $16.5 billion annually, with no adjustments for inflation or population growth. As a result, the real value of TANF funding has declined by 49% from 1997 to 2024, significantly reducing its purchasing power and the ability of states to assist needy families.

Proposed Budget Cuts and Policy Changes

Recent budget proposals, such as those outlined in Project 2025, suggest further reductions to TANF funding and expansions of work requirements. These changes could exacerbate existing challenges within the program:

• Reduced Funding: Cuts to TANF would limit states’ capacity to provide cash assistance and essential services, potentially increasing child poverty and family instability. Eliminating the Contingency Fund, which is designed to respond during times of economic downturn, would hurt families when they are in most need of support.
• Expanded Work Requirements: Nearly 30 years of evidence show that TANF’s work requirements have failed to improve employment outcomes for program participants. Instead of promoting family economic mobility, TANF’s work requirements lead to decreased participation in the program, depriving children of critical assistance.

Impact on Children

Children are the most vulnerable to the adverse effects of TANF funding reductions and policy changes:

• Increased Poverty: With diminished financial support, more families may fall below the poverty line, leading to long-term negative outcomes for children, including poorer health and educational attainment.
• Limited Access to Services: States may be forced to cut back on supportive services such as child care and job training, which are crucial for parents striving to achieve self-sufficiency while providing a stable environment for their children.

The erosion of TANF’s funding and the potential for further cuts pose significant risks to the well-being of millions of children in low-income families. To uphold this nation’s commitment to supporting vulnerable populations, it is imperative to reassess and strengthen TANF’s structure and funding, ensuring it effectively serves the families and children who depend on it.

Cuts to Child Nutrition and Their Impact on Children

The Supplemental Nutrition Assistance Program (SNAP) is the nation’s largest anti-hunger program, providing vital food assistance to low-income families. In 2022 alone, over 15 million children benefited from SNAP, representing nearly half of all recipients. By alleviating food insecurity, SNAP lays the groundwork for better health, education, and long-term outcomes for children. However, recent proposals to cut SNAP funding and impose stricter eligibility requirements threaten to undermine these essential benefits, disproportionately harming children in the process.

How SNAP Benefits Children

SNAP’s effectiveness in improving outcomes for children is well-documented:

Health:

• Studies show that children in households receiving SNAP are healthier and less likely to be hospitalized due to malnutrition or preventable illnesses.
• SNAP benefits during pregnancy are associated with reduced rates of low birth weight and infant mortality.

Education:

• Food security provided by SNAP ensures that children can focus on learning rather than hunger. Research shows that SNAP participation leads to better academic performance and fewer behavioral problems in school.

Long-Term Benefits:

• Children who grow up in SNAP households are more likely to achieve higher earnings as adults and less likely to rely on public assistance programs in the future, creating a ripple effect of societal benefits.

Potential Impact of SNAP Cuts on Children

Proposed cuts and eligibility restrictions could unravel these gains, resulting in:

Increased Food Insecurity:

• SNAP kept over 3.7 million children out of poverty in 2021 alone. Reductions in benefits would likely reverse this progress, leaving more children hungry.

Worse Health Outcomes:

• Malnutrition during critical developmental years can lead to long-term health issues, such as stunted growth, obesity, and chronic diseases like diabetes.

Educational Setbacks:

• Hunger directly affects children’s ability to concentrate, learn, and succeed in school, jeopardizing their future opportunities.

SNAP is a cornerstone of America’s commitment to reducing child hunger and poverty, with decades of evidence supporting its effectiveness. Weakening SNAP benefits would disproportionately harm children, pushing many into deeper hardship and undermining their ability to succeed. Policymakers must recognize that an investment in SNAP is an investment in the nation’s future. Cutting this lifeline is not only unjust but also economically short-sighted.

New Barriers to School Meals

School meal programs, including the National School Lunch Program (NSLP) and the School Breakfast Program (SBP), provide millions of low-income children with nutritious meals, ensuring they have the energy and focus needed to succeed in school.

Proposed Changes:

1. Income Verification Requirements: A new proposal would require additional proof of income for families applying for free or reduced-price meals, creating administrative hurdles that could deter eligible families from applying.
2. Stricter Community Eligibility Provision (CEP) Standards: Raising the threshold for schools to qualify for universal free meals from 40% to 60% of students in poverty would make it harder for schools in low-income areas to provide free meals to all students.

Impact on Children:

• Increased paperwork and verification processes could lead to eligible children missing out on crucial nutrition.
• Many schools serving low-income communities would lose their ability to offer free meals to all students, resulting in fewer children receiving healthy meals during the school day.
• Hunger affects academic performance, increasing absenteeism and lowering test scores among food-insecure students.

Placing additional barriers to school meal programs would deepen child hunger and widen educational disparities for low-income children.

Additional Cuts That Threaten Children’s Well-Being

While proposed cuts to Medicaid, TANF, and SNAP present immediate threats to children’s health and economic stability, additional budget proposals targeting key safety-net programs would further erode the support systems that millions of children rely on. These proposed cuts would exacerbate the already shrinking share of federal investment in children, leaving families with fewer resources to provide for their basic needs and jeopardizing children’s long-term well-being.

Eliminating the Social Services Block Grant (SSBG)

The Social Services Block Grant (SSBG) provides states with flexible funding to support programs that protect and promote the well-being of vulnerable populations, particularly children in lowincome families. States use SSBG funds for critical services such as:

• Child welfare programs, including foster care and child protective services.
• Child care assistance to help working parents stay employed.
• Services for children with disabilities and those at risk of neglect or abuse.

Proposed Cut: The House proposes eliminating the SSBG, citing concerns over inefficiency and duplication with other federal programs.

Impact on Children:

• Without SSBG funding, states would be forced to cut or scale back vital child welfare services, increasing the risk of abuse, neglect, and homelessness for vulnerable children.
• Child care support, a key factor in enabling parents to work and provide stable homes, would be significantly reduced, forcing many low-income parents to choose between work and caregiving.
• Children in foster care or at risk of placement could see fewer resources available to support their transition to stable, permanent homes.

Tightening SSI eligibility requirements would make it harder for families to care for children with disabilities, potentially pushing them further into poverty and deepening existing health and economic disparities.

Push for Private School Vouchers:

In addition to the items posted in the proposed federal budget cuts, First Focus on Children remains concerned by the possibility of a private school voucher program being pushed through reconciliation. We have concerns that a tax-credit incentive for donations to private schools could be included in a reconciliation package. First Focus on Children opposes private school voucher programs and believes the inclusion of this measure in a reconciliation package would harm the 90% of students who attend public schools.

• Voucher programs often do not provide non-discrimination protections, meaning that students could be discriminated against in the schools they attend for reasons including disability status or sexual orientation.
• Voucher programs often lack accountability measures, and private school voucher programs have previously paid for expenses such as espresso machines and Disney tickets, while stripping funds from public schools.
• School voucher programs are particularly harmful to low-income and rural schools, hurting some of the students who need education support the most.

Tax Policy Changes that Harm Children to Pay for Benefits for Billionaires

The tax code offers one of the strongest tools for improving the lives of children. Tax reforms that ensure everybody pays their fair share, would raise revenue to invest in children’s health, safety and well-being. In addition to raising the necessary revenue to fund critical children’s programs, tax policy also offers direct support to children and families. In 2023, the refundable portion of the Child Tax Credit prevented 1.34 million children from experiencing poverty and households receiving the CTC payments saw food insecurity rates drop by over 6 percentage points from December 2020 to December 2021.

Proposed Adverse Changes by House Leaders:

1. Limit the availability of the CTC to households in which both the children and the tax filer have Social Security numbers
2. Eliminate the Head of Household filing status
3. Eliminate the American Opportunity Tax Credit
4. Eliminate the Child and Dependent Care Tax Credit
5. Repeal the Inflation Reduction Act’s IRS funding

Impact on Children:

• Prior to the passage of the 2017 tax law, households filing for the CTC needed to have an Individual Taxpayer Identification Number (ITIN) to be eligible for the credit. The passage of the 2017 law changed the requirements through 2025 and only children with a Social Security number now qualify for the CTC. Limiting availability of the CTC to households in which both parents and children have social security numbers would deny millions of children the credit. As of 2018, 4.4 million U.S. citizen children under age 18 lived with at least one undocumented parent and would no longer be eligible for the CTC.
• Eliminating the Head of Household filing status would impact millions of tax payers, many of them single parents. In 2021 over 21 million filers used the Head of Household filing status. Created in 1951, the head of household filing status offers preferential tax benefits for unmarried adults with dependents. This filing status recognized the high and rising costs of raising children and/or supporting other qualifying family members by offering a larger standard deduction and wider tax brackets compared to single or married individuals filing separately, but less than the deduction for married couples filing jointly. According to the National Women’s Law Center, government data shows that the majority of single parents who use this filing status are women. Millions of single mothers and their children would face a reduction in household income with this tax increase if the head of household status is eliminated, including middle-income single parents and their children.
• The American Opportunity Tax Credit is a partially refundable tax credit that provides financial assistance to taxpayers (or their children) for students enrolled in post-secondary education programs. According to the Congressional Research Service, the credit primarily benefits low- and middle-income families: 46.6% of AOTC benefits go to families with incomes between $30,000 and $100,000 with the refundable portion of the credit benefitting lower income earners with little or no tax liability. For example, in 2015, more than half (55.3%) of the refundable portion of the credit was claimed by taxpayers with less than $20,000 in income.
• Eliminating the Child and Dependent Care Credit would harm children whose parents rely on the targeted credit to support the high cost of child care. For far too many families the cost of child care is prohibitive. According to the U.S. Department of Labor (DOL), U.S. families spend between 8.9% and 16.0% of their median income on full-day care for just one child and that figure varies widely depending on the age of the child, population size of the county, and type of care provided. Even with the high cost of child care, DOL estimates nearly 14 million parents rely on paid caregivers. The U.S. economy loses $122 billion per year in lost revenue, earnings, and productivity due to child care challenges faced by families. Eliminating this credit for families will harm their economic well-being and the U.S. economy by exacerbating the current child care crisis.
• Slashing funding for the IRS would result in delayed refunds, slower service for taxpayers and businesses, and would increase the deficit. With additional resources granted under the Inflation Reduction Act, the IRS has taken action to improve customer service, ensure the wealthiest and corporations pay what they owe in taxes, and reduce the deficit. Over the last two years, the IRS collected more than $1.1 billion from 1,600 millionaires who had not paid tax debts and launched more digital tools than it had in the 20 years prior. One such tool is Direct File, which allows certain taxpayers to file for free online directly with the IRS. According to the IRS, there were 140,000 users of the pilot program and more than $90 million was claimed in refunds and an estimated $5.6 million in savings on tax preparation fees.

Taking Assistance from Immigrant Families

Proposed Changes:

Reinstating the Public Charge policy first proposed by the Trump Administration in 2018, which makes changes to long-standing, bipartisan immigration policy known as “public charge.” The changes would allow government officials to consider the use of an applicant’s broad range of services such as health care, nutrition assistance, and housing assistance when determining eligibility for green cards or lawful admission to the U.S.

Impact on Children:

No family should fear seeking health care, food, child care, housing, or other support their child needs. Although the vast majority of children with an immigrant parent are U.S. citizens and are not subject to restricted access to benefits, their access to health care, housing, nutrition, and income support is affected if one or both parents are ineligible for benefits or if families have concerns about how applying for benefits could impact their legal status. Government policies must not impose unnecessary barriers or create fear in children and families seeking access to public benefits that support children’s well-being.

Why These Cuts Are Shortsighted

The proposed budget cuts targeting critical safety-net programs for children are not just cruel — they are shortsighted and economically self-defeating. Children represent our nation’s future workforce, innovators, and leaders, yet they remain one of the most underfunded and overlooked groups in federal spending. Despite mountains of evidence showing that investing in children yields substantial long-term economic and social benefits, lawmakers continue to prioritize shortterm fiscal austerity over the well-being of future generations.

This approach is not only morally indefensible, it also ignores the overwhelming body of research proving that failing to invest in children today will result in higher costs to society tomorrow — increased health care expenses, higher rates of incarceration, and lost economic productivity.

In other words, when we fail our children, we ultimately fail our nation.

Economic Returns on Investments in Children

The data is clear: investments in children’s health, nutrition, and early education generate longterm economic benefits that far outweigh the upfront costs. Consider the following:

• Medicaid: Children who receive Medicaid are healthier as adults, have higher educational attainment, and earn more over their lifetimes, ultimately contributing more in taxes. An analysis by Nathaniel Hendren and Ben Sprung-Keyser found that for each dollar spent on children’s health coverage, the government receives a $1.78 return.
• SNAP: Providing children with adequate nutrition through programs such as  SNAP reduces long-term health care costs by preventing diet-related illnesses such as diabetes and heart disease. SNAP participation in childhood is linked to fewer days of missed school, improved overall health, higher high school graduation rates, and improved earnings as adults.
• Early Childhood Education: Programs such as Head Start have been shown to improve cognitive skills, increase high school graduation rates, and reduce future dependence on public assistance. Research indicates that every $1 invested in high-quality early education yields a return of $4 to $16 through improved life outcomes.

Cutting these programs risks reversing decades of progress and forfeiting the immense economic potential of future generations.

The Long-Term Cost of Child Poverty

Child poverty is not just a policy decision — it is an economic liability. When children grow up in poverty, they are more likely to experience poor health, struggle in school, and require government assistance as adults. The costs associated with child poverty in the United States are staggering, estimated at up to $1.1 trillion annually in lost productivity, increased health care spending, and higher crime rates, according to the National Academy of Sciences, Engineering, and Medicine (NASEM).

Instead of addressing child poverty, the proposed budget cuts will:

• Increase reliance on emergency services, such as emergency room visits for preventable conditions due to loss of Medicaid coverage.
• Lead to higher rates of homelessness and hunger, pushing more families into deep poverty and forcing children to grow up in unstable environments.
• Worsen educational disparities, as hungry, unhealthy children struggle to succeed in school and eventually in the workforce.

Investing in children today prevents these long-term costs and helps break the cycle of poverty that burdens families, communities and the nation as a whole.

Shortchanging Children Is Shortsighted

A budget that sacrifices children’s well-being to maintain tax cuts and entitlement spending for wealthier populations is a profoundly shortsighted and unjust trade-off.

The evidence is overwhelming: cutting investments in children is a costly mistake. Policymakers should recognize the return on investment these programs provide and prioritize children in the federal budget.

It’s time to reframe our thinking. Children are not just another line item in the budget — they are our most valuable asset. If we are serious about securing our nation’s future, we must invest in it today by ensuring every child has the opportunity to thrive, contribute, and succeed.

A budget that values children is a budget that values the future. Congress must put children first.

Children Deserve a New Vision for Their Future

Congress must recognize that investing in children is not an expense but a contribution to our collective future. Lawmakers should:

• Reject Harmful Cuts: Oppose reductions to Medicaid, TANF, SNAP, and other initiatives that would leave millions of children without health care, food, financial support, early childhood, child care, or social services.
• Increase Federal Investment in Children: Ensure that children receive their fair share of federal spending, reversing the trend of declining investments in programs that support their well-being.
• Strengthen Existing Investments: Expand access to critical services and improve program efficiency without erecting additional barriers for struggling families.
• Adopt a Children’s Budget Target: Commit to adopting a federal budget that no longer shortchanges and disproportionately cuts investment in children and our future.

Elected officials must ensure that policy decisions reflect our values and future aspirations.

Advocates will ask and answer, “Who’s for kids, and who’s just kidding?”

A Vision for a Child-Centered Future

Children deserve a country where every child has access to health care, nutritious food, and education. A nation where no child grows up in poverty, and where investments in early childhood programs lay the foundation for lifelong success.

This vision is achievable if we choose to prioritize children in our budget and policy decisions. Investing in children today means building a stronger, healthier, and more prosperous America tomorrow.

Instead of asking, “How much does it cost to invest in children?”, we should be asking, “How much will it cost if we don’t?”

Only then will the United States be a country that truly puts its children first.

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