tag:theconversation.com,2011:/fr/topics/safety-net-2185/articlesSafety net – The Conversation2024-03-18T12:24:52Ztag:theconversation.com,2011:article/2232702024-03-18T12:24:52Z2024-03-18T12:24:52ZFree school meals for all may reduce childhood obesity, while easing financial and logistical burdens for families and schools<figure><img src="https://images.theconversation.com/files/580529/original/file-20240307-16-nylyj3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">School meal waivers that started with the COVID-19 pandemic stopped with the end of the public health emergency.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/plymouth-ma-a-student-at-plymouth-county-intermediate-news-photo/1242013592">Jonathan Wiggs/The Boston Globe via Getty Images</a></span></figcaption></figure><p>School meals are critical to child health. Research has shown that <a href="https://doi.org/10.3390/nu9090924">school meals can be more nutritious</a> than meals from other sources, such as meals brought from home. </p>
<p>A recent study that one of us conducted found the quality of school meals has steadily improved, especially since the 2010 <a href="https://doi.org/10.1001/jama.2020.9517">Healthy, Hunger-Free Kids Act</a> strengthened nutrition standards for school meals. In fact, by 2017, another study found that school meals provided the <a href="https://doi.org/10.1001/jamanetworkopen.2021.5262">best diet quality</a> of any major U.S. food source.</p>
<p>Many American families became familiar with universal free school meals during the COVID-19 pandemic. To ease the financial and logistical burdens of the pandemic on families and schools, the <a href="https://www.fns.usda.gov/coronavirus">U.S. Department of Agriculture issued waivers</a> that allowed schools nationwide to provide free breakfast and lunch to all students. However, these <a href="https://www.fns.usda.gov/cn/offsite-monitoring-after-phe#">waivers expired</a> by the 2022-23 school year. </p>
<p>Since that time, there has been a substantial increase in schools participating in the <a href="https://www.fns.usda.gov/cn/community-eligibility-provision">Community Eligibility Provision</a>, a federal policy that allows schools in high poverty areas to provide free breakfast and lunch to all attending students. The policy became available as an option for low-income schools nationwide in 2014 and was part of the <a href="https://obamawhitehouse.archives.gov/sites/default/files/Child_Nutrition_Fact_Sheet_12_10_10.pdf">Healthy, Hunger-Free Kids Act</a>. By the 2022-23 school year, <a href="https://frac.org/cep-report-2023">over 40,000 schools</a> had adopted the Community Eligibility Provision, an increase of more than 20% over the prior year.</p>
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<figcaption><span class="caption">Many families felt stressed when a federal program providing free school meals during the pandemic came to an end.</span></figcaption>
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<p>We are <a href="https://scholar.google.com/citations?user=ihU7JuoAAAAJ&hl=en">public health</a> <a href="https://scholar.google.com/citations?user=VkqyJPcAAAAJ&hl=en">researchers who</a> study the health effects of nutrition-related policies, particularly those that alleviate poverty. Our newly published research found that the Community Eligibility Provision was associated with a net <a href="https://doi.org/10.1542/peds.2023-063749">reduction in the prevalence of childhood obesity</a>.</p>
<h2>Improving the health of American children</h2>
<p>President Harry Truman <a href="https://www.fns.usda.gov/nslp/nslp-fact-sheet">established the National School Lunch Program</a> in 1946, with the stated goal of protecting the health and well-being of American children. The program established permanent federal funding for school lunches, and participating schools were required to provide free or reduced-price lunches to children from qualifying households. Eligibility is <a href="https://www.fns.usda.gov/cn/fr-020923">determined by income</a> based on federal poverty levels, both of which are <a href="https://www.federalregister.gov/documents/2024/01/17/2024-00796/annual-update-of-the-hhs-poverty-guidelines#">revised annually</a>.</p>
<p>In 1966, the <a href="https://www.fns.usda.gov/cna-amended-pl-111-296">Child Nutrition Act</a> piloted the <a href="https://www.fns.usda.gov/sbp/program-history">School Breakfast Program</a>, which provides free, reduced-price and full-price breakfasts to students. This program was later made permanent through an amendment in 1975.</p>
<p>The <a href="https://www.fns.usda.gov/cn/community-eligibility-provision">Community Eligibility Provision</a> was piloted in several states beginning in 2011 and became an option for eligible schools nationwide beginning in 2014. It operates through the national school lunch and school breakfast programs and expands on these programs.</p>
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<a href="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Gloved hand placing cheese slices on bun slices" src="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Various federal and state programs have sought to make food more accessible to children.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/cafeteria-worker-puts-together-sandwiches-for-free-meals-as-news-photo/1213018954">John Moore/Getty Images</a></span>
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<p>The policy allows all students in a school to receive free breakfast and lunch, rather than determine eligibility by individual households. Entire schools or school districts are eligible for free lunches if at least 40% of their students are directly certified to receive free meals, meaning their household participated in a means-based safety net program, such as the <a href="https://fns-prod.azureedge.us/sites/default/files/resource-files/NSLPDirectCertification2016.pdf">Supplemental Nutrition Assistance Program</a>, or the child is identified as runaway, homeless, in foster care or enrolled in Head Start. Some states also <a href="https://www.fns.usda.gov/cn/direct-certification-medicaid-demonstration-project">use Medicaid for direct certification</a>.</p>
<p>The Community Eligibility Provision increases school meal participation by <a href="https://doi.org/10.2105/AJPH.2011.300134">reducing the stigma</a> associated with receiving free meals, eliminating the need to complete and process applications and extending access to students in households with incomes above the eligibility threshold for free meals. As of 2023, the eligibility threshold for free meals is 130% of the federal poverty level, which amounts to US$39,000 for a family of four.</p>
<h2>Universal free meals and obesity</h2>
<p>We analyzed whether providing universal free meals at school through the Community Eligibility Provision was associated with lower childhood obesity before the COVID-19 pandemic.</p>
<p>To do this, we measured <a href="https://doi.org/10.1542/peds.2023-063749">changes in obesity prevalence</a> from 2013 to 2019 among 3,531 low-income California schools. We used over 3.5 million body mass index measurements of students in fifth, seventh and ninth grade that were taken annually and aggregated at the school level. To ensure rigorous results, we <a href="https://doi.org/10.1016/j.jeconom.2020.12.001">accounted for differences</a> between schools that adopted the policy and eligible schools that did not. We also followed the same schools over time, comparing obesity prevalence before and after the policy.</p>
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<a href="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child scooping food from salad bar onto a tray; other children lean against the wall" src="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=381&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=381&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=381&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=479&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=479&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=479&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Free school meals may help reduce health disparities among marginalized and low-income children.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/westbrook-middle-school-fifth-grade-student-salem-bukasa-news-photo/469592304">Whitney Hayward/Portland Portland Press Herald via Getty Images</a></span>
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<p>We found that schools participating in the Community Eligibility Provision had a <a href="https://doi.org/10.1542/peds.2023-063749">2.4% relative reduction</a> in obesity prevalence compared with eligible schools that did not participate in the provision. Although our findings are modest, even small improvements in obesity levels are notable because effective strategies to reduce obesity at a population level <a href="https://doi.org/10.1038/s41574-019-0176-8">remain elusive</a>. Additionally, because obesity <a href="http://dx.doi.org/10.15620/cdc:106273">disproportionately affects</a> racially and ethnically marginalized and low-income children, this policy could contribute to reducing health disparities.</p>
<p>The Community Eligibility Provision likely reduces obesity prevalence by substituting up to half of a child’s weekly diet with healthier options and simultaneously <a href="https://doi.org/10.1016/j.jhealeco.2022.102646">freeing up more disposable income</a> for low-to-middle-income families. Families receiving free breakfast and lunch save approximately $4.70 per day per child, or $850 per year. For low-income families, particularly those with multiple school-age children, this could result in meaningful savings that families can use for other health-promoting goods or services.</p>
<h2>Expanding access to school meals</h2>
<p>Childhood obesity <a href="https://doi.org/10.1542/peds.2021-053708">has been</a> <a href="https://doi.org/10.1001/jama.2020.14590">increasing over</a> the past several decades. Obesity often <a href="https://doi.org/10.1111/obr.12334">continues into adulthood</a> <a href="https://theconversation.com/obesity-in-children-is-rising-dramatically-and-it-comes-with-major-and-sometimes-lifelong-health-consequences-202595">and is linked</a> to a range of <a href="https://doi.org/10.2105/ajph.2016.303326">chronic health conditions and premature death</a>. </p>
<p>Growing research is showing the benefits of universal free school meals for the health and well-being of children. Along with our study of California schools, other researchers have found an association between universal free school meals and reduced obesity in <a href="https://doi.org/10.1086/723824">Chile</a>, <a href="https://doi.org/10.1016/j.ssmph.2022.101072">South Korea</a> and <a href="https://doi.org/10.1016/j.pubecp.2022.100016">England</a>, as well as among <a href="https://doi.org/10.1002/pam.22175">New York City schools</a> and school districts in <a href="https://doi.org/10.1162/edfp_a_00380">New York state</a>.</p>
<p>Studies have also linked the Community Eligibility Provision to <a href="https://doi.org/10.3368/jhr.57.3.0518-9509R3">improvements in academic performance</a> and <a href="https://doi.org/10.3102/00028312231222266">reductions in suspensions</a>.</p>
<p>While our research observed a reduction in the prevalence of obesity among schools participating in the Community Eligibility Provision relative to schools that did not, obesity increased over time in both groups, with a greater increase among nonparticipating schools.</p>
<p>Universal free meals policies may slow the rise in childhood obesity rates, but they alone will not be sufficient to reverse these trends. Alongside universal free meals, identifying <a href="https://theconversation.com/fixing-the-global-childhood-obesity-epidemic-begins-with-making-healthy-choices-the-easier-choices-and-that-requires-new-laws-and-policies-207975">other population-level strategies</a> to reduce obesity among children is necessary to address this public health issue.</p>
<p>As of 2023, <a href="https://www.americanprogress.org/article/5-states-addressing-child-hunger-and-food-insecurity-with-free-school-meals-for-all/">several states have implemented their own</a> universal free school meals policies. States such as California, Maine, Colorado, Minnesota and New Mexico have pledged to cover the difference between school meal expenditures and federal reimbursements. As more states adopt their own universal free meals policies, understanding their effects on child health and well-being, as well as barriers and supports to successfully implementing these programs, will be critical.</p><img src="https://counter.theconversation.com/content/223270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Jones-Smith receives funding from the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Anna Localio does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Since nutrition standards were strengthened in 2010, eating at school provides many students with healthier food than is available cheaply elsewhere. Plus, reducing stigma increases the number of kids getting fed.Anna Localio, Ph.D. Candidate in Health Services, University of WashingtonJessica Jones-Smith, Associate Professor of Health Systems and Population Health, Epidemiology, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2235212024-03-05T14:01:43Z2024-03-05T14:01:43ZMichigan Gov. Whitmer proposes a caregiver tax credit − an idea many Americans support<figure><img src="https://images.theconversation.com/files/578799/original/file-20240229-24-loeyq2.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C2302%2C1285&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As the population of older adults in the U.S. grows, more people need care.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/comforting-hand-on-shoulder-of-man-royalty-free-image/1576851402?phrase=elderly&adppopup=true">seb_ra/via Getty Images</a></span></figcaption></figure><p>People caring for elderly or disabled relatives need a break – and, in Michigan, Gov. Gretchen Whitmer has a proposal to give them one.</p>
<p>Whitmer’s <a href="https://www.bridgemi.com/michigan-government/whitmer-seeks-5000-tax-credit-michigan-caregivers-how-much-will-it-help">recently proposed US$5,000 tax credit</a>, the Caring for MI Family Tax Credit, is part of a growing trend of public subsidies for families shouldering the responsibilities of caring for family members. </p>
<p>Americans strongly endorse the idea that families, not the government or other organizations, are responsible for providing care for family members. They especially endorse <a href="https://www.pewresearch.org/social-trends/2023/09/14/family-responsibilities/">adult children</a> providing care for their aging parents. </p>
<p>That may help explain why family members are the main and sometimes only <a href="https://www.aei.org/wp-content/uploads/2020/11/Paid-Leave-for-Caregiving.pdf">caregivers for older adults</a> and others with <a href="https://www.aarp.org/caregiving/home-care/info-2023/caregiving-for-your-adult-disabled-child.html">long-term care needs</a> in the United States.</p>
<p>We are researchers who study <a href="https://scholar.google.com/citations?user=ytD3n0IAAAAJ&hl=en&oi=ao">families</a> and <a href="https://scholar.google.com/citations?user=ruC6veMAAAAJ&hl=en&oi=ao">caregiving</a>. Our <a href="https://doi.org/10.1177/23780231231225574">recent study</a> finds that when given a choice between family, government or other care providers, many Americans think family should provide care but the government should pay for it.</p>
<p>Caregiving costs can be substantial. On average, a caregiver in Michigan can expect to spend over <a href="https://states.aarp.org/michigan/supporting-family-caregivers-in-michigan">$7,000 out of pocket</a> per year. One study estimates the cost of care for a person with dementia are even higher, ranging <a href="https://doi.org/10.1111/j.1525-1497.2001.10123.x">from $3,000 to $17,000</a>, depending on the severity of the disease. Another estimate that accounts for the total impact of caregiving, including costs such as lost wages and the impact on caregiver’s health, puts the personal expense of caring for a loved one at roughly <a href="https://ldi.upenn.edu/our-work/research-updates/a-comprehensive-measure-of-the-costs-of-caring-for-a-parent-differences-according-to-functional-status/">$90,000 a year</a>. </p>
<p>Despite this steep price, <a href="https://doi.org/10.1111%2F1468-0009.12567">few federal governmental programs</a> address caregivers’ financial burdens. </p>
<p>In response, states have begun to pass their own policies, like <a href="https://www.ncsl.org/labor-and-employment/state-family-and-medical-leave-laws">paid leave</a> in states such as California, Washington and Massachusetts, and, increasingly, <a href="https://www.taxpolicycenter.org/taxvox/are-tax-credits-best-way-subsidize-long-term-care-costs">tax credit policies</a> like Whitmer’s proposal in Michigan.</p>
<h2>Helping to offset, reduce costs</h2>
<p>Currently, <a href="https://ltsschoices.aarp.org/scorecard-report/2023/dimensions-and-indicators/state-caregiver-tax-credits#:%7E:text=Six%20states%20(Georgia%2C%20Missouri%2C,one%20activity%20of%20daily%20living.">six states</a> – Montana, North Dakota, Missouri, Georgia, South Carolina and New Jersey – offer a tax credit to offset <a href="https://doi.org/10.1080/08959420.2022.2127599">the costs of caregiving</a>. </p>
<p>The credit can be used to cover home modifications such as ramps or bathroom grab bars, assistive devices such as a cane or walker, or to pay a professional care worker.</p>
<p>Whitmer’s proposal is generous compared with other states. For example, <a href="https://support.taxslayer.com/hc/en-us/articles/360015705352-Georgia-Qualified-Caregiving-Expense-Credit">Georgia’s caregiving tax credit</a> reimburses up to 10% of costs, with a cap of $150.</p>
<h2>A needed break</h2>
<p>The proposed Michigan tax credit would support counseling, transportation and nursing or respite services that pay a caregiver to come help so the family caregiver can have a break.</p>
<p>These types of services <a href="https://doi.org/10.1017/s1041610218000686">delay transitions into nursing homes</a>, which helps <a href="https://doi.org/10.1093/geroni/igz040">keep costs down for Medicaid</a> and individual <a href="https://doi.org/10.1016/j.jamda.2023.09.010">monthly out-of-pocket spending</a>.</p>
<p>Respite care use has become <a href="https://doi.org/10.1093/geront/gnx093">more common over the past two decades</a>, especially among families providing care for older adults with dementia. However, many caregivers are unable to access these services. One barrier is <a href="https://doi.org/10.1093/geront/gnz095">the cost</a>, which averages <a href="https://www.genworth.com/aging-and-you/finances/cost-of-care.html/">$29 per hour</a>. </p>
<h2>Public support for caregivers increasing</h2>
<p>Recent polls show that a majority of Americans want Medicare, the federal program that provides health care to people over 65, to help cover <a href="https://www.longtermcarepoll.org/visualizing-support-for-greater-government-role-in-health-care-for-older-adults/">the cost of long-term care</a>. </p>
<p>In terms of what supports should be made available to caregivers, <a href="https://doi.org/10.1177/0164027501233004">tax credits</a> receive the greatest public support relative to other programs, such as unpaid time off. </p>
<p>A recent AARP study of registered voters ages 50 and older found 8 in 10 people support a $5,000 annual <a href="https://www.aarp.org/research/topics/care/info-2021/caregiving-tax-credit-in-home-care-bipartisan-support.html">caregiver tax credit</a>. Another study of voters of all ages found similar support for expanding the <a href="https://economicsecurityproject.org/resource/polls-support-for-eitc-with-automatic-filing-caregiver-credit/">earned income tax credit</a> to include family caregivers.</p>
<p>Evidence suggests that tax credits implemented in Arizona and Idaho in a three-year test of the program in the early 1980s had the desired effect – <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195118/">more care by family members</a> and a reduced use of formal care. Paid leave in California is also associated with a reduction in <a href="https://doi.org/10.1002/pam.22038">nursing home usage</a>. </p>
<p>The benefit of the Caring for MI Family Tax Credit will depend in large part on the details and design of the policy. A refundable tax credit will provide greatest benefit to low-income households.</p>
<p>A similar federal bill, the <a href="https://www.congress.gov/bill/117th-congress/house-bill/3321">Credit for Caring Act</a>, has been introduced in Congress. If passed, the legislation would provide a federal tax credit for working family caregivers to cover 30% of expenses incurred above $2,000. </p>
<p>And other <a href="https://www.ftb.ca.gov/tax-pros/law/legislation/2019-2020/AB2136-021020.pdf">states such as California</a> are also considering introducing tax credits to help offset the cost of caregiving. </p>
<p>The population of <a href="https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html">Americans over 65 is increasing</a>, <a href="https://aspe.hhs.gov/reports/most-older-adults-are-likely-need-use-long-term-services-supports-issue-brief-0">meaning more people</a> will need caregiving in the near future.</p>
<p>The introduction of these bills reflects Americans’ growing support for new solutions to defray the costs associated with providing care to a loved one.</p><img src="https://counter.theconversation.com/content/223521/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah E. Patterson receives funding from the National Institute on Aging (NIA). She volunteers with the Alzheimer's Association in Michigan. </span></em></p><p class="fine-print"><em><span>Ariana Reyes receives funding from the National Institute on Aging (NIA). </span></em></p>Michigan Gov. Gretchen Whitmer’s proposed tax credit is part of a trend toward public support for family caregiving.Sarah E. Patterson, Research Investigator at the Survey Research Center at the Institute of Social Research, University of MichiganAdriana Reyes, Assistant Professor of Public Policy, Cornell UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2186822024-02-21T13:19:25Z2024-02-21T13:19:25ZMarriage is not as effective an anti-poverty strategy as you’ve been led to believe<figure><img src="https://images.theconversation.com/files/575664/original/file-20240214-26-6cr98q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite the popular guidance, marriage can be an economic risk for single parents with unstable partners.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/divorce-process-royalty-free-image/1329914655">simarik/iStock/Getty Images Plus</a></span></figcaption></figure><p>Brides.com predicts that 2024 will be the “<a href="https://www.brides.com/marriage-proposal-boom-2024-8358024">year of the proposal</a>” as engagements tick back up after a pandemic-driven slowdown.</p>
<p>Meanwhile, support for marriage has found new grist in recent books, including <a href="https://sociology.as.virginia.edu/people/w-bradford-wilcox">sociologist</a> Brad Wilcox’s “<a href="https://www.amazon.com/Get-Married-Americans-Families-Civilization/dp/0063210851">Get Married: Why Americans Must Defy the Elites, Forge Strong Families and Save Civilization</a>” and economist Melissa Kearney’s “<a href="https://press.uchicago.edu/ucp/books/book/chicago/T/bo205550079.html">The Two-Parent Privilege</a>.”</p>
<p>Kearney’s book was <a href="https://www.city-journal.org/article/review-of-the-two-parent-privilege-by-melissa-kearney">hailed by economist Tyler Cowen</a> as possibly “the most important economics and policy book of this year.” This is not because it treads new ground but because, as author <a href="https://www.city-journal.org/article/review-of-the-two-parent-privilege-by-melissa-kearney">Kay Hymowitz writes</a>, it breaks the supposed “taboo about an honest accounting of family decline.” </p>
<p>These developments are good news for the marriage promotion movement, which <a href="https://www.dol.gov/general/aboutdol/history/webid-moynihan">for decades</a> has claimed that marriage supports children’s well-being and combats poverty. The movement dates back at least to the U.S. Department of Labor’s <a href="https://www.dol.gov/general/aboutdol/history/webid-moynihan">Moynihan Report of 1965</a>, which argued that <a href="https://www.theatlantic.com/politics/archive/2015/09/the-moynihan-report-an-annotated-edition/404632/">family structure aggravated Black poverty</a>.</p>
<p>Forty years after the Moynihan Report, George W. Bush-era programs such as the <a href="https://www.acf.hhs.gov/ocs/policy-guidance/csbg-im-no-89-healthy-marriage-initiative">Healthy Marriage Initiative</a> sought to <a href="https://www.jstor.org/stable/4624797">enlist churches</a> and other community groups in an effort to channel childbearing back into marriage. These initiatives continue today, with the federally subsidized <a href="https://www.acf.hhs.gov/ofa/programs/healthy-marriage-responsible-fatherhood">Healthy Marriage and Responsible Fatherhood programs</a>.</p>
<p>Still, nearly <a href="https://www.census.gov/newsroom/stories/single-parent-day.html">30% of U.S. children</a> live in single-parent homes today, compared with 10% in 1965.</p>
<p>We are <a href="https://scholar.google.com/citations?user=gCJEShUAAAAJ&hl=en&oi=ao">law professors</a> who have written extensively about <a href="https://scholar.google.com/citations?user=0BBCYNAAAAAJ&hl=en&oi=ao">family structure</a> and <a href="https://www.fordham.edu/school-of-law/faculty/directory/full-time/eleanor-brown/">poverty</a>. We, and others, have found that there is almost no evidence that federal programs that promote marriage <a href="https://www.bgsu.edu/content/dam/BGSU/college-of-arts-and-sciences/NCFMR/documents/FP/FP-14-02_HMIInitiative.pdf">have made a difference</a> in encouraging two-parent households. That’s in large part because they forgo effective solutions that directly address poverty for measures that embrace the culture wars. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child hangs upside down on playground equipment" src="https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Having a parent who has a college degree makes kids less likely to live in poverty than having parents who are married.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girl-upside-down-on-the-jungle-gym-royalty-free-image/1127705002">Mayur Kakade/Moment Collection via Getty Images</a></span>
</figcaption>
</figure>
<h2>Marriage and social class</h2>
<p>Today’s marriage promoters claim that <a href="https://ifstudies.org/blog/the-benefits-of-marriage-shouldnt-only-be-for-elites">marriage should not be just for elites</a>. The emergence of marriage as a marker of class, they believe, is a sign of societal dysfunction.</p>
<p>According to census data released in 2021, 9.5% of children living with two parents – and 7.5% with married parents – <a href="https://ojjdp.ojp.gov/statistical-briefing-book/population/faqs/qa01203#:%7E:text=In%202021%2C%209.5%25%20of%20children,17.4%25">lived below the poverty level</a>, compared with 31.7% of children living with a single parent.</p>
<p>Kearney’s argument comes down to: 1 + 1 = 2. Two parents have more resources, including money and time to spend with children, than one. She marshals extensive research designed to show that children from married couple families are <a href="https://doi.org/10.1146/annurev-economics-063016-103749">more likely to graduate</a> from high school, complete college and earn <a href="https://doi.org/10.1146/annurev-economics-063016-103749">higher incomes as adults</a> than the children of single parents.</p>
<p>It is undoubtedly true that two parents – that is, two nonviolent parents with reliable incomes and cooperative behavior – have <a href="https://www.brookings.edu/articles/cohabiting-parents-differ-from-married-ones-in-three-big-ways/">more resources for their children</a> than one parent who has to work two jobs to pay the rent. However, this equation <a href="https://doi.org/10.31235/osf.io/pmyhj">does not address causation</a>. In other words, parents who have stable incomes and behaviors are more likely to stay together than parents who don’t.</p>
<p>Ethnographic studies indicate, for example, that the most common reasons unmarried women are no longer with the fathers of their children are the men’s <a href="https://ssrn.com/abstract=3841832">violent behavior, infidelity</a> and <a href="https://www.ucpress.edu/book/9780520335233/essential-dads">substance abuse</a>.</p>
<p>Moreover, income volatility disproportionately affects parents who don’t go to college. So while they may have more money to invest in children together than apart, when one of these parents experiences a substantial drop in income, the other parent may have to decide whether to <a href="https://elibrary.law.psu.edu/cgi/viewcontent.cgi?article=1455&context=fac_works">support the partner or the children</a> on what is often a meager income.</p>
<p>The <a href="https://theconversation.com/having-a-single-parent-doesnt-determine-your-life-chances-the-data-shows-poverty-is-far-more-important-217841">impact of having single parents</a> also plays out differently by race and class. As sociologist and researcher <a href="https://www.nytimes.com/2019/12/09/opinion/two-parent-family.html">Christina Cross explains</a>, “Living apart from a biological parent does not carry the same cost for Black youths as for their white peers, and being raised in a two-parent family is not equally beneficial.” </p>
<p>For example, Cross found that living in a single-mother family is less likely to affect high school completion rates for Black children than for white children. Also, Black families tend to be more embedded in extended family than white families, and this additional support system may help protect children from negative outcomes associated with single-parent households.</p>
<p><iframe id="A2rK0" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/A2rK0/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Making men more ‘marriageable’</h2>
<p>Kearney, to her credit, does note that economic insecurity largely explains what is happening to working-class families, and that no parent should have to tolerate violence or substance abuse. But she doubles down on the need to restore a norm of two-parent families.</p>
<p>Many of her policy prescriptions are sensible. She advocates for better opportunities for low-income men – to make them, in the words of <a href="https://press.uchicago.edu/ucp/books/book/chicago/T/bo13375722.html">sociologist William Julius Wilson</a>, “marriageable.” Such policies would include wage subsidies to improve their job opportunities, investment in community colleges that provide skills training, and the <a href="https://theconversation.com/banning-the-box-would-help-people-released-from-prison-rebuild-their-lives-45539">removal of questions about criminal histories</a> from job applications, so that candidates who have previously been incarcerated are not immediately disqualified.</p>
<h2>A new marriage model</h2>
<p>What marriage promotion efforts overlook, however, are the underlying changes in what marriage has become – both legally and practically. </p>
<p>The new marriage model rests on three premises.</p>
<p>The first is a moral command: Have sex if you want to, but don’t have children until you are ready. While the shotgun marriage once served as the primary response to unplanned pregnancy, such marriages today often derail education and careers and are <a href="https://today.duke.edu/2016/11/shotgun-marriage-dead#:%7E:text=After%20a%20decade%2C%2030%20percent,prior%20to%20a%20child's%20conception.">more likely to result in divorce</a> than other marriages. Research shows that lower-income women’s pregnancies are much <a href="https://www.guttmacher.org/sites/default/files/factsheet/fb-unintended-pregnancy-us_0_4.pdf">more likely to be unplanned</a>. </p>
<p>The second is the ability to pick a partner who will support you and assume joint responsibility for parenting. As women have attained more economic independence, they are less in need of men to raise children, particularly if their partners are insensitive or abusive. With healthy relationships, couples pick partners based on trust, commitment and equal respect. This is more difficult to do in communities with high rates of incarceration and few opportunities for stable employment. </p>
<p>And the third is economic and behavioral stability. Instability undermines even committed unions. Parents who wait until they find the right partner and have stable lives bring a lot more to parenting, whether they marry or not.</p>
<p>We believe that creating opportunities for low-income parents to reach this middle-class model is likely to be the most effective marriage promotion policy.</p>
<h2>Economic support is key</h2>
<p>In relationships that fall outside of these premises, 1 + 1 often becomes 1 + -1, which equals 0.</p>
<p>Being committed to a partner who can’t pay speeding tickets, runs up credit card bills, comes home drunk or can’t be relied on to pick up the children after school is not a recipe for success. </p>
<p>Economic principles suggest that businesses with more volatile income streams need a stronger capital base to withstand the downturns. Working-class couples who face economic insecurity see commitment as similarly misguided; without a capital base, a downturn for one partner can wipe out the other.</p>
<p>The Biden administration’s child tax credit expansion included in the <a href="https://www.bloomberg.com/news/newsletters/2024-02-08/the-child-tax-credit-bill-seems-destined-for-defeat-in-the-senate?embedded-checkout=true">American Rescue Plan Act of 2021</a> helped cut the child poverty rate – after accounting for government assistance – <a href="https://www.cbpp.org/research/poverty-and-inequality/governments-pandemic-response-turned-a-would-be-poverty-surge-into">to a record low</a> that year. It did more to address child poverty than <a href="https://www.sciencedaily.com/releases/2014/01/140106094155.htm">marriage promotion efforts have ever done</a>.</p>
<p>Researchers have described such income-support policies as the “<a href="https://doi.org/10.1007/s12187-020-09782-0">ultimate multipurpose policy instrument</a>.” They improve the economic circumstances of single-parent families and, in doing so, may also provide greater support for two-parent relationships. </p>
<p>Policymakers know how to solve child poverty – and these measures are far more effective than efforts to put two married parents in every household.</p><img src="https://counter.theconversation.com/content/218682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Marriage on its own won’t do away with child poverty, and in fact it can create even more instability for low-income families.Eleanor Brown, Professor of Law, Fordham UniversityJune Carbone, Professor of Law, University of MinnesotaNaomi Cahn, Professor of Law, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1944332024-02-14T13:23:10Z2024-02-14T13:23:10ZReal-world experiments in messaging show that getting low-income people the help they need is more effective when stigma is reduced<figure><img src="https://images.theconversation.com/files/518833/original/file-20230401-14-crh8sz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5168%2C2916&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Stigma tied to poverty can create a barrier to the very help people need. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/BUkU-VhzW-s">@felipepelaquim for Unsplash.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>There are pervasive stereotypes that Americans who are low income and access government assistance are lazy, lack a work ethic and are even morally inferior. This stigma has been <a href="https://doi.org/10.1016/j.ssmph.2022.101117">shown to have many negative consequences</a>. </p>
<p>But until now, there’s been little research on whether this stigma influences the willingness to use government assistance.</p>
<p>We studied the effect of stigma in the context of <a href="https://home.treasury.gov/policy-issues/coronavirus/assistance-for-state-local-and-tribal-governments/emergency-rental-assistance-program">Emergency Rental Assistance</a>. The purpose of rental assistance programs is to help low-income people avoid eviction by helping them pay overdue rent. While these programs have long existed, they received a large influx of new funds as part of the federal government’s response to the COVID-19 pandemic.</p>
<p>This offered an opportunity for our team at <a href="https://www.peoplelab.hks.harvard.edu/">The People Lab</a>, which is based at the Harvard Kennedy School, to examine some of the barriers that low-income populations face in accessing safety net programs.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/518832/original/file-20230401-28-bvpye4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A worn-out sign street advertising apartments for rent." src="https://images.theconversation.com/files/518832/original/file-20230401-28-bvpye4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/518832/original/file-20230401-28-bvpye4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518832/original/file-20230401-28-bvpye4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518832/original/file-20230401-28-bvpye4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518832/original/file-20230401-28-bvpye4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518832/original/file-20230401-28-bvpye4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518832/original/file-20230401-28-bvpye4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The federal government helped low-income Americans pay overdue rent during the pandemic – but they had to apply for this benefit.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/zZ2mUNET5DQ">Bethany Reeves for Unsplash.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>A less stigmatizing message</h2>
<p>In a <a href="https://dx.doi.org/10.2139/ssrn.4040234">recently published paper</a>, we described the results of two large studies we conducted in collaboration with the Denver Department of Housing Stability, the Denver Office of Social Equity and Innovation, and the Austin Housing and Planning Department. </p>
<p>Our goal was to test the impact of different outreach messages on the likelihood that people eligible for rental assistance would apply for benefits.</p>
<p>In the first randomized experiment, about 25,000 presumed renters in 56 neighborhoods in Denver received a mailer with straightforward information about the rental assistance program. Another group of approximately 25,000 presumed renters received a mailer with subtle language changes that aimed to reduce the internalized shame and potentially expected discrimination associated with participation in rental assistance.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/575123/original/file-20240212-22-qg8aki.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A promotional message for help paying rent" src="https://images.theconversation.com/files/575123/original/file-20240212-22-qg8aki.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/575123/original/file-20240212-22-qg8aki.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=847&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575123/original/file-20240212-22-qg8aki.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=847&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575123/original/file-20240212-22-qg8aki.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=847&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575123/original/file-20240212-22-qg8aki.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1064&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575123/original/file-20240212-22-qg8aki.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1064&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575123/original/file-20240212-22-qg8aki.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1064&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A destigmatizing email from this experiment with some information redacted.</span>
<span class="attribution"><span class="source">The People Lab</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>This destigmatizing message emphasized, for instance, that “it’s not your fault” if you need rental assistance.</p>
<p>We found that people who received the destigmatizing mailer were 11% more likely to apply for rental assistance than people who received the mailer that only included basic information, and 37% more likely to apply than people who did not receive anything in the mail.</p>
<p>In the second randomized experiment, we tested similar messages delivered via email to approximately 50,000 residents in Austin, Texas. We found similar results: Sending people a destigmatizing email that emphasized “it’s not your fault” if you need rental assistance led to higher engagement than a purely informational email. </p>
<p>Our findings suggest that it is possible to reduce internalized shame in a way that makes people who are eligible for government benefits more likely to apply for them – despite the presence of pervasive societal stigma. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/518834/original/file-20230401-16-xrhwaf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="One person stops to give something to another person sitting on the ground in a tunnel." src="https://images.theconversation.com/files/518834/original/file-20230401-16-xrhwaf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518834/original/file-20230401-16-xrhwaf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518834/original/file-20230401-16-xrhwaf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518834/original/file-20230401-16-xrhwaf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518834/original/file-20230401-16-xrhwaf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518834/original/file-20230401-16-xrhwaf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518834/original/file-20230401-16-xrhwaf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There should be no shame in getting assistance.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/kyeJW1zRH0I">Elyse Chia for Unsplash.com</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Overcoming stigma</h2>
<p>U.S. safety net programs are <a href="https://www.cbpp.org/research/poverty-and-inequality/safety-net-more-effective-against-poverty-than-previously-thought">highly effective</a>, but only if people who are eligible for benefits use them. Applying for <a href="https://www.nytimes.com/interactive/2020/01/28/upshot/administrative-burden-quiz.html">assistance can be onerous</a>.</p>
<p><a href="https://doi.org/10.1093/qje/qjz013">Research</a> demonstrates that simplifying processes and providing clear and simple information about program benefits can increase participation in some contexts. Yet, gaps remain: <a href="https://doi.org/10.1257/pol.20200603">Simply providing information about programs and benefits</a> doesn’t always increase participation, and it doesn’t necessarily reach those who need assistance the most.</p>
<p>We hope our research sheds light on the way in which stigma may affect people’s willingness to use government benefits. And we hope these findings encourage government agencies to reconsider their approach to providing information and assistance to avoid inadvertently reinforcing the stigma associated with benefits use.</p><img src="https://counter.theconversation.com/content/194433/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Linos receives funding for her research from many foundations, including the Russell Sage Foundation, the Hewlett Foundation, the Gates Foundation, J-PAL and others. She is a nonresident fellow at the Brookings Institution, and a Faculty Affiliate of J-PAL and the California Policy Lab. </span></em></p><p class="fine-print"><em><span>Jessica Lasky-Fink does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The stigma around poverty and government benefits can make those initiatives less effective.Jessica Lasky-Fink, Research Director of the People Lab, Harvard Kennedy SchoolElizabeth Linos, Associate Professor of Public Policy and Management, Harvard Kennedy SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2199532024-02-12T13:26:57Z2024-02-12T13:26:57ZFamily caregivers face financial burdens, isolation and limited resources − a social worker explains how to improve quality of life for this growing population<figure><img src="https://images.theconversation.com/files/574183/original/file-20240207-27-pcczxx.jpg?ixlib=rb-1.1.0&rect=30%2C30%2C5061%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Family caregivers may be less likely to turn to others when they need their own support. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-woman-pushing-father-in-wheelchair-royalty-free-image/494327497?phrase=caring+for+the+elderly&adppopup=true">Terry Vine/DigitalVision via Getty Images</a></span></figcaption></figure><p>Millions of Americans have <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">become informal family caregivers</a>: people who provide family members or friends with unpaid assistance in accomplishing daily tasks such as bathing, eating, transportation and managing medications. </p>
<p>Driven in part by a <a href="https://www.aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html">preference for home-based care</a> rather than long-term care options such as assisted living facilities, and the <a href="https://doi.org/10.1155/2012/680265">limited availability and high cost</a> of formal care services, family caregivers play a pivotal role in the safety and well-being of their loved ones.</p>
<p>Approximately 34.2 million people in the United States <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">provide unpaid assistance</a> to adults age 50 or above, according to the Family Caregiver Alliance. Among them, about 15.7 million adult family caregivers care for someone with dementia.</p>
<p>I am a licensed clinical social worker and an assistant professor of social work <a href="https://scholar.google.com/citations?user=AikbrQ4AAAAJ&hl=en">studying disparities in health and health care systems</a>. I focus on underrepresented populations in the field of aging. </p>
<h2>Challenges for family caregivers</h2>
<p>In my research focusing on <a href="https://doi.org/10.1093/geront/gnad086">East Asian family caregivers</a> for people with Alzheimer’s and related dementia, I discovered that <a href="https://doi.org/10.1177/07334648221142600">Chinese American</a> and <a href="https://doi.org/10.1080/13607863.2022.2122932">Korean American caregivers</a> often encounter challenging situations. These include discrimination from health care facilities or providers, feelings of loneliness and financial issues. Some of these caregivers even find themselves <a href="https://doi.org/10.1080/13607863.2022.2122932">having to retire early</a> because they struggle to balance both work and caregiving responsibilities. </p>
<p>My findings join a growing body of research showing that <a href="https://doi.org/10.1111/scs.12463">family caregivers</a> commonly <a href="https://doi.org/10.1177/0733464818813466">encounter five specific challenges</a>: financial burdens, limited use of home- and community-based services, difficulties accessing resources, a lack of knowledge about existing educational programs, and physical and emotional challenges, such as feelings of helplessness and caregiver burnout. </p>
<p>However, researchers are also finding that family caregivers feel more capable of managing these challenges when they can tap into formal services that offer practical guidance and insights for their situations, as well as assistance with some unique challenges involved with family caregiving.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dskLxMc2MW0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How to find your way back if you feel that you’ve lost yourself in a caregiving role.</span></figcaption>
</figure>
<h2>The demographics of informal caregivers</h2>
<p>More than 6 in 10 family caregivers are women. </p>
<p>Society has always expected <a href="https://doi.org/10.1093/geront/32.5.607">women to take on caregiving responsibilities</a>. Women also usually earn less money or rely on other family members for financial support. This is because equal pay in the workplace <a href="https://iwpr.org/wp-content/uploads/2020/09/C455.pdf">has been slow to happen</a>, and women often take on roles like becoming the primary caregiver for their own children as well as their aging relatives, which can drastically affect their earnings. </p>
<p>While nearly half of care recipients live in their own homes, 1 in 3 live <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">with their caregivers</a>.</p>
<p>Sometimes termed “resident caregivers,” these individuals are less likely to turn to others outside the family for caregiving support, often because they feel that it’s important to keep caregiving within the family. These caregivers <a href="https://doi.org/10.1080/13607863.2021.1935460">are typically older, retired or unemployed</a> and have lower income than caregivers who live separately.</p>
<p>According to a 2020 report from the AARP Public Policy Institute, about 1 in 3 family caregivers <a href="https://www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html">provide more than 21 hours of care a week</a> to a loved one. </p>
<p><iframe id="4L0re" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/4L0re/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Juggling caregiving with everyday life</h2>
<p>Caregiving often creates financial burdens because it <a href="https://doi.org/10.1093/geronb/gbv095">makes it harder to hold a full-time or part-time job</a>, or to <a href="https://doi.org/10.1093/geronb/gbv095">return to work</a> after taking time off, particularly for spouses who are caregivers.</p>
<p>Often, community-based organizations such as nonprofits that serve older adults offer a variety of in-home services and educational programs. These can help family caregivers <a href="https://www.cdc.gov/aging/caregiving/caregiver-brief.html">manage or reduce</a> the physical and emotional strains of their responsibilities. However, these demands also can make it difficult for some caregivers to even learn that these resources exist, or take advantage of them, particularly as the care recipient’s condition progresses. </p>
<p>These challenges <a href="https://doi.org/10.23750/abm.v93iS2.12979">worsened at the height of the COVID-19 pandemic</a>. Many support programs were canceled, and it was hard to access health care, which made things even more stressful and tiring for caregivers. </p>
<p>Research shows that those who are new to family caregiving often take care of their loved ones <a href="https://www.ncbi.nlm.nih.gov/books/NBK2665/">without any formal support initially</a>. As a result, they may face increased emotional burdens. And caregivers age 70 and above face particular challenges, since they may be navigating their own health issues at the same time. These individuals are less likely to receive informal support, which can lead to social isolation and burnout.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=1000&fit=clip"><img alt="Mature woman places a cardigan on an elderly adult." src="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Caregivers age 70 and above may be navigating their own health challenges with little support.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-caring-for-her-elderly-mother-royalty-free-image/1390975112?phrase=family+caregivers&adppopup=true">Alistair Berg/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<h2>Support for family caregivers</h2>
<p>There are numerous programs and services available for family caregivers and their loved ones, whether they reside at home or in a residential facility. These resources include government health and disability programs, legal assistance and disease-specific organizations, some of which are <a href="https://www.caregiver.org/connecting-caregivers/services-by-state/">specific to certain states</a>.</p>
<p>In addition, research has found that providing appropriate <a href="https://doi.org/10.1046/j.1532-5415.2001.49090.x">education and training</a> to people in the early stages of caregiving enables them to better balance their own health and well-being with successfully fulfilling their responsibilities. Many community-based organizations, such as local nonprofits focused on aging, as well as government programs or senior centers, <a href="https://doi.org/10.1111/jgs.14259">may offer case management services</a> for older adults, which can be beneficial for learning about existing resources and services. </p>
<p>For family caregivers of people with dementia, formal support services are particularly crucial to their <a href="https://doi.org/10.1590/1809-98232016019.150117">ability to cope and navigate the challenges</a> they face.</p>
<h2>The role of Medicaid</h2>
<p>Formal support may also be helpful in finding affordable home-based and community resources that can help compensate for a lack of informal support. These include <a href="https://www.medicare.gov/coverage/home-health-services">home health services</a> funded by Medicare and <a href="https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html">Medicaid-funded providers</a> of medical and nonmedical services, including transportation.</p>
<p>Medicaid, which targets low-income Americans, seniors, people with disabilities and a few select other groups, has certain income requirements. Determine the eligibility requirements first to find out whether your loved one qualifies for Medicaid.</p>
<p>The <a href="http://www.thescanfoundation.org/sites/default/files/the-need-to-include-family-caregiver-assessment-medicaid-hcbs-waiver-programs-report-aarp-ppi-ltc.pdf">services and support covered by Medicaid may vary</a> <a href="https://www.payingforseniorcare.com/medicaid-waivers/home-care">based on a number of factors</a>, such as timing of care, the specific needs of caregivers and their loved ones, the care plan in place for the loved one and the location or state in which the caregiver and their loved one reside. </p>
<p>Each state also has its own Medicaid program with unique rules, regulations and eligibility criteria. This can result in variations in the types of services covered, the extent of coverage and the specific requirements for <a href="https://www.medicaidplanningassistance.org/getting-paid-as-caregiver/">accessing Medicaid-funded support</a>.</p>
<p>If so, <a href="https://www.medicaid.gov/about-us/contact-us/index.html">contact your state’s Medicaid office</a> to get more information about self-directed services and whether you can become a paid family caregiver.</p>
<h2>Medicare might help</h2>
<p>Medicare may <a href="https://www.medicare.gov/coverage/home-health-services">help pay for certain home health services</a> if an older adult needs skilled services part time and is considered homebound.</p>
<p>This assistance can alleviate some of the caregiving responsibilities and financial burdens on the family caregiver, allowing them to focus on providing care and support to their loved ones without worrying about the cost of essential medical services. </p>
<p>Peer-to-peer support is also crucial. Family caregivers who join support groups tend to <a href="https://doi.org/10.1080/13607863.2016.1231169">manage their stress more effectively</a> and <a href="https://doi.org/10.3389/fpubh.2019.00122">experience an overall better</a> <a href="https://doi.org/10.1111/j.1532-5415.1990.tb03544.x">quality of life</a>.</p><img src="https://counter.theconversation.com/content/219953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathy Lee has received funding from the Alzheimer's Association - New to the Field (AARG-NTF-20-678171). </span></em></p>Family caregivers who have stronger support networks and positive communication with loved ones tend to be more resilient.Kathy L. Lee, Assistant Professor of Gerontological Social Work, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2213822024-01-22T13:28:57Z2024-01-22T13:28:57ZCongress is close to expanding the child tax credit again − with a smaller boost for families this time<figure><img src="https://images.theconversation.com/files/570367/original/file-20240119-25-35ut1k.jpg?ixlib=rb-1.1.0&rect=94%2C83%2C6903%2C4395&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The costs of raising children can strain a household's budget.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-and-daughter-shopping-school-supplies-in-a-royalty-free-image/1585987057?adppopup=true">Phynart Studio/E+ via Getty Images</a></span></figcaption></figure><p><em><a href="https://www.axios.com/2024/01/16/child-tax-credit-reduce-poverty">Influential lawmakers have struck a deal</a> that could increase the extent to which low-income U.S. families can benefit from the child tax credit for three years. The Conversation asked <a href="https://fordschool.umich.edu/faculty/natasha-pilkauskas">Natasha Pilkauskas</a> and <a href="https://fordschool.umich.edu/faculty/katherine-michelmore">Katherine Michelmore</a>, public policy researchers at the University of Michigan, to explain what may change and why.</em></p>
<h2>Why does Congress want to expand the child tax credit?</h2>
<p>The child tax credit, <a href="https://www.ncsl.org/human-services/child-tax-credit-overview">first enacted in 1997</a>, was originally designed to help middle-class families with the costs of raising kids by giving them and upper-class families a tax credit of US$400 per child.</p>
<p>After several changes, this credit grew to as much as $2,000. Then the government temporarily expanded the credit in two main ways for the 2021 tax year. </p>
<p>Families could get up to $3,600 for each child, and nearly all low-income families could obtain it. In addition, half of this money was disbursed in monthly payments in the second half of 2021.</p>
<p>In 2022, the credit reverted to its previous terms, in accordance with the tax reform package that President Donald Trump <a href="https://www.taxpolicycenter.org/sites/default/files/briefing-book/what-is-the-child-tax-credit.pdf">signed into law in late 2017</a>.</p>
<p>The maximum credit is currently worth $2,000. Families must earn at least $2,500 to claim any credit, but their earnings must be higher to get the full credit. For example, a family with two children must earn at least about $40,000 to receive the full $4,000 in child tax credits. Families with three or more children have to earn even more to get the full benefits.</p>
<h2>What could change this time?</h2>
<p>A bipartisan group of House and Senate <a href="https://gop-waysandmeans.house.gov/wp-content/uploads/2024/01/The-Tax-Relief-for-American-Families-and-Workers-Act-of-2024-Technical-Summary.pdf">lawmakers agreed on Jan. 16, 2024</a>, to expand the credit again. If Congress <a href="https://www.nytimes.com/2024/01/16/us/politics/tax-deal-congress.html">passes the $33 billion measure</a> and President Joe Biden signs it into law, the credit would still be smaller than the 2021 version, and it would not be available to all low-income families.</p>
<p>The new proposal would adjust the earnings requirements. These changes would make it easier for many lower-income families – those earning roughly between $10,000 and $50,000 – to get the full credit. These families would get an <a href="https://www.vox.com/future-perfect/2024/1/16/24035922/child-tax-credit-wyden-smith-deal">average credit that is about $1,130 higher</a> than in 2022.</p>
<p>Families with higher incomes will also see larger benefits in future years if this expansion is passed, because the credit would be indexed to inflation to help families keep pace with rising expenses.</p>
<p>Unlike the 2021 expansion, which gave families monthly checks for six months, this credit would come only at tax time as a lump sum.</p>
<p>The Center on Budget and Policy Priorities <a href="https://www.cbpp.org/sites/default/files/1-16-24tax.pdf">projects that this policy would boost benefits</a> for 16 million kids. That’s more than <a href="https://www.childstats.gov/americaschildren/demo.asp">1 in 5 of the nation’s 72 million children</a>.</p>
<p>Families who would <a href="https://www.investopedia.com/financial-edge/0411/5-groups-that-dont-pay-taxes.aspx">not otherwise have to file their taxes</a> will need to do so to claim the child tax credit. In our own research, we found that almost 25% of lower-income families <a href="https://doi.org/10.1257/pandp.20231089">didn’t receive any of the monthly child tax credits</a>, perhaps because they didn’t file their taxes. </p>
<p>For parents who worked in 2023 and have kids younger than 17 who live with them, it may be worth filing taxes in 2024.</p>
<h2>What’s the rationale for this expansion?</h2>
<p>Raising children can be very expensive.</p>
<p>Consider a mother who is working year-round in a full-time, minimum-wage job who has two kids. Assuming she earns the <a href="https://www.usa.gov/minimum-wage">federal minimum wage of $7.25 an hour</a>, she would <a href="https://www.indeed.com/career-advice/pay-salary/how-much-does-a-minimum-wage-job-pay-a-year">earn just over $15,000 each year</a>. Once she pays her rent, food and utility bills, she likely has very little money left for other important expenses like child care or school fees.</p>
<p>For this woman, getting a bigger check at tax time could really help her make ends meet. This new plan would nearly double her child tax credit <a href="https://www.cbpp.org/sites/default/files/1-16-24tax.pdf">from about $1,875 to $3,600</a>.</p>
<p>There’s also widespread support to expand the child tax credit because the 2021 child tax credit lifted <a href="https://www.census.gov/library/stories/2022/09/record-drop-in-child-poverty.html">3 million children out of poverty</a>. </p>
<p>Many researchers, including us, have found that most <a href="https://doi.org/10.1257/pandp.20231089">families with low incomes</a> spent the 2021 credit on bills, <a href="https://doi.org/10.3386/w31339">rent</a>, <a href="https://doi.org/10.3386/w30533">food and clothing</a>.</p>
<p>We also determined that the expanded child tax credit made <a href="https://doi.org/10.1016/j.ssmph.2023.101420">parents less anxious and depressed</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/570384/original/file-20240119-25-yp90kj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of children sit and stand in front of a banner that says 'hungry for the child tax credit.'" src="https://images.theconversation.com/files/570384/original/file-20240119-25-yp90kj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570384/original/file-20240119-25-yp90kj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570384/original/file-20240119-25-yp90kj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570384/original/file-20240119-25-yp90kj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570384/original/file-20240119-25-yp90kj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570384/original/file-20240119-25-yp90kj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570384/original/file-20240119-25-yp90kj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The children of advocates for changes to the child tax credit gathered in front of the White House in September 2022.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/parents-and-caregivers-with-the-economic-security-project-news-photo/1425648693?adppopup=true">Larry French/Getty Images for SKDK</a></span>
</figcaption>
</figure>
<h2>Who wants this expansion to go into effect?</h2>
<p>In the past, bipartisan coalitions have voted to expand the child tax credit. Republicans and Democrats alike have proposed making it more generous over the years.</p>
<p>The current expansion also has bipartisan support, even though <a href="https://www.washingtonpost.com/business/2024/01/15/child-tax-credit-increase-2024/">progressive lawmakers would have preferred</a> a return to the 2021 version of the credit, which was larger, available to more low-income families and disbursed in monthly installments. </p>
<p>Some conservatives worry that bigger credits <a href="https://www.aei.org/center-on-opportunity-and-social-mobility/tax-extenders-package-would-cut-the-child-tax-credits-annual-work-requirement-in-half/">make people less likely to work</a>. There’s not much evidence to support that claim. </p>
<p>Instead, <a href="https://doi.org/10.1002/pam.22528">there’s ample evidence</a> that the <a href="https://www.nber.org/papers/w29823">2021 tax credit expansion</a> <a href="https://www.aeaweb.org/articles?id=10.1257/pandp.20231087">didn’t make parents less likely to earn money</a>.</p>
<p>And it’s important to remember that families will still have to work in order to receive any benefit from the child tax credit under this proposal.</p>
<h2>How long would the expansion last?</h2>
<p>To be clear, <a href="https://www.washingtonpost.com/business/2024/01/15/child-tax-credit-increase-2024/">there is no guarantee that Congress will approve</a> this measure. It’s part of a <a href="https://www.politico.com/news/2024/01/16/tax-chiefs-reach-deal-on-child-credit-business-breaks-00135631">larger array of tax changes</a> subject to other partisan battles.</p>
<p>Should Congress pass the tax package and Biden sign it by Jan. 29, American families would be able to claim this expanded credit in 2024 on their 2023 taxes.</p>
<p>Even so, this expansion would be short-lived. The current child tax credit <a href="https://www.taxpolicycenter.org/taxvox/evidence-suggests-expanding-child-tax-credit-could-ease-hardship-among-families-kids">is slated to become smaller after the 2025 tax year</a> unless Congress takes further action. It’s one of the many 2017 tax reforms that will expire in 2026.</p>
<p>After that point, the child tax credit will <a href="https://www.taxpolicycenter.org/briefing-book/what-child-tax-credit">decline to a maximum of $1,000</a> per child.</p><img src="https://counter.theconversation.com/content/221382/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Pilkauskas has received funding from the Charles and Lynn Schusterman Family Philanthropies and the Washington Center for Equitable Growth.</span></em></p><p class="fine-print"><em><span>Katherine Michelmore has received funding from the Washington Center for Equitable Growth</span></em></p>Republicans and Democrats have committed to making this family-friendly government benefit a little more generous. Unless lawmakers act, it will get much smaller in 2026.Natasha Pilkauskas, Associate Professor of Public Policy, University of MichiganKatherine Michelmore, Associate Professor of Public Policy, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168722023-11-29T13:39:23Z2023-11-29T13:39:23ZUS food insecurity surveys aren’t getting accurate data regarding Latino families<figure><img src="https://images.theconversation.com/files/560038/original/file-20231116-28-l00ddr.jpg?ixlib=rb-1.1.0&rect=0%2C38%2C5052%2C2997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's hard to divulge an inability to put food on the table.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hispanic-woman-cooking-for-granddaughter-in-kitchen-royalty-free-image/579979911?adppopup=true">Shestock/Tetra images via Getty Images</a></span></figcaption></figure><p>The federal government has conducted the <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/history-background/">U.S. Household Food Security Survey Module</a> for more than 25 years. <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/measurement/">The data collected annually</a> from <a href="https://www.ers.usda.gov/data-products/food-security-in-the-united-states/documentation/">about 50,000 U.S. households</a> helps form estimates of the scale of food insecurity – not having <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/">access to enough food</a> for a healthy life – at the national and state levels. </p>
<p>But the way Latino parents respond to some of the questions in the annual <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/survey-tools/">U.S. Department of Agriculture survey used to measure food insecurity</a> doesn’t always reflect their true experiences. We published this finding in a special October 2023 issue of the <a href="https://doi.org/10.1016/j.jand.2023.07.007">Journal of the Academy of Nutrition and Dietetics</a>.</p>
<p>Our team, which included development sociologist <a href="https://scholar.google.com/citations?hl=en&user=PXjyYOAAAAAJ">Christian DiRado-Owens</a>, conducted a study in California, New York and Texas, using surveys and interviews to <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-assistance-data-collaborative-research-programs/twenty-five-years-of-food-security-measurement-extramural-research-grants/">help the USDA assess the accuracy and acceptability</a> of these questions among Latino families.</p>
<p>Many of the responses to the survey questions didn’t align with more detailed descriptions of the personal situations of the people we interviewed. When asked to explain their answers, many of them found it easier to talk about how they managed or coped with food insecurity than to respond to questions about how often they worried about or were not able to feed their families as they wished. </p>
<h2>Room for improvement</h2>
<p>Student researchers asked 62 Latino parents and caregivers the questions from the <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/survey-tools/">U.S. Household Food Security Survey Module</a>, letting them select either the English or Spanish version. For half of the 18 questions, people need to answer “often,” “sometimes” or “never.”</p>
<p>For example, the first statement is:</p>
<p><em>(I/We) worried whether (my/our) food would run out before (I/we) got money to buy more. Was that often true, sometimes true, or never true for (you/your household) in the last 12 months?</em></p>
<p>The rest are “yes” or “no” questions, such as:</p>
<p><em>In the last 12 months, since last (name of current month), did (you/you or other adults in your household) ever cut the size of your meals or skip meals because there wasn’t enough money for food?</em></p>
<p>After people completed the survey, interviewers prompted them with open-ended questions to elaborate further. This approach allowed participants to give feedback about the survey and share their thought processes about their responses. </p>
<p>We found that comprehension of the English words or the Spanish translation of these questions wasn’t the main issue. Rather, the way the questions were written could be improved.</p>
<p>For instance, when asked how often they skipped meals or reduced the size of meals, some of the people we interviewed answered “never.” But they went on to describe how they often prepared significantly smaller meals. In some cases, they recounted having eaten a small snack instead of a meal.</p>
<p>In addition, some of the people who responded that they could always afford enough food for their families later shared how they regularly relied on food pantries and similar programs designed for intermittent or emergency use. While their answers showed a commitment to feeding their families, they did not align with the intention of the questions – indicating that the survey may be underestimating true levels of food insecurity.</p>
<p>Overall, the sensitive nature of the questions and the limited number of possible response options made it hard for some people to answer them accurately – especially on the subject of their children not having enough food. Many people also said they felt that the phrasing of the questions about being able to afford food didn’t reflect their personal situations or experiences. </p>
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<a href="https://images.theconversation.com/files/559453/original/file-20231114-21-5davd8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People bundled up for cold weather receive donated food." src="https://images.theconversation.com/files/559453/original/file-20231114-21-5davd8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559453/original/file-20231114-21-5davd8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559453/original/file-20231114-21-5davd8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559453/original/file-20231114-21-5davd8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559453/original/file-20231114-21-5davd8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559453/original/file-20231114-21-5davd8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559453/original/file-20231114-21-5davd8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Food is distributed at a food and toy holiday pantry run by La Colaborativa and the Salvation Army in Chelsea, Mass.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/food-is-given-to-those-in-line-at-a-food-and-toy-holiday-news-photo/1245786431?adppopup=true">Joseph Prezioso/AFP via Getty Images</a></span>
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<h2>Higher levels of food insecurity</h2>
<p><a href="https://www.ers.usda.gov/publications/pub-details/?pubid=107702">U.S. food insecurity</a> increased from 10.2% in 2021 to 12.8% in 2022, according to official estimates.</p>
<p>Government agencies, nonprofits and researchers like us <a href="https://doi.org/10.1016/j.jand.2023.01.007">use the survey’s findings</a> to address food insecurity and make decisions about food assistance and nutrition policies and programs, including the <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-199929">Supplemental Nutrition Assistance Program</a>.</p>
<p>The Latino population is <a href="https://www.pewresearch.org/science/2022/06/14/a-brief-statistical-portrait-of-u-s-hispanics/">growing quickly</a> and has become the nation’s largest racial or ethnic group. About <a href="https://www.census.gov/quickfacts/fact/table/US/RHI725222">19% of the U.S. population, as of 2022</a>, identified as Hispanic or Latino. Without accurate data regarding this large community, the picture of food insecurity is incomplete. And until now, there has been <a href="https://doi.org/10.1016/j.jand.2023.01.007">too little research done to assess</a> whether the survey questions are eliciting valid data for Latinos.</p>
<p>Food insecurity among Latino families with children is already high, according to the most recent official data, which was collected in 2022: <a href="https://www.ers.usda.gov/webdocs/publications/107703/err-325.pdf?v=4909">13.2% compared with 5.5% for white households</a> with children. But based on our findings, it’s likely that the real picture is even worse.</p>
<h2>Next steps</h2>
<p>Our team is now analyzing data from the interviews we conducted to take a closer look at the strategies these Latino families used to cope with food insecurity at the height of the COVID-19 pandemic.</p>
<p>We’re also seeing whether Latino parents and caregivers living in very large urban communities answered questions differently compared with those residing in smaller cities and towns.</p>
<p>In addition, we want to assess any differences among Latinos of different heritages – such as Mexican Americans and Puerto Ricans – to find ways to get more accurate data regarding food security for Latino families with children.</p><img src="https://counter.theconversation.com/content/216872/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cassandra M. Johnson received funding from the U.S. Department of Agriculture for the research in this article. In addition, she receives external funding through research grants from the U.S. Department of Agriculture and U.S. Department of Health and Human Services and a contract with the Sustainable Food Center. </span></em></p><p class="fine-print"><em><span>Amanda C. McClain received funding for this, and other community-based, research from the U.S. Department of Agriculture. She also receives research support from the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Katherine Dickin received funding from the U.S. Department of Agriculture (USDA) for the research in this article. She has also received previous funding from the USDA, the U.S. Agency for International Development, and UK-AID.</span></em></p>Questions about food insecurity can be less straightforward than they appear.Cassandra M. Johnson, Assistant Professor of Nutrition, Texas State UniversityAmanda C. McClain, Assistant Professor of Nutrition, San Diego State UniversityKatherine Dickin, Associate Professor of Public & Ecosystem Health, Cornell UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2167232023-11-07T13:37:35Z2023-11-07T13:37:35ZLetting low-income Americans buy groceries online in 2020 with SNAP benefits decreased the share of people without enough food – new research<figure><img src="https://images.theconversation.com/files/557328/original/file-20231102-19-fa5rs.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C4648%2C3259&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Few people with SNAP benefits could use them for online purchases before the COVID-19 pandemic.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/online-shopping-royalty-free-image/1153881995?phrase=online+groceries&adppopup=true">Urupong/ iStock via Getty Images Plus</a></span></figcaption></figure><p>The share of low-income U.S. families experiencing <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/measurement/#insufficiency">food insufficiency</a> – sometimes or often not having enough food to eat – fell from 24.5% to 22.5% at the outset of the COVID-19 pandemic in 2020, we found in a new <a href="https://doi.org/10.1016/j.foodpol.2023.102538">study published in the November 2023 issue of Food Policy</a>.</p>
<p>This 2 percentage-point decline coincided with the <a href="https://doi.org/10.1016%2Fj.healthplace.2022.102811">rapid expansion of a pilot program</a> that allows the purchase of groceries online with benefits from the Supplemental Nutrition Assistance Program, also known as SNAP.</p>
<p>First mandated by the <a href="https://theconversation.com/these-four-challenges-will-shape-the-next-farm-bill-and-how-the-us-eats-202555">farm bill</a> Congress passed in 2014, the SNAP <a href="https://www.ers.usda.gov/amber-waves/2022/september/supplemental-nutrition-assistance-program-online-purchasing-expanded-in-first-two-years-of-pandemic/">Online Purchasing Pilot</a> was initially <a href="https://www.fns.usda.gov/pressrelease/2019/fns-000319">rolled out on a limited basis in 2019</a>. </p>
<p>Once COVID-19 arrived in the U.S. in early 2020, the pilot was rapidly expanded nationwide because the pandemic disrupted schooling, child care, transportation and in-person retail shopping. All of those changes curtailed access to food – especially for people with low incomes. </p>
<p>Nationally, SNAP online grocery purchases soared to US$155 million in June 2020, from less than <a href="https://doi.org/10.1016%2Fj.healthplace.2022.102811">$3 million in January of that year</a>.</p>
<p>To investigate whether the rapid rollout of the Online Purchasing Pilot played a role in the food insufficiency decline at that time, we teamed up with <a href="https://scholar.google.com/citations?user=xjoaXxkAAAAJ&hl=en">Jordan Jones</a>, a U.S. Department of Agriculture economist. We analyzed 12 weeks of data covering April 23, 2020, to July 21, 2020, from the <a href="https://www.census.gov/data/experimental-data-products/household-pulse-survey.html">Household Pulse Survey</a> involving aproximately 10,000 low-income households.</p>
<p>Because the pilot was rolled out gradually in different states, we were able to leverage the differences in the timing using a <a href="https://web.mit.edu/insong/www/pdf/FEmatch-twoway.pdf">two-way fixed-effects</a> model. This method made it possible to determine that SNAP’s online purchasing program contributed to the decline in food insufficiency.</p>
<p>The prevalence of <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/measurement/#insufficiency">very low food security</a> – a condition in which people may skip meals – increased for <a href="https://www.ers.usda.gov/publications/pub-details/?pubid=102075">families with children in 2020</a>. But the impact of the Online Purchasing Pilot was not larger for these households as opposed to those without any kids.</p>
<p>We believe this suggests that the ability to use SNAP benefits online does not resolve some food-related problems, such as those that arise because of <a href="https://www.cbpp.org/sites/default/files/4-27-21fa2.pdf">school closures</a>.</p>
<p>Low-income children are eligible for free meals at school. While many school districts found creative ways to <a href="https://theconversation.com/schools-will-stop-serving-free-lunch-to-all-students-a-pandemic-solution-left-out-of-a-new-federal-spending-package-179058">distribute grab-and-go meals</a> when school buildings were closed in 2020 and 2021, not all families were able to take advantage of those opportunities. </p>
<h2>Why it matters</h2>
<p>SNAP benefits currently help <a href="https://fns-prod.azureedge.us/sites/default/files/resource-files/snap-4fymonthly-10.pdf">more than 42 million Americans</a> buy food. The <a href="https://www.fns.usda.gov/snap/fy-2024-cola">maximum monthly amount for a family of four</a> in the 2024 fiscal year, which began on Oct. 1, 2023, is $973 in the 48 mainland states and the District of Columbia. </p>
<p><a href="https://www.fns.usda.gov/snap/online-purchasing-pilot">Online options for using these benefits</a> vary by state. In many locations, they include big stores that sell groceries, such as Walmart, Target, Whole Foods and Safeway, and some popular online retailers like Amazon.</p>
<p>Buying groceries online makes life easier for anyone who has trouble purchasing food in person, including people with disabilities, those with limited transportation access or those living in remote locations.</p>
<p>About <a href="https://retailwire.com/discussion/will-more-americans-make-e-grocery-delivery-a-weekly-habit/">1 in 6 Americans</a> pay for groceries online every week, and more than half have done so in the past 12 months.</p>
<h2>What other research is being done in this field</h2>
<p>This is one of several studies that have evaluated the impact of <a href="https://www.ers.usda.gov/amber-waves/2022/september/pandemic-related-program-changes-continued-to-shape-the-u-s-food-and-nutrition-assistance-landscape-in-fiscal-year-2021/">temporary food assistance policies at the height of the COVID-19 pandemic</a>. One member of our group, Grace Melo, conducted research with a different team that found that the <a href="https://theconversation.com/extra-food-assistance-cushioned-the-early-pandemics-blow-on-kids-mental-health-200893">mental health of children in low-income families</a> that got a boost in SNAP benefits did not <a href="https://doi.org/10.1016/j.ypmed.2023.107456">decline</a>, even though they were <a href="https://www.oecd.org/coronavirus/policy-responses/combatting-covid-19-s-effect-on-children-2e1f3b2f/">disproportionately affected by the pandemic</a>.</p>
<h2>What’s next</h2>
<p>Another member of our research team, Kyle Jones, is now researching how this pilot affects what kinds of groceries Americans are buying with SNAP benefits. He also plans to analyze how <a href="https://www.ncoa.org/article/what-stores-accept-ebt-for-online-grocery-delivery-and-pickup">using the benefits for online purchases</a> changes how much time people with these benefits spend on grocery shopping.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/216723/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrea Leschewski receives funding from the United States Department of Agriculture National Institute of Food and Agriculture. </span></em></p><p class="fine-print"><em><span>Grace Melo and Kyle Jones do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The share of low-income US families who sometimes or often didn’t have enough food to eat fell from 24.5% to 22.5% between late April and late July of 2020, a research team found.Grace Melo, Assistant professor of Agricultural Economics, Texas A&M UniversityAndrea Leschewski, Associate Professor of Applied Economics, South Dakota State UniversityKyle Jones, PhD Candidate in Economics, University of KentuckyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2146762023-10-05T12:35:12Z2023-10-05T12:35:12Z2 in 5 US babies benefit from the WIC nutrition program<figure><img src="https://images.theconversation.com/files/551430/original/file-20231002-19-tihdrm.jpg?ixlib=rb-1.1.0&rect=116%2C0%2C6324%2C2570&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This safety net program helps infants, toddlers and their moms eat right.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/group-of-babies-wearing-diapers-royalty-free-image/200017262-008?adppopup=true">Camille Tokerud/Stone via Getty Images</a></span></figcaption></figure><figure class="align-center zoomable">
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>A monthly average of more than <a href="https://www.ers.usda.gov/publications/pub-details/?pubid=106762">6 million U.S. women</a>, infants and young children received benefits in 2022 from the nutrition program known as WIC.</p>
<p>The Special Supplemental Nutrition Program for Women, Infants and Children, which is federally funded and state-administered, has served hundreds of millions of American families since its <a href="https://www.nwica.org/overview-and-history">inception in 1974</a>. It provides infant formula, food, nutritional education and health care referrals to <a href="https://www.fns.usda.gov/wic/frequently-asked-questions">low-income pregnant women</a>, the mothers of newborns and very young children, and infants and kids up to 5 years old. The government spent about <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/wic-program/">US$5.7 billion on it in 2022</a>.</p>
<p>At its peak, in 2010, the program was helping feed over <a href="https://www.ers.usda.gov/publications/pub-details/?pubid=44783">half of the babies born that year</a>. Participation in the program subsequently declined. About 2 in 5 of the <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr028.pdf">3.7 million babies born in the U.S.</a> in 2022 benefited from WIC.</p>
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<h2>Long-term benefits</h2>
<p>I am a <a href="https://scholar.google.com/citations?user=1CmLVGsAAAAJ&hl=en">sociologist who researches food insecurity</a> and participation in the safety net programs that help people get enough to eat. To do this, I analyze nationally representative data from the University of Michigan’s <a href="https://psidonline.isr.umich.edu/">Panel Study of Income Dynamics</a>, which started in 1968 and is the longest-running longitudinal household panel survey in the world. My colleagues and I have used this data to follow the same children from birth through adulthood, observing how their life circumstances change over time. </p>
<p>My <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2022.306967">research team</a> followed a group of 1,406 individuals from low-income families from birth through ages 20 to 36 years. We looked at reports of food insecurity from their parents during childhood as compared with their own reports of food insecurity as adults living on their own.</p>
<p>We found that food-insecure children who received benefits from WIC and the <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-199929">Supplemental Nutrition Assistance Program, or SNAP</a>, from 1984 to 2019, at anytime from birth to age 17, were four times more likely to report improved food security years later, as young adults, as compared with those who did not receive SNAP or WIC benefits as kids.</p>
<p>We have also found that being food insecure was correlated with having <a href="https://publichealth.jhu.edu/2021/food-insecurity-during-college-years-linked-to-lower-graduation-rate">fewer years of formal education</a> and a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0749379721003792">higher chance of being food insecure</a> in the future.</p>
<h2>Personal experience</h2>
<p>I have also personally seen how WIC can make a big difference for families.</p>
<p>When I was born in 1985, both of my parents were employed – but we lacked health insurance. My mother found out about WIC through the well-baby clinic in Oakland County, Michigan. While she was on leave from work, my father working two jobs and my older sister still under age 5, the program provided us with health exams, food and additional benefits free of charge.</p>
<p>When my mother returned to her position as a public high school teacher, our needs changed. We no longer needed – or received – the assistance.</p>
<p>The results from the national data study tell my story and the story of many other people: Kids from low-income and potentially food-insecure households can realize a better future with public assistance.</p>
<h2>Funding could be interrupted</h2>
<p>Millions of Americans depend on public safety net programs, whether for a month or for years. That assistance will be jeopardized should the government shut down if Congress fails to pass a budget before its mid-November 2023 deadline.</p>
<p>Federal WIC funding doesn’t flow <a href="https://www.axios.com/2023/09/24/federal-government-shutdown-history-list">during government shutdowns</a>. It “stops immediately when the shutdown occurs,” U.S. Agriculture Secretary <a href="https://www.whitehouse.gov/briefing-room/press-briefings/2023/09/25/press-briefing-by-press-secretary-karine-jean-pierre-and-secretary-of-agriculture-tom-vilsack/">Tom Vilsack told reporters</a> in late September.</p>
<p>But county and state governments can make <a href="https://www.naco.org/resources/what-counties-need-know-when-government-shutdown-happens">contingency plans to prevent disruption</a>. <a href="https://www.mprnews.org/episode/2023/09/28/minn-dept-of-health-wic-will-operate-during-government-shutdown">Minnesota</a> and <a href="https://www.wbur.org/news/2023/09/27/government-shutdown-congress-massachusetts-wic">Massachusetts</a> are among the states doing that.</p>
<p>Even if Congress moves past this budget impasse without a shutdown, the program won’t necessarily be unscathed. House Republicans have been trying to scale it back, and in June the <a href="https://appropriations.house.gov/news/press-releases/committee-approves-fy24-agriculture-rural-development-food-and-drug">House Appropriations Committee passed</a> a <a href="https://www.washingtonpost.com/business/2023/09/01/wic-cuts-congress-budget-shutdown/">measure that would reduce WIC benefits</a> to trim spending. In contrast, legislation in the <a href="https://www.appropriations.senate.gov/news/majority/bill-summary-agriculture-rural-development-food-and-drug-administration-and-related-agencies-fiscal-year-2024-appropriations-bill">Senate would instead increase WIC funding</a> in 2024.</p><img src="https://counter.theconversation.com/content/214676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Noura Insolera has received funding from USDA-ERS. </span></em></p>Funding for the Special Supplemental Nutrition Program for Women, Infants and Children quickly halts during government shutdowns.Noura Insolera, Assistant Research Scientist, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2101542023-08-08T12:29:52Z2023-08-08T12:29:52ZOlder ‘sandwich generation’ Californians spent more time with parents and less with grandkids after paid family leave law took effect<figure><img src="https://images.theconversation.com/files/541049/original/file-20230803-27-xpn12q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4535%2C2841&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nearly a dozen states have enacted these policies so far.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-taking-care-of-old-woman-in-wheelchair-royalty-free-image/970176900?adppopup=true">Westend61 via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>A California law that mandates paid family leave has led to adults in their 50s, 60s and 70s spending more time taking care of their parents and less time being their grandkids’ caregivers.</p>
<p>The law requires all employers to allow eligible workers to <a href="https://edd.ca.gov/en/disability/Am_I_Eligible_for_PFL_Benefits/">take up to six weeks of paid leave</a> to care for newborns, newly adopted children or seriously ill family members.</p>
<p>From 2006, two years after the law went into effect, to 2016, <a href="https://ca.db101.org/ca/situations/workandbenefits/rights/program2c.htm">this policy led to older adults’ spending 19 fewer hours</a> per year caring for their grandchildren, a 17% decrease. They spent 20 additional hours on average helping their own parents, a 50% increase. </p>
<p>The effect was most striking for people with newborn grandchildren and parents in need of help, but the law also benefited Californians with older grandchildren and those who don’t have parents requiring their assistance.</p>
<p><a href="https://doi.org/10.1080/08959420.2023.2226283">These findings</a> are from research I conducted with <a href="https://scholar.google.com/citations?user=yWNlAzcAAAAJ">Marcus Dillender</a>, a fellow economist. They suggest the law had effects through two channels. It enabled older adults to take paid leave to care for relatives with medical needs and it reduced the need for older adults to care for their grandchildren by granting paid parental leave to these children’s parents.</p>
<p>To assess how older adults spend their time, we analyzed data for people between the ages of 50 and 79 from the Health and Retirement Study, a <a href="https://hrs.isr.umich.edu/">longitudinal study of approximately 20,000 Americans</a>.</p>
<p>The survey asks respondents in that age group how much time they spend taking care of their grandchildren and helping their aging parents with basic personal activities like dressing, eating and bathing. We compared outcomes for people who lived in California with what happened to Americans in other states before and the law’s enactment.</p>
<p>We also looked into what happened for people who had different combinations of caregiving obligations – grandchildren less than 2 years old or older grandkids, or parents who need help or no parents requiring assistance.</p>
<h2>Why it matters</h2>
<p>The U.S. is the only wealthy country that <a href="https://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf">doesn’t require employers to provide paid family leave</a>. California was the first state to implement its own policies; <a href="https://www.ncsl.org/labor-and-employment/state-family-and-medical-leave-laws">10 others and the District of Columbia</a> have followed suit so far.</p>
<p>These policies can significantly affect older adults, who spend substantial time caring for their relatives.</p>
<p>Caregiving has become a more urgent policy issue because of the growing number of Americans who feel that they belong to a “<a href="https://www.michiganmedicine.org/health-lab/sandwich-generation-study-shows-challenges-caring-both-kids-and-aging-parents">sandwich generation</a>” of people who have to take care of their children or grandchildren and their parents at the same time. </p>
<h2>What other research is being done</h2>
<p>Other research has found that California’s paid family leave policy doubled the overall length of maternity leave by new mothers, <a href="https://doi.org/10.1002/pam.21676">increasing it from an average of three weeks to six weeks</a>. It also upped the likelihood that <a href="https://doi.org/10.1002/pam.22030">fathers take parental leave</a> following the birth or adoption of a child by 46% – although <a href="https://doi.org/10.1002/pam.21894">fathers take less leave on average than mothers</a>.</p>
<p>According to some of the many other studies conducted so far, California’s paid family leave law helped workers with caregiving responsibilities stay employed by allowing them to take time off with reduced financial risk and increased job continuity, <a href="https://doi.org/10.1093/workar/waab022">including for those ages 45 to 64 with a disabled spouse</a> and <a href="https://doi.org/10.1093/geront/gny105">middle-aged female caregivers</a>. The law has, in addition, reduced the share of elderly people using nursing homes by <a href="https://doi.org/10.1002/pam.22038">facilitating more informal care</a>.</p><img src="https://counter.theconversation.com/content/210154/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joelle Abramowitz receives funding from the National Institute on Aging, the Social Security Administration and the National Science Foundation. </span></em></p>The law changed older adults’ caregiving behavior because their children became more able to take paid time off work to care for their own newborns.Joelle Abramowitz, Assistant Research Scientist at the Survey Research Center, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085272023-07-26T12:18:41Z2023-07-26T12:18:41ZWhere the government draws the line for Medicaid coverage leaves out many older Americans who may need help paying for medical and long-term care bills – new research<figure><img src="https://images.theconversation.com/files/539037/original/file-20230724-23-hxz8n7.jpg?ixlib=rb-1.1.0&rect=0%2C738%2C3929%2C2144&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many older people with health insurance coverage through Medicare still can't afford the care they need.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-healthcare-assistance-in-a-home-royalty-free-image/1397246920?phrase=elder+care+drugs&adppopup=true">RichLegg/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Medicaid, which provides low-income Americans with health insurance coverage, currently excludes large numbers of adults over 65 with social, health and financial profiles similar to those of people the program does cover. Based on a <a href="https://doi.org/10.1080/08959420.2023.2195784">study we conducted</a>, we determined that if <a href="https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html">strict eligibility rules for Medicaid</a> were changed to help cover such people, from 700,000 to 11.5 million people over 65 would be newly eligible for the program.</p>
<p>We analyzed data from the 2018 <a href="https://hrs.isr.umich.edu/about">Health and Retirement Study</a>, a large national survey of older adults conducted by the Institute for Social Research at the University of Michigan every two years, to determine how using five different financial eligibility criteria would increase the number of older adults who would qualify for Medicaid and what they would look like.</p>
<p>Depending on which rules were changed, we would expect to see one of the following scenarios:</p>
<ul>
<li><p>If the government switched from the <a href="https://healthcare.gov/glossary/federal-poverty-level-fpl/">official poverty measurement Medicaid uses</a> – currently an annual income of US$14,580 for one person – to its more accurate <a href="https://www.census.gov/topics/income-poverty/supplemental-poverty-measure.html">supplemental one</a>, which takes taxes, health care costs and certain other expenses into account, about 700,000 more older Americans would get Medicaid coverage.</p></li>
<li><p>If the <a href="https://www.verywellhealth.com/your-assets-magi-and-medicaid-eligibility-4144975">amount of assets that people can have</a> were in line with other programs, such as the <a href="https://www.medicare.gov/medicare-savings-programs">Medicare Savings Plan</a>, an additional 1.4 million people would qualify. Medicare Savings Programs help pay Medicare costs for older adults with limited income and savings.</p></li>
<li><p>If Medicaid stopped <a href="https://www.agingcare.com/articles/asset-limits-to-qualify-for-medicaid-141681.htm">considering assets</a> altogether, an additional 2 million would qualify. </p></li>
<li><p>If the income eligibility threshold were higher, equal to 138% of the <a href="https://www.healthinsurance.org/glossary/federal-poverty-level/">federal poverty level</a>, it would <a href="https://www.medicaid.gov/medicaid/eligibility/index.html">mirror how the government determines</a> whether adults under 65 can get Medicaid, and 4.7 million more older people could be covered by the program. </p></li>
<li><p>A measure that’s increasingly used to evaluate the vulnerability of older adults is the <a href="https://theconversation.com/turning-gray-and-into-the-red-the-true-cost-of-growing-old-in-america-127162">Elder Index</a>, which takes into account basic expenses like housing, health care and food. People over 65 with incomes that fall <a href="https://www.census.gov/library/visualizations/2021/demo/poverty_measure-how.html">above the official poverty line</a> but below the Elder Index are considered to be financially vulnerable. If the government used the Elder Index as a basis for Medicaid eligibility, 11.5 million additional older adults would qualify for the program.</p></li>
</ul>
<p>Unless the government adopted the Elder Index approach, most of the additional enrollees in these scenarios would have poor health and few financial assets.</p>
<h2>Why it matters</h2>
<p>The extra Medicaid enrollment would be in addition to the <a href="https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html">7.2 million older people</a> already in the program.</p>
<p>All the people who would potentially qualify under these different eligibility standards are unable to shoulder even modest long-term care costs without <a href="https://www.aarp.org/aarp-foundation/our-work/income/public-benefits-guide-senior-assistance/">public assistance</a> aside from their <a href="https://www.ssa.gov/news/press/factsheets/basicfact-alt.pdf">Social Security benefits</a> – one of the largest risks facing the over <a href="https://aspe.hhs.gov/reports/what-lifetime-risk-needing-receiving-long-term-services-supports-0">70% of older adults</a> who will have such needs. This risk persists in part because Medicare does not cover such needs. </p>
<p>Low-income adults who are excluded from Medicaid under existing criteria also face high health care costs that contribute to their financial insecurity. Researchers found that <a href="https://doi.org/10.1001/jamanetworkopen.2023.14211">1 in 5 Americans over 65 skipped, delayed or used less</a> medical care or drugs because of financial constraints. </p>
<p>Increasing the number of low-income older people with both Medicaid and Medicare coverage would reduce their out-of-pocket health spending. That would make it <a href="https://doi.org/10.1016/j.jfineco.2019.10.008">easier for them to hang on to their modest savings</a> and also enable them to expand their own caregiving options should they have high medical or <a href="https://www.aplaceformom.com/caregiver-resources/articles/average-cost-long-term-care">long-term care expenses</a> as they age.</p>
<h2>What still isn’t known</h2>
<p>Increasing the number of older people with Medicaid coverage would require more government funding, although the degree of extra spending would depend on which rules the government would change.</p>
<p>Based on the average cost per Medicaid user, our rough estimates suggest that the cost of expanding Medicaid coverage for older people in the first four of the five scenarios we considered would range between about $8 billion and about $51 billion per year. We could not provide an estimate for the Elder Index scenario because the profile of individuals brought into the program would be substantially different from the current Medicaid users, so the per-person costs would be harder to predict.</p>
<p>Accurately estimating these costs and the potential benefits for families and communities that would come from these changes would require additional research.</p><img src="https://counter.theconversation.com/content/208527/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc Cohen receives funding from the National Council on Aging (NCOA).</span></em></p><p class="fine-print"><em><span>Jane Tavares receives funding from the National Council on Aging</span></em></p>Increasing the number of older people with both Medicaid and Medicare would mean fewer of them would be forced to skimp on the care and treatment they need.Marc Cohen, Clinical Professor of Gerontology and Co-Director LeadingAge LTSS Center, UMass BostonJane Tavares, Senior Research Fellow and Lecturer of Gerontology, LeadingAge LTSS Center @UMass Boston, UMass BostonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2081462023-06-23T12:28:57Z2023-06-23T12:28:57ZMore than 1.5 million Americans lost Medicaid coverage in the spring of 2023 due to the end of pandemic policies – and paperwork problems<figure><img src="https://images.theconversation.com/files/533251/original/file-20230621-15460-7pdgnh.jpg?ixlib=rb-1.1.0&rect=1802%2C134%2C6377%2C4574&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medicaid helps millions of low-income Americans get health care.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sad-girl-having-a-medical-appointment-with-her-royalty-free-image/1448475165?adppopup=true">skynesher/E+ via Getty Images</a></span></figcaption></figure><figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>At least 1.5 million Americans lost Medicaid coverage in <a href="https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/">April, May and the first three weeks of June 2023</a>, according to the Kaiser Family Foundation, a nonprofit that tracks health data. </p>
<p>Because only 25 states had publicly reported this data as of June 22, the actual number of people who lost coverage through Medicaid, the government’s main health insurance program for low-income people and people with certain disabilities, is surely much higher.</p>
<p>This swift <a href="https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/">decline in Medicaid enrollment follows a huge increase</a> that started in early 2020 and was brought about by <a href="https://ysph.yale.edu/news-article/3-essential-questions-the-end-of-medicaid-continuous-enrollment/">temporary policy changes</a> in effect for the first three years of the COVID-19 pandemic. During that time, the <a href="https://theconversation.com/medicaid-enrollment-soared-by-25-during-the-covid-19-pandemic-but-a-big-decline-could-happen-soon-190494">federal government didn’t let states</a>, which administer Medicaid, drop anyone from the program – even if their income grew too high to qualify.</p>
<p>As of January 2023, the most recent month for which full data is available, a <a href="https://data.medicaid.gov/dataset/6165f45b-ca93-5bb5-9d06-db29c692a360/data">total of 93 million Americans were insured</a> through either Medicaid or the <a href="https://www.verywellhealth.com/understanding-the-difference-between-medicaid-and-chip-4137934">Children’s Health Insurance Program</a>, known as CHIP, a related program. That marked a 30.7% increase from February 2020.</p>
<p>The federal government has estimated that <a href="https://aspe.hhs.gov/sites/default/files/documents/a892859839a80f8c3b9a1df1fcb79844/aspe-end-mcaid-continuous-coverage.pdf">15 million people will lose their coverage</a>, including 5.3 million children, by mid-2024 due to the end of the continuous enrollment policy.</p>
<p><iframe id="ELIcj" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/ELIcj/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Public health emergency over</h2>
<p>The sharp spike in Medicaid enrollment stopped abruptly because the U.S. <a href="https://theconversation.com/what-does-ending-the-emergency-status-of-the-covid-19-pandemic-in-the-us-mean-in-practice-4-questions-answered-205165">COVID-19 pandemic public health emergency status has expired</a>.</p>
<p>States now must phase out <a href="https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/">their continuous enrollment policies</a>, but they are doing it on different schedules. Some began in April 2023; others started to send out termination letters in May or June. There are also states that will not begin this process until later in the year or <a href="https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/covid-19-phe-unwinding-section-1902e14a-waiver-approvals/index.html">are taking steps to minimize</a> the number of people losing their coverage.</p>
<p>For about 3 in 4 of the people who lost their Medicaid coverage, it was <a href="https://www.nytimes.com/2023/05/26/us/politics/medicaid-coverage-pandemic-loss.html">for procedural reasons</a>, such as not filing required paperwork. The remaining 1 in 4 probably became ineligible due to an <a href="https://www.policygenius.com/health-insurance/a-state-by-state-guide-to-medicaid/">increase in their income</a>.</p>
<h2>Gains from Medicaid</h2>
<p>There is <a href="https://doi.org/10.1177/0002716219874772">mounting evidence</a> that Medicaid has many benefits for society – especially children.</p>
<p>For example, when low-income families <a href="https://doi.org/10.3368/jhr.54.3.0816.8173R1">remain in the program for long periods of time</a>, they tend to have <a href="https://www.jstor.org/stable/2138939">lower child mortality rates</a>. Medicaid coverage is also associated with <a href="https://doi.org/10.1002/soej.12614">kids faring better in school</a>.</p>
<p>Researchers have also determined that the federal government and state governments can get <a href="https://doi.org/10.1377/hlthaff.2020.00633">boosts in tax revenue</a> when families obtain this health insurance coverage through Medicaid and CHIP that exceed government spending on these programs. That’s because having better access to health care in the long term is <a href="https://doi.org/10.1093/qje/qjaa006">associated with being healthier</a>, staying in school longer and eventually earning a higher income.</p>
<p>The toll that the steep decline in health insurance coverage now underway will take on Americans remains to be seen.</p><img src="https://counter.theconversation.com/content/208146/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maithreyi Gopalan has received funding from the Spencer Foundation, American Educational Research Association, Russell Sage Foundation, and the Student Experience Research Network. She is an Impact Fellow (2023-24) at the Federation of American Scientists. </span></em></p>The health coverage program’s enrollment soared during the three years after March 2020 due to temporary policies adopted at the start of the COVID-19 pandemic.Maithreyi Gopalan, Assistant Professor of Education and Public Policy, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2064892023-06-02T12:40:21Z2023-06-02T12:40:21ZWork requirements don’t work for domestic violence survivors – but Michigan data shows they rarely get waivers they should receive for cash assistance<figure><img src="https://images.theconversation.com/files/529631/original/file-20230601-26-jmk5gb.jpg?ixlib=rb-1.1.0&rect=48%2C104%2C5318%2C3231&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Denying waivers to survivors of domestic violence can hinder their independence from their abusers. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rear-view-of-an-unrecognizable-abused-woman-sitting-royalty-free-image/1327080394">Alvaro Medina Jurado/Moment via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Very few people who have survived domestic violence are <a href="https://www.acf.hhs.gov/opre/project/family-self-sufficiency-and-stability-research-scholars-network-fssrn-2020-2025">getting Temporary Assistance for Needy Families (TANF) waivers</a> from the work requirements and time limits tied to those benefits – even though they’re eligible for them, according to our new research.</p>
<p>State governments administer the federal TANF program, commonly known as welfare or cash assistance, in accordance with their own guidelines. Federal law allows states to <a href="https://crsreports.congress.gov/product/pdf/RL/RL32748">grant domestic violence waivers</a> to TANF recipients when time limits, work requirements and other policies increase their risk of abuse or would unfairly penalize victims of abuse. Without a waiver, people who receive these benefits can only get <a href="https://research.upjohn.org/jrnlarticles/214/">TANF benefits for a limited time</a>, which can’t exceed a total of five years, and they must document the completion of up to 120 hours a month of “<a href="https://www.acf.hhs.gov/opre/report/tanf-work-requirements-and-state-strategies-fulfill-them">work activities</a>,” according to a <a href="https://www.cbpp.org/research/income-security/temporary-assistance-for-needy-families">complex compliance formula</a>.</p>
<p>We examined annual reports from Michigan to the federal government on the number of domestic violence waivers it issued from 2008 to 2021. Even when the number of approved TANF applications increased, as occurred at the beginning of the <a href="https://mlpp.org/revitalize-the-family-independence-program-to-help-more-michigan-families-reach-financial-stability/">COVID-19 pandemic</a>, the number of domestic violence waivers issued remained flat.</p>
<p>In recent years, an average of 12,600 families in Michigan received TANF benefits in a typical month. More than 75% were female-led single-parent households. Since studies have found that 25% to 50% of women who get these benefits <a href="https://www.doi.org/10.1891/1946-6560.2.2.147">have experienced domestic violence</a>, we would expect at least 750 to 1,000 women getting this assistance to be experiencing domestic violence or to have recently left a violent relationship.</p>
<p>Instead, the state has only issued a total of from seven to 36 waivers per year for the past decade.</p>
<p>Our estimates of how many domestic violence waivers should be issued exclude men and transgender and binary people due to a <a href="http://dx.doi.org/10.1136/bmjopen-2018-021960">lack of relevant research</a>. </p>
<p>To better understand what causes this discrepancy, we conducted focus groups with TANF caseworkers in 10 Michigan counties. They said they got no training on what domestic violence does to survivors’ ability to work, or guidance on when to grant the waivers. They also said there were no standard screening practices.</p>
<p>They also told us that survivors typically have to request waivers – even though by offering the waivers, Michigan has agreed to certify that TANF applicants and recipients are <a href="https://crsreports.congress.gov/product/pdf/RL/RL32748">notified that they are available</a>.</p>
<p>The caseworkers also said that domestic violence survivors who didn’t meet TANF work requirements often lost their benefits.</p>
<h2>Why it matters</h2>
<p>People who have experienced domestic violence can have <a href="https://econpapers.repec.org/article/rfajournl/v_3a5_3ay_3a2017_3ai_3a12_3ap_3a20-31.htm">trouble finding and keeping jobs</a> because of physical injuries and their abusers’ <a href="https://doi.org/10.1177/0886260520962075">efforts to sabotage their employment</a>. </p>
<p>Denying waivers to survivors can hinder their ability to gain financial independence and could place them at risk for returning to their abusive partner as a way to meet their housing and child care needs.</p>
<p>The <a href="https://theconversation.com/house-approval-of-debt-ceiling-deal-a-triumph-of-the-political-center-206837">debt-ceiling deal</a> struck between the White House and Republican leaders now pending in Congress would exempt people who are experiencing homelessness, former foster youth and veterans from <a href="https://theconversation.com/snap-work-requirements-dont-actually-get-more-people-working-but-they-do-drastically-limit-the-availability-of-food-aid-204257">Supplemental Nutrition Assistance Program</a> work requirements. Known as SNAP, that program provides low-income people with money they must spend on groceries.</p>
<p>Our findings show that even with exemptions in place for at-risk groups, people who are eligible for such exceptions do not automatically get them.</p>
<p>That same deal also includes provisions that may encourage <a href="https://www.foxbusiness.com/money/debt-ceiling-deal-includes-new-work-requirements-snap-how-they-would-work">states to further restrict TANF waivers</a> by setting stricter overall work requirement goals for all parents who get this aid. </p>
<h2>What other work is being done</h2>
<p>In states with more lenient work requirements, such as not immediately stopping benefits when people miss work requirement targets, and more generous financial incentives, people who get TANF benefits tend to have better and <a href="https://doi.org/10.1007/s10834-020-09714-8">higher-paying jobs</a> when they exit the program. In contrast, recent research indicates that taking TANF benefits away from domestic violence survivors can increase the risk that they will <a href="https://doi.org/10.1016/j.socscimed.2020.113355">experience further abuse</a>. </p>
<h2>What’s next</h2>
<p>We plan to expand our analysis to include the entire country and to see how waivers can be successfully used to help domestic violence survivors escape poverty.</p><img src="https://counter.theconversation.com/content/206489/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristina Nikolova Andrea Hetling receives funding from the Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, Grant Number 90PE0044.</span></em></p><p class="fine-print"><em><span>Andrea Hetling receives funding from the Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, Grant Number 90PE0043-01-01.</span></em></p>People who have experienced domestic violence can have trouble finding and keeping jobs because of physical injuries and their abusers’ efforts to sabotage their employment.Kristina Nikolova, Research Assistant Professor of Social Work, University of Windsor, and Adjunct Professor of Social Work, Wayne State UniversityAndrea Hetling, Professor of Public Policy, Rutgers UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2064622023-06-01T12:31:37Z2023-06-01T12:31:37ZGetting Social Security on a more stable path is hard but essential – 2 experts suggest a way forward<figure><img src="https://images.theconversation.com/files/528714/original/file-20230528-19-7mz301.jpg?ixlib=rb-1.1.0&rect=54%2C39%2C5166%2C3475&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No big Social Security reforms have taken effect since the Reagan administration.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-reagan-speaks-before-signing-the-social-security-news-photo/568872063">David Hume Kennerly/Getty Images</a></span></figcaption></figure><p>Social Security is in trouble. </p>
<p>The retirement and disability program has been running a cash-flow deficit since 2010. Its trust fund, which holds US$2.7 trillion, is rapidly diminishing. Social Security’s trustees, a group that includes the secretaries of the departments of Treasury, Labor, and Health and Human Services, as well as the Social Security commissioner, project that the trust fund will be <a href="https://www.ssa.gov/OACT/TR/2023/tr2023.pdf">completely drained by 2033</a>. </p>
<p>Under current law, when that trust fund is empty, Social Security can pay benefits only from dedicated tax revenues, which would by that point cover about <a href="https://www.ssa.gov/OACT/TRSUM/tr23summary.pdf">77% of promised benefits</a>. Another way to say this is that when the trust fund is depleted, under current law, Social Security beneficiaries would see a sudden 23% cut in their monthly checks in 2034. </p>
<p><a href="https://scholar.google.com/citations?hl=en&user=CwMgD5QAAAAJ">As economists</a> who <a href="https://scholar.google.com/citations?user=y0lrTOoAAAAJ&hl=en&oi=ao">study the Medicare and Social Security programs</a>, we view the above scenario as politically unacceptable. Such a sudden and dramatic benefit cut would anger a lot of voters. Unfortunately, the actions necessary now to avoid it – like raising taxes or cutting benefits – aren’t getting serious consideration today. But we believe there are strategies that could work.</p>
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<h2>Where the money for benefits comes from</h2>
<p>Roughly <a href="https://www.ssa.gov/news/press/factsheets/basicfact-alt.pdf">67 million Americans, most of whom are 65 or older</a>, receive Social Security benefits. The agency <a href="https://www.ssa.gov/news/press/releases/2021/#8-2021-2">disburses more than $1 trillion annually</a>. It’s the government’s largest single expenditure, constituting nearly <a href="https://fiscaldata.treasury.gov/americas-finance-guide/federal-spending/">20% of the total federal budget</a>.</p>
<p><a href="https://www.ssa.gov/oact/progdata/taxRates.html">Social Security is funded</a> by a payroll tax of 12.4% on wages split equally between workers and employers. Self-employed people pay the entire 12.4%. This payroll tax applies to earnings up to $160,200 as of 2023. The government increases this cap annually based on increases in the <a href="https://www.investopedia.com/terms/n/national-average-wage-index-nawi.asp">National Average Wage Index</a> – a measure that combines wage growth and inflation. The program also receives about 4% of its revenue from a <a href="https://www.ssa.gov/OACT/TR/2023/tr2023.pdf">tax on Social Security benefits</a>, though not everyone who receives them has to pay this tax.</p>
<p>Social Security tax revenue stayed relatively flat after 1990. But the costs of the program rose sharply in 2010, in part because of early <a href="https://doi.org/10.1177/0002716213499535">retirements in response to the Great Recession</a>.</p>
<p>Social Security spending has recently been growing more rapidly because of a <a href="https://www.pewresearch.org/short-reads/2020/11/09/the-pace-of-boomer-retirements-has-accelerated-in-the-past-year/">wave of baby boomer retirements</a>, which added to a decline in the <a href="https://retirementincomejournal.com/article/does-social-security-use-the-wrong-dependency-ratio">number of workers per retiree</a>.</p>
<p>Costs of the program are expected to further exceed the money that’s coming in, which will <a href="https://www.ssa.gov/OACT/TR/2023/tr2023.pdf">continue to drain the trust fund</a>, according to the program’s trustees. </p>
<p>Barring immediate action by the government, the trust fund’s exhaustion is only a little more than a decade away. And yet few members of Congress seem willing to do something about it. For example, <a href="https://thehill.com/homenews/sunday-talk-shows/3835082-mccarthy-social-security-medicare-cuts-off-the-table/">Social Security reform was not even</a> on the table during the 2023 negotiations over the debt ceiling and spending cuts.</p>
<h2>Trust fund</h2>
<p>Where did the trust fund, which helps cover the program’s costs, come from?</p>
<p>While the Social Security program was collecting surpluses from 1984 to 2009, that extra money funded other spending – keeping other taxes lower than they would have been otherwise and <a href="https://www.whitehouse.gov/omb/budget/historical-tables/">partially covering the budget deficit</a>.</p>
<p>During Social Security’s years of surplus, the excess revenues were credited to the trust fund in the form of <a href="https://www.ssa.gov/oact/progdata/specialissues.html">special-issue government bonds</a> that yielded the prevailing interest rates. When those bonds are needed to pay for Social Security expenses, the Treasury redeems them.</p>
<p>Those bonds are components of the <a href="https://www.crfb.org/papers/qa-gross-debt-versus-debt-held-public">government’s $31.4 trillion gross debt</a>. </p>
<h2>Last reformed during the Reagan administration</h2>
<p>Reducing the benefits current retirees receive would be extremely unpopular. Likewise, people now in the workforce who are nearing retirement would certainly object strongly if they were told to expect lower benefits in retirement than they have been promised throughout their careers.</p>
<p>The last time the government made big changes to Social Security was in 1983, during the Reagan administration, when the government enacted reforms that <a href="https://www.ssa.gov/history/1983amend.html">slowly reduced benefits over time</a>. These changes included raising the full retirement age, a change that is <a href="https://www.ssa.gov/benefits/retirement/planner/agereduction.html">still being phased in</a>. Because of those changes, workers born in 1960 or later cannot retire with full benefits until age 67 – two years later than the original retirement age.</p>
<p>The 1983 reforms also included increases in the Social Security payroll tax rate from 10.4% in 1983 to 12.4% by 1990, and for the first time levied federal income taxes on higher-income retirees’ benefits. Workers bore the burden of the payroll tax increases and <a href="https://faq.ssa.gov/en-us/Topic/article/KA-02471">higher-income retirees bore the burden of the tax on benefits</a>.</p>
<p>Those changes bolstered the program’s finances, but they no longer suffice.</p>
<p>The bipartisan <a href="https://www.ssa.gov/history/reports/pcsss/pcsss.html">2001 Commission to Strengthen Social Security</a> tried – and failed – during George W. Bush’s presidency to get Congress to enact reforms to shore up the program’s finances. There’s been no momentum toward resolving the problem since then.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man with gray hair sits at a table in front of a giant replica of a Social Security card." src="https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">George W. Bush sought to reform Social Security early in his presidency.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/george-bush-speaks-about-social-security-during-a-news-photo/525606778">Brooks Kraft LLC/Sygma via Getty Images</a></span>
</figcaption>
</figure>
<h2>4 principles</h2>
<p>We believe that policymakers and lawmakers need to follow four principles as they consider how to move forward.</p>
<ol>
<li><p>The program should be self-funded in the long run so that its annual revenues match its annual expenses. That way the many questions that arise related to trust fund accounting and whether Social Security tax revenues are being used for their intended purposes would be eliminated. </p></li>
<li><p>The reform burden should be shared across generations. Current retirees can share the burden through a reform that reduces the cost-of-living adjustment. Today’s workers can share the burden through an increase in the cap on income subjected to Social Security taxes so that 90% of total earnings are taxed. Continued gradual increases in the retirement age to keep pace with <a href="https://www.cbo.gov/system/files/2022-07/57975-demographic-outlook.pdf">anticipated longevity gains</a> would also be borne by current workers. </p></li>
<li><p>The government should make sure that Social Security benefits will be adequate for lower-income retirees for years to come. That means reforms that slow the benefit growth of future retirees would be designed to affect only higher-income retirees. </p></li>
<li><p>Any changes to Social Security should help constrain the future growth of federal spending, given the <a href="https://www.cbo.gov/publication/58946#_idTextAnchor004">current and projected growth in the budget deficit</a>.</p></li>
</ol>
<h2>Advantages of ending the delay</h2>
<p>It appears that the U.S. – citizens and elected officials included – are deferring serious debate on this urgent matter until the trust fund’s depletion is imminent. That’s unwise. Acting sooner rather than later would leave more options available to gradually resolve the program’s financial shortfalls. </p>
<p>Ending this procrastination would also give the millions of people who rely on Social Security benefits, taxpayers and businesses more time to prepare for any changes required by overdue reforms.</p><img src="https://counter.theconversation.com/content/206462/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Rettenmaier does not work for, consult, or own shares in or receive funding from any company or organization that would benefit from this article. He has received funding from the American Enterprise Institute, the Bradley Foundation, the Charles Koch Foundation, and the National Center for Policy Analysis. </span></em></p><p class="fine-print"><em><span>Dennis W. Jansen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If Congress and the White House fail to take action, Social Security beneficiaries would see a sudden 23% cut in their monthly checks in 2034.Andrew Rettenmaier, Executive Associate Director of the Private Enterprise Research Center, Texas A&M UniversityDennis W. Jansen, Professor of Economics and Director of the Private Enterprise Research Center, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2059602023-05-22T12:27:43Z2023-05-22T12:27:43ZGOP’s proposed expansion of SNAP work requirements targets many low-income people in their early 50s – but many of them already work<figure><img src="https://images.theconversation.com/files/527300/original/file-20230519-21-rnxqd4.jpg?ixlib=rb-1.1.0&rect=0%2C33%2C5488%2C3190&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many Americans in their early 50s take care of older loved ones.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caregiver-woman-helping-senior-man-with-shopping-royalty-free-image/587506108">FredFroese/E+ via Getty Imagres</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Roughly half of the people who would be affected by a proposed expansion of <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-199929">Supplemental Nutrition Assistance Program</a> work requirements already do what’s needed to meet those requirements. There’s also evidence suggesting that many of the rest have caregiving or health conditions that prevent them from working.</p>
<p>Formerly known as food stamps, SNAP helps low-income people buy groceries. </p>
<p>Republicans want the federal government to make SNAP benefits for <a href="https://www.cnn.com/2023/04/26/politics/work-requirements-food-stamps-medicaid-debt-ceiling/index.html">adults age 50 to 55</a> without dependents or disabilities contingent on spending <a href="https://www.fns.usda.gov/snap/work-requirements#:%7E:text=Work%20at%20least%2080%20hours,least%2080%20hours%20a%20month">80 hours per month on work activities</a>, which may include employment, short-term training and community service. This proposed change is in a package that the Republican-led <a href="https://www.cnn.com/2023/04/19/politics/mccarthy-debt-limit-bill/index.html">House of Representatives passed in April 2023</a> that seeks to cut spending on several social programs.</p>
<p>Currently, the requirements only apply to adults under 50 without dependents who aren’t disabled.</p>
<p>We’re basing these estimates on our analysis of nationally representative time-diary data from the Bureau of Labor Statistics’ <a href="https://www.bls.gov/tus/">American Time Use Survey</a>.</p>
<p>We analyzed the time that low-income Americans ages 50-55 who didn’t have a disability or child at home spent working, caring for others or dealing with their personal health and well-being from 2012 to 2021. </p>
<p>We found that in most years, more than half of them worked at least 20 hours per week. We estimated that, on average, those who met the work requirement actually worked about 41-51 hours per week – a full-time schedule. </p>
<p>We also determined that relative to their counterparts who met the work requirements, those who did not spent 10 times as much time managing their own health, five times as much time on child care, and more than five times as much time caring for an elderly or disabled adult.</p>
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<h2>Why it matters</h2>
<p>The GOP bill is <a href="https://www.washingtonexaminer.com/restoring-america/faith-freedom-self-reliance/how-to-stop-the-lefts-dangerous-despicable-war-on-work">grounded in a belief</a> that people who get SNAP benefits and aid through other assistance programs are not employed but capable of working, and that enforcing work requirements can increase employment and earnings.</p>
<p>But <a href="https://www.census.gov/library/stories/2020/07/most-families-that-received-snap-benefits-in-2018-had-at-least-one-person-working.html">that’s a misconception</a>.</p>
<p>This measure and <a href="https://networklobby.org/devastating-debt-ceiling-bill/">several others like it</a> are part of a package that would raise the debt limit to avert a potential U.S. default and a global economic crisis.</p>
<p>Our findings <a href="https://www.cbpp.org/research/food-assistance/house-republicans-agriculture-appropriations-bill-would-cut-wic-benefits">support widespread concerns</a> that expanding SNAP work requirements would sever food assistance benefits for an estimated <a href="https://www.cbo.gov/publication/59102">275,000 low-income people</a> between the ages of 50 and 55, including many with health conditions and who care for others.</p>
<p>That’s troubling because the cost of <a href="https://blog.dol.gov/2023/01/24/new-childcare-data-shows-prices-are-untenable-for-families">professional child care</a> and <a href="https://www.cnn.com/2023/04/20/health/senior-care-cost/index.html">elder care</a>, as well as the <a href="https://www.nationaldisabilityinstitute.org/wp-content/uploads/2020/10/extra-costs-living-with-disability-brief.pdf">care for the disabled</a>, is very high in the U.S.</p>
<p>It’s reasonable to expect that the new work requirements would force many people to make hard choices between the caregiving arrangements for their loved ones and keeping their benefits. Also, since people who have poor health may not be able to work, they may find themselves unable to put food on the table if they lose SNAP benefits.</p>
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<h2>What other research is being done</h2>
<p>SNAP is associated with many positive trends beyond getting enough to eat. These include <a href="https://doi.org/10.1001/jamainternmed.2017.4841">spending less on health care</a>, having <a href="https://doi.org/10.1017/s1368980021003815">better health</a> and <a href="https://www.federalreserve.gov/econres/feds/financial-repercussions-of-snap-work-requirements.htm">becoming more financially secure</a>.</p>
<p>Further, when Americans use SNAP to buy groceries, studies have shown that it <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/supplemental-nutrition-assistance-program-snap/economic-linkages/">stimulates the economy where they live</a>, supporting low-income communities. </p>
<p>Additional research has found that work requirements tied to aid programs <a href="https://theconversation.com/snap-work-requirements-dont-actually-get-more-people-working-but-they-do-drastically-limit-the-availability-of-food-aid-204257">don’t get more low-income people to enter the labor force</a>. Studies also have found that these policies cause many people who are eligible for assistance to <a href="https://theconversation.com/medicaid-work-requirements-would-leave-more-low-income-people-without-health-insurance-but-this-policy-is-unlikely-to-pass-this-time-around-204731">lose their benefits</a> due to paperwork hassles and unclear guidelines.</p><img src="https://counter.theconversation.com/content/205960/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Engel receives funding from the U.S. Department of Agriculture.</span></em></p><p class="fine-print"><em><span>Taryn Morrissey has received funding from the U.S. Department of Agriculture, the U.S. Department of Health and Human Services, the Robert Wood Johnson Foundation, the Bainum Family Foundation, DC Action for Children, and the Peter G. Peterson and Ford Foundations. Morrissey is a non-resident Fellow at the Urban Institute and previously a Senior Fellow at the Center for American Progress.</span></em></p>Republicans are pressing for policy changes based on a misconception that hardly anyone who gets help buying groceries with Supplemental Nutrition Assistance Program benefits is employed.Katherine Engel, PhD Student in Public Administration and Policy, American University School of Public AffairsTaryn Morrissey, Professor of Public Administration and Policy, American University School of Public AffairsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2051652023-05-10T18:49:55Z2023-05-10T18:49:55ZWhat does ending the emergency status of the COVID-19 pandemic in the US mean in practice? 4 questions answered<figure><img src="https://images.theconversation.com/files/524939/original/file-20230508-197326-1kuk6o.jpg?ixlib=rb-1.1.0&rect=181%2C142%2C8465%2C5418&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID-19 hasn't vanished, but at this point it's doing less damage.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-erasing-red-covid-19-virus-with-paint-roller-royalty-free-image/1292684629?phrase=covid-19&adppopup=true">Klaus Vedfelt/DigitalVision via Getty Images</a></span></figcaption></figure><p><em>The COVID-19 pandemic’s public health emergency status in the U.S. <a href="https://www.npr.org/2023/04/11/1169191865/biden-ends-covid-national-emergency">expires on May 11, 2023</a>. And on May 5, the World Health Organization declared <a href="https://www.statnews.com/2023/05/05/who-declares-end-to-covid-global-health-emergency/?">an end to the COVID-19 public health emergency of international concern</a>, or PHEIC, designation that had been in place since Jan. 30, 2020.</em> </p>
<p><em>Still, both the WHO and the White House have made clear that while the emergency phase of the pandemic has ended, the virus is here to stay and <a href="https://www.washingtonpost.com/health/2023/05/05/covid-forecast-next-two-years/">could continue to wreak havoc</a>.</em> </p>
<p><em>WHO Director General Tedros Adhanom Ghebreyesus noted that, over that time, the virus has taken the lives of <a href="https://www.washingtonpost.com/world/2023/05/05/who-covid-global-health-emergency/">more than 1 million people in the U.S.</a> and <a href="https://doi.org/10.1038/d41586-023-01559-z">about 7 million people globally</a> based on reported cases, though he said the true toll is likely <a href="https://www.npr.org/sections/goatsandsoda/2023/05/05/1174269442/who-ends-global-health-emergency-declaration-for-covid-19">closer to 20 million people worldwide</a>. While the global emergency status has ended, COVID-19 is still an “<a href="https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic">established and ongoing health issue</a>,” he said.</em></p>
<p><em>The Conversation asked public health experts <a href="https://cph.osu.edu/people/mjones">Marian Moser Jones</a> and <a href="https://cph.osu.edu/people/afairchild">Amy Lauren Fairchild</a> to put these changes into context and to explain their ramifications for the next stage of the pandemic.</em> </p>
<h2>1. What does ending the national emergency phase of the pandemic mean?</h2>
<p>Ending the federal emergency reflects both a scientific and political judgment that the acute phase of the COVID-19 pandemic crisis has ended and that special federal resources are no longer needed to prevent disease transmission across borders. </p>
<p>In practical terms, it means that two declarations – the <a href="https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx">federal Public Health Emergency</a>, first declared on Jan. 31, 2020, and the <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2022/02/18/notice-on-the-continuation-of-the-national-emergency-concerning-the-coronavirus-disease-2019-covid-19-pandemic-2/">COVID-19 national emergency</a> that former President Donald Trump announced on March 13, 2020, are expiring.</p>
<p>Declaring those emergencies enabled the federal government to cut through mountains of red tape to respond to the pandemic more efficiently. For instance, the declarations allowed <a href="https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx">funds to be made available</a> so that federal agencies could direct personnel, equipment, supplies and services to state and local governments wherever they were needed. In addition, the declarations made funding and other resources available to launch investigations into the “<a href="https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx">cause, treatment or prevention</a>” of COVID-19 and to enter into contracts with other organizations to meet needs stemming from the emergency. </p>
<p>The emergency status also allowed the federal government to make health care more widely available by <a href="https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx">suspending many requirements</a> for accessing Medicare, Medicaid and the Children’s Health Program, or CHIP. And they made it possible for people to receive free COVID-19 testing, treatment and vaccines and <a href="https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-telehealth-services.pdf">enabled Medicaid</a> and Medicare to <a href="https://telehealth.hhs.gov/providers/billing-and-reimbursement/">more easily cover telehealth services</a>. </p>
<p>Finally, the Trump administration used the national emergency to invoke <a href="https://www.dhs.gov/news/2023/01/05/dhs-continues-prepare-end-title-42-announces-new-border-enforcement-measures-and">Title 42</a>, a section of the Public Health Service Act that allows the federal government to <a href="https://theconversation.com/a-trump-era-law-used-to-restrict-immigration-is-nearing-its-end-despite-gop-warnings-of-a-looming-crisis-at-the-southern-border-194971">stop people at the nation’s borders</a> to prevent introduction of communicable diseases. Asylum seekers and others who normally undergo processing when they enter the U.S. have been turned away under this rule. </p>
<h2>2. What domestic policies are changing?</h2>
<p>An estimated 15 million people are likely to lose Medicaid or CHIP coverage, <a href="https://aspe.hhs.gov/sites/default/files/documents/a892859839a80f8c3b9a1df1fcb79844/aspe-end-mcaid-continuous-coverage.pdf">according to the federal government</a>. <a href="https://www.kff.org/medicaid/issue-brief/how-many-people-might-lose-medicaid-when-states-unwind-continuous-enrollment/">Another analysis projected</a> that as many as 24 million people will be kicked off the Medicaid rolls.</p>
<p>Before the pandemic, states required people to prove every year that they met income and other eligibility requirements. This <a href="https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-growth-estimates-by-state-and-eligibility-group-show-who-may-be-at-risk-as-continuous-enrollment-ends/">resulted in “churning”</a> – a process whereby people who did not complete renewal paperwork were being periodically disenrolled from state Medicaid programs before they could reapply and prove eligibility. </p>
<p>In March 2020, Congress enacted a continuous enrollment provision in Medicaid that prevented states from removing anyone from their rolls during the pandemic. From February 2020 to March 31, 2023, <a href="https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-growth-estimates-by-state-and-eligibility-group-show-who-may-be-at-risk-as-continuous-enrollment-ends/">enrollment in Medicaid and CHIP grew by nearly 23.5%</a> to a total of more than 93 million. In a December 2022 appropriations bill, Congress passed a provision that ended continuous enrollment on March 31, 2023.</p>
<p>The Biden administration <a href="https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf">defended this time frame as sufficient</a> to ensure that patients did not “lose access to care unpredictably” and that state Medicaid budgets – which received emergency funds beginning in 2020 – didn’t “face a radical cliff.” </p>
<p>But many people who have Medicaid or who enrolled their children in CHIP during this period may be unaware of these changes until they actually lose their benefits over the next several months.</p>
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<p>At least five states already <a href="https://ccf.georgetown.edu/2023/04/01/state-unwinding-tracker/">began disenrolling Medicaid members in April</a>. Other states are <a href="https://medicaid.ohio.gov/stakeholders-and-partners/covidunwinding/covidunwinding">sending out termination letters</a> and <a href="https://www.hhs.texas.gov/services/health/medicaid-chip/end-continuous-medicaid-coverage">renewal notices</a> and will <a href="https://ccf.georgetown.edu/2023/04/01/state-unwinding-tracker/">disenroll members starting in May, June and July</a>.</p>
<p>Only Oregon has set up a comprehensive program to minimize disenrollments. That state is running a <a href="https://www.oregon.gov/oha/HSD/Medicaid-Policy/Documents/2022-2027-1115-Demonstration-Approval.pdf">five-year federal demonstration program</a> that allows it to temporarily let people stay on Medicaid if their income is up to 200% of the federal poverty level and lets eligible children stay on Medicaid through age 6. Many other states are <a href="https://www.medicaid.gov/covid-19-phe-unwinding-section-1902e14a-waiver-approvals/index.html">trying more limited strategies</a> to improve the renewal process and decrease churning.</p>
<p>The array of telehealth services that Medicare began <a href="https://telehealth.hhs.gov/providers/billing-and-reimbursement/billing-and-coding-medicare-fee-for-service-claims/?">covering during the pandemic</a> will continue to be covered through December 2024. Medicare is also making coverage for <a href="https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency">behavioral and mental telehealth services a permanent benefit</a>.</p>
<p>The end of the emergency also means that the federal government is no longer covering the costs of COVID-19 vaccines and treatments for everyone. However, in April, the Biden administration announced a new $1.1 billion <a href="https://www.hhs.gov/about/news/2023/04/18/fact-sheet-hhs-announces-hhs-bridge-access-program-covid-19-vaccines-treatments-maintain-access-covid-19-care-uninsured.html">public-private “bridge access program</a>” that will provide COVID-19 vaccines and treatments free of charge for uninsured people through state and local health departments and pharmacies. Insured individuals may have out-of-pocket costs depending on their coverage.</p>
<p>The end of the emergency lifts the pandemic restriction on border crossing. Large numbers of migrants <a href="https://www.cnn.com/2023/05/08/us/title-42-expires-border-immigration/index.html">have gathered at the Mexico-U.S. border</a> and are expected to enter the country in the coming weeks, further straining already overwhelmed staff and facilities. </p>
<h2>3. What does this mean for the status of the pandemic?</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK143061">A pandemic declaration</a> represents an assessment that human transmission of a disease, whether well known or novel, is “extraordinary,” that it constitutes a public health risk to two or more U.S. states and that controlling it requires an international response. But declaring an end to the emergency doesn’t mean a return to business as usual.</p>
<p><a href="https://www.who.int/publications/i/item/WHO-WHE-SPP-2023.1">New global guidelines for long-term disease management</a> of COVID-19, released on May 3, 2023, urged countries “to maintain sufficient capacity, operational readiness and flexibility to scale up during surges of COVID-19, while maintaining other essential health services and preparing for the emergence of new variants with increased severity or capacity.”</p>
<p>Former White House COVID-19 response coordinator <a href="https://fortune.com/well/2023/04/29/covid-antiviral-paxlovid-evade-deborah-birx-double-deaths/">Deborah Birx recently warned</a> that the omicron COVID-19 variant continues to mutate and may become resistant to existing treatments. She called for more federally funded research into therapeutics and durable vaccines that protect against many variants. </p>
<p>Birx’s warnings come as <a href="https://www.krem.com/article/news/health/coronavirus/washington-covid-final-press-conference/293-3f109a05-5e8a-4c80-8868-18f8cd9d3fbe">remaining states have ended their COVID-19 press briefings</a> and <a href="https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/CANotify/CANotifyMain.aspx">shut down their exposure notification systems</a>, and the <a href="https://apnews.com/article/covid-home-test-78960c4c36422907a2eab3eb0dcdfadd">federal government has ended its free COVID-19 at-home test program</a>. </p>
<p>With the end of the emergency, the CDC is also changing the way it presents its COVID-19 data to a “<a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html">sustainable national COVID-19 surveillance” model</a>. This shift in COVID-19 monitoring and communication strategies accompanying the end of the emergency means that the virus is disappearing from the headlines, even though it has not disappeared from our lives and communities.</p>
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<h2>4. How will state and local pandemic measures be affected?</h2>
<p>The end of the federal emergency does not affect state-level or local-level emergency declarations. These declarations have allowed states to allocate resources to meet pandemic needs and have <a href="https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/telehealth-licensing-requirements-and-interstate-compacts/">included provisions</a> allowing them to respond to surges in COVID-19 cases by allowing out-of-state physicians and other health care providers to practice in person and through telehealth. </p>
<p>Most U.S. states, however, have ended their own public health emergency declarations. Six states – Delaware, Illinois, Massachusetts, New York, Rhode Island and Texas – still had emergency declarations in effect as of May 3, 2023, that will expire by the end of the month. So far, <a href="https://nashp.org/states-covid-19-public-health-emergency-declarations/">Massachusetts Gov. Maura Healey</a> stands alone in having indicated that she will “extend key flexibilities provided by the public health emergency” related to health care staffing and emergency medical services.</p>
<p>While some states may choose to make permanent some COVID-era emergency standards, such as looser restrictions on telemedicine or out-of-state health providers, we believe it could be a long time before either politicians or members of the public regain an appetite for any emergency orders directly related to COVID-19. </p>
<p><em>This is an updated version of an article that was <a href="https://theconversation.com/bidens-plan-for-ending-the-emergency-declaration-for-covid-19-signals-a-pivotal-point-in-the-pandemic-4-questions-answered-199060">originally published</a> on Feb. 3, 2023.</em></p><img src="https://counter.theconversation.com/content/205165/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marian Moser Jones receives funding from the National Endowment for the Humanities and The American Public Health Association. In the past she has received funding from the National Institutes of Health and the American Association for the History of Nursing, as well as the State of Maryland.</span></em></p><p class="fine-print"><em><span>Amy Lauren Fairchild has received funding from NIH, NSF, NEH, the RWJ Foundation, and the Greenwall Foundation. </span></em></p>The emergency status allowed the federal government to cut through a mountain of red tape, with the goal of responding to the pandemic more efficiently.Marian Moser Jones, Associate Professor of Health Services Management, Policy and History, The Ohio State UniversityAmy Lauren Fairchild, Dean and Professor of Public Health, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2025552023-05-08T12:19:43Z2023-05-08T12:19:43ZThese four challenges will shape the next farm bill – and how the US eats<figure><img src="https://images.theconversation.com/files/524429/original/file-20230504-15-4xz4fi.jpg?ixlib=rb-1.1.0&rect=31%2C15%2C5161%2C3425&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Small-scale farmers, organic producers and local markets receive a tiny fraction of farm bill funding.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/fresh-produce-at-the-waverly-market-baltimore-maryland-news-photo/1296520990">Edwin Remsberg/VWPics/Universal Images Group/Getty Images</a></span></figcaption></figure><p>For the 20th time since 1933, Congress is writing a multiyear farm bill that will shape what kind of food U.S. farmers grow, how they raise it and how it gets to consumers. These measures are large, complex and expensive: The next farm bill is projected to cost taxpayers <a href="https://farmdocdaily.illinois.edu/2023/02/a-view-of-the-2023-farm-bill-from-the-cbo-baseline.html">US$1.5 trillion</a> over 10 years. </p>
<p>Modern farm bills address many things besides food, from rural broadband access to biofuels and even help for small towns to buy police cars. These measures bring out a dizzying range of interest groups with diverse agendas.</p>
<p>Umbrella organizations like the <a href="https://www.fb.org/files/2023-Farm-Bill-Priorities-FINAL-23.0119.pdf">American Farm Bureau Federation</a> and the <a href="https://nfu.org/wp-content/uploads/2023/03/2023-NFU-Special-Order-of-Business-Farm-Bill.pdf">National Farmers Union</a> typically focus on farm subsidies and crop insurance. The <a href="https://sustainableagriculture.net/wp-content/uploads/2022/11/2023-Farm-Bill-Platform.pdf">National Sustainable Agriculture Coalition</a> advocates for small farmers and ranchers. Industry-specific groups, such as <a href="https://www.ncba.org/Media/NCBAorg/Docs/jan-2023-farm-bill-one-pager.pdf">cattlemen</a>, <a href="https://www.wga.com/wp-content/uploads/d7files/Farm%20Bill%20Cover%20Letter-Formatted%20v2.pdf">fruit and vegetable growers</a> and <a href="https://ota.com/sites/default/files/indexed_files/2023%20Farm%20Bill%20Platform%20Priorities.pdf">organic producers</a>, all have their own interests. </p>
<p><a href="https://files.worldwildlife.org/wwfcmsprod/files/Publication/file/4ts36tbe1v_Farm_Bill_Recommendations_Final.pdf?_ga=2.63891951.1986224278.1680824658-413312318.1680545091">Environmental</a> and <a href="https://farmland.org/wp-content/uploads/2022/10/AFT_2023_Farm_Bill_Recommendations_Summary.pdf">conservation groups</a> seek to influence policies that affect land use and sustainable farming practices. <a href="https://www.cspinet.org/sites/default/files/2023-01/NANA%20Combined%20Farm%20Bill%20Priorities.pdf">Hunger and nutrition groups</a> target the bill’s sections on food aid. <a href="https://www.naco.org/resources/2023-farm-bill-primer">Rural counties</a>, <a href="https://www.trcp.org/wp-content/uploads/2023/02/TRCP-AWWG-2023-FB-Platform_1-31-23.pdf">hunters and anglers</a>, <a href="https://www.aba.com/-/media/documents/testimonies-and-speeches/aba-statement-for-the-record-farm-bill-2023.pdf?rev=c490c77291fb4781b4e999b4d127e1de">bankers</a> and dozens of other organizations have their own wish lists.</p>
<p>As a <a href="https://sustainability-innovation.asu.edu/person/kathleen-merrigan/">former Senate aide and senior official</a> at the U.S. Department of Agriculture, I’ve seen this intricate process from all sides. In my view, with the challenges in this round so complex and with critical 2024 elections looming, it could take Congress until 2025 to craft and enact a bill. Here are four key issues shaping the next farm bill, and through it, the future of the U.S. food system. </p>
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<h2>The price tag</h2>
<p>Farm bills always are controversial because of their high cost, but this year the timing is especially tricky. In the past two years, Congress has enacted major bills to <a href="https://www.whitehouse.gov/american-rescue-plan/">provide economic relief from the COVID-19 pandemic</a>, <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/15/by-the-numbers-the-inflation-reduction-act/">counter inflation</a>, <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/11/06/fact-sheet-the-bipartisan-infrastructure-deal/">invest in infrastructure</a> and <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/09/fact-sheet-chips-and-science-act-will-lower-costs-create-jobs-strengthen-supply-chains-and-counter-china/">boost domestic manufacturing</a>. </p>
<p>These measures follow <a href="https://www.politico.com/news/2020/07/14/donald-trump-coronavirus-farmer-bailouts-359932">unprecedented spending</a> for farm support during the Trump administration. Now legislators are jockeying over <a href="https://theconversation.com/why-america-has-a-debt-ceiling-5-questions-answered-164977">raising the debt ceiling</a>, which limits how much the federal government can borrow to pay its bills.</p>
<p><a href="https://fj-corp-pub.s3.us-east-2.amazonaws.com/inline-files/FY24%20Views%20and%20Estimates%20Letter%20-%20final.pdf">Agriculture Committee leaders</a> and <a href="https://soygrowers.com/wp-content/uploads/2023/03/Farm-Bill-Budget-Letter-3-14-2023-FINAL.pdf">farm groups</a> argue that more money is necessary to strengthen the food and farm sector. If they have their way, the price tag for the next farm bill would increase significantly from current projections. </p>
<p>On the other side, <a href="https://www.rstreet.org/research/the-shaky-foundations-of-modern-farm-policy/">reformers argue</a> for <a href="https://www.ewg.org/research/updated-ewg-farm-subsidy-database-shows-largest-producers-reap-billions-despite-climate">capping payments to farmers</a>, which The Washington Post recently described as an “expensive <a href="https://www.washingtonpost.com/opinions/2023/05/05/congress-farm-bill-subsidies-debt/">agricultural safety net</a>,” and restricting payment eligibility. In their view, too much money goes to very large farms that produce <a href="https://www.fao.org/3/w3240e/w3240e06.htm">commodity crops</a> like wheat, corn, soybeans and rice, while small and medium-size producers receive far less support.</p>
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<h2>Food aid is the key fight</h2>
<p>Many people are surprised to learn that nutrition assistance – mainly through the <a href="https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program">Supplemental Nutrition Assistance Program</a>, formerly known as food stamps – is where most farm bill money is spent. Back in the 1970s, Congress began including nutrition assistance in the farm bill to secure votes from an increasingly urban nation. </p>
<p>Today, <a href="https://www.cbpp.org/research/food-assistance/the-supplemental-nutrition-assistance-program-snap">over 42 million Americans depend on SNAP</a>, including nearly 1 in every 4 children. Along with a few smaller programs, SNAP will likely consume 80% of the money in the new farm bill, up from <a href="https://www.ers.usda.gov/agriculture-improvement-act-of-2018-highlights-and-implications/">76% in 2018</a>. </p>
<p>Why have SNAP costs grown? During the pandemic, SNAP benefits were increased on an emergency basis, but that temporary arrangement <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-199929">expired in March 2023</a>. Also, in response to a directive included in the 2018 farm bill, the Department of Agriculture recalculated what it takes to afford a healthy diet, known as the <a href="https://www.fns.usda.gov/snap/thriftyfoodplan">Thrifty Food Plan</a>, and determined that it required an additional $12-$16 per month per recipient, or 40 cents per meal. </p>
<p>Because it’s such a large target, SNAP is where much of the budget battle will play out. Most Republicans typically seek to rein in SNAP; most Democrats usually support expanding it.</p>
<p>Anti-hunger advocates are lobbying to make the increased pandemic benefits permanent and defend the revised Thrifty Food Plan. In contrast, Republicans are calling for SNAP reductions, and are particularly focused on expanding <a href="https://georgiarecorder.com/2023/03/28/usda-secretary-battles-with-u-s-house-republicans-over-costs-of-federal-nutrition-programs/">work requirements</a> for recipients. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/524514/original/file-20230504-19-qqkzt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Groceries on a kitchen counter." src="https://images.theconversation.com/files/524514/original/file-20230504-19-qqkzt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524514/original/file-20230504-19-qqkzt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524514/original/file-20230504-19-qqkzt9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524514/original/file-20230504-19-qqkzt9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524514/original/file-20230504-19-qqkzt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524514/original/file-20230504-19-qqkzt9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524514/original/file-20230504-19-qqkzt9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Jaqueline Benitez puts away groceries at her home in Bellflower, Calif., Feb. 13, 2023. Benitez, 21, works as a preschool teacher and depends on SNAP benefits to help pay for food.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/FoodStamps/95413d28987347f09dfc93598e7dbb45/photo">AP Photo/Allison Dinner</a></span>
</figcaption>
</figure>
<h2>Debating climate solutions</h2>
<p>The 2022 <a href="https://www.scientificamerican.com/article/biden-signs-historic-climate-bill-as-scientists-applaud/">Inflation Reduction Act</a> provided $19.5 billion to the Department of Agriculture for programs that address climate change. Environmentalists and farmers alike <a href="https://www.farmanddairy.com/news/farm-conservation-groups-applaud-climate-ag-funding/730970.html">applauded this investment</a>, which is intended to help the agriculture sector embrace climate-smart farming practices and move toward markets that reward carbon sequestration and other ecosystem services. </p>
<p>This big pot of money has become a prime target for members of Congress who are <a href="https://www.agriculture.com/news/business/gop-senators-eye-climate-bill-funding-as-way-to-fatten-farm-bill-accounts">looking for more farm bill funding</a>. On the other side, conservation advocates, sustainable farmers and progressive businesses oppose diverting climate funds for other purposes. </p>
<p>There also is growing demand for Congress to require USDA to develop better standards for measuring, reporting and verifying actions designed to <a href="https://www.fsa.usda.gov/news-room/news-releases/2021/usda-announces-new-initiative-to-quantify-climate-benefits-of-conservation-reserve-program">protect or increase soil carbon</a>. Interest is rising in “<a href="https://www.spglobal.com/esg/insights/topics/carbon-farming-opportunities-for-agriculture-and-farmers-to-gain-from-decarbonization">carbon farming</a>” – paying farmers for practices such as <a href="https://theconversation.com/restoring-soil-can-help-address-climate-change-121733">no-till agriculture and planting cover crops</a>, which some studies indicate can <a href="https://rodaleinstitute.org/why-organic/issues-and-priorities/carbon-sequestration/">increase carbon storage in soil</a>. </p>
<p>But without more research and standards, observers worry that investments in climate-smart agriculture will support <a href="https://www.fastcompany.com/90796487/is-regenerative-agriculture-the-future-of-farming-or-the-next-greenwashing-fad">greenwashing</a> – misleading claims about environmental benefits – rather than a fundamentally different system of production. <a href="https://thefern.org/2022/12/a-pillar-of-the-climate-smart-agriculture-movement-is-on-shaky-ground/">Mixed research results</a> have raised questions as to whether establishing carbon markets based on such practices is premature. </p>
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<h2>A complex bill and inexperienced legislators</h2>
<p>Understanding farm bills requires highly specialized knowledge about issues ranging from crop insurance to nutrition to forestry. Nearly one-third of current members of Congress were first elected after the 2018 farm bill was enacted, so this is their first farm bill cycle. </p>
<p>I expect that, as often occurs in Congress, new members will follow more senior legislators’ cues and go along with traditional decision making. This will make it easier for entrenched interests, like the American Farm Bureau Federation and major commodity groups, to maintain support for <a href="https://www.ers.usda.gov/topics/farm-economy/farm-commodity-policy/title-i-crop-commodity-program-provisions/">Title I programs</a>, which provide revenue support for major commodity crops like corn, wheat and soybeans. These programs are complex, cost billions of dollars and go mainly to large-scale operations.</p>
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<figcaption><span class="caption">How the U.S. became a corn superpower.</span></figcaption>
</figure>
<p>Agriculture Secretary Tom Vilsack’s current stump speech spotlights the fact that 89% of U.S. farmers <a href="https://civileats.com/2022/06/02/field-report-tom-vilsack-usda-food-system-transformation-climate-equity-justice/">failed to make a livable profit</a> in 2022, even though total farm income <a href="https://www.ers.usda.gov/topics/farm-economy/farm-sector-income-finances/highlights-from-the-farm-income-forecast">set a record at $162 billion</a>. Vilsack asserts that less-profitable operations should be the focus of this farm bill – but when pressed, he appears <a href="https://thehill.com/policy/equilibrium-sustainability/3903829-support-for-small-farms-wont-hurt-big-ones-vilsack-tells-lawmakers/">unwilling to concede</a> that support for large-scale operations should be changed in any way. </p>
<p>When I served as deputy secretary of agriculture from 2009 to 2011, I oversaw the department’s budget process and learned that investing in one thing often requires defunding another. My dream farm bill would invest in three priorities: <a href="https://www.nrdc.org/resources/grow-organic-climate-health-and-economic-case-expanding-organic-agriculture">organic agriculture as a climate solution</a>; infrastructure to support vibrant local and regional markets and shift away from an agricultural economy dependent on exporting low-value crops; and agricultural science and technology research aimed at reducing labor and <a href="https://theconversation.com/fertilizer-prices-are-soaring-and-thats-an-opportunity-to-promote-more-sustainable-ways-of-growing-crops-183418">chemical inputs</a> and providing new solutions for sustainable livestock production. </p>
<p>In my view, it is time for tough policy choices, and it won’t be possible to fund everything. Congress’ response will show whether it supports business as usual in agriculture, or a more diverse and sustainable U.S. farm system.</p><img src="https://counter.theconversation.com/content/202555/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathleen Merrigan is a former Deputy Secretary of the US Department of Agriculture</span></em></p>Even if you don’t live near farm country, you’ve got a stake in the upcoming farm bill – including what kind of farms your tax dollars support.Kathleen Merrigan, Executive Director, Swette Center for Sustainable Food Systems, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047312023-05-08T12:17:57Z2023-05-08T12:17:57ZMedicaid work requirements would leave more low-income people without health insurance – but this policy is unlikely to pass this time around<figure><img src="https://images.theconversation.com/files/524627/original/file-20230505-6263-k3g9u0.jpg?ixlib=rb-1.1.0&rect=55%2C7%2C5230%2C2868&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Speaker Kevin McCarthy got the House to approve a package that could reduce the Medicaid program's scale.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/house-speaker-kevin-mccarthy-speaks-about-the-countrys-debt-news-photo/1463574682">Alex Wong/Getty Images</a></span></figcaption></figure><p><em>The legislative package the U.S. <a href="https://www.congress.gov/bill/118th-congress/house-bill/2811/text">House of Representatives passed on April 26, 2023</a>, by a narrow margin would pare federal spending over the next decade while also <a href="https://theconversation.com/why-america-has-a-debt-ceiling-5-questions-answered-164977">raising the debt ceiling</a>. One important measure in the Republican-backed bill would restrict access to Medicaid for millions of Americans.</em></p>
<p><em>About <a href="https://theconversation.com/1-in-4-americans-are-covered-by-medicaid-or-chip-a-program-that-insures-low-income-kids-176424">1 in 4 Americans have health coverage</a> through the program, which primarily serves low-income and disabled people and which is <a href="https://doi.org/10.1215/03616878-2882219">funded jointly by the federal government and the states</a>. Should the Republican-backed legislation prevail, the federal government would require <a href="https://apnews.com/article/senate-hearing-debt-ceiling-bae2b777086b0e232cc0d51fe03a3930">adults insured by Medicaid who are 19 to 55</a> years old and don’t have children or other dependents to spend 80 hours a month doing paid work, job training or community service.</em></p>
<p><em>The Conversation asked <a href="https://scholar.google.com/citations?user=QY68LSIAAAAJ&hl=en&oi=ao">Simon F. Haeder</a>, a public health scholar, to explain what the proposed work requirements would do and why the <a href="https://apnews.com/article/medicaid-enrollees-removed-review-health-insurance-pandemic-bffc3c67ab2767e4e3cea8250683ea7a">Republican effort to institute them matters</a> for the millions of Americans who rely on Medicaid.</em></p>
<h2>What would change if this policy took effect?</h2>
<p>Unlike some other government programs that assist low-income Americans, including the <a href="https://theconversation.com/snap-work-requirements-dont-actually-get-more-people-working-but-they-do-drastically-limit-the-availability-of-food-aid-204257">Supplemental Nutrition Assistance Program</a>, or SNAP, and <a href="https://www.acf.hhs.gov/ofa/programs/temporary-assistance-needy-families-tanf">Temporary Assistance for Needy Families</a>, Medicaid currently has no work requirements.</p>
<p>The package the House recently passed would require all states to implement this policy. <a href="https://www.cbo.gov/system/files/2023-04/59109-Pallone.pdf">An estimated 15 million Americans</a> with Medicaid would need to comply with the requirements.</p>
<p>This change would dramatically increase bureaucratic hassles for Medicaid beneficiaries who are disproportionately low-income, disabled and nonwhite. KFF, a health care research nonprofit, <a href="https://www.kff.org/medicaid/issue-brief/tough-tradeoffs-under-republican-work-requirement-plan-some-people-lose-medicaid-or-states-could-pay-to-maintain-coverage/">estimates that 1.7 million</a> people would lose federal coverage. However, states have the option to continue to pay for these individuals solely with state funds.</p>
<p>Those who would be subject to the new rules would not be the only ones at risk. It is well known that many of the exempt populations, including the aged and disabled, <a href="https://www.milkenreview.org/articles/tangled-up-in-side-effects">struggle to complete paperwork</a> or fail to understand complex bureaucratic rules. Many experts predict that coverage losses could be <a href="https://doi.org/10.1056/NEJMsr1901772">even higher among these demographics</a>, as states would consider them to be out of compliance with work requirements. </p>
<h2>Are there precedents for this policy?</h2>
<p>This is <a href="https://www.milkenreview.org/articles/tangled-up-in-side-effects">not the first time</a> that Republicans sought to make access to Medicaid contingent on meeting work requirements for at least some beneficiaries. The Trump administration worked with various Republican-led states to use what are known as <a href="https://www.kff.org/medicaid/issue-brief/the-landscape-of-medicaid-demonstration-waivers-ahead-of-the-2020-election/">1115 demonstration waivers</a> for that purpose. These waivers allow states to make temporary changes to their Medicaid programs that depart from certain statutory requirements. However, those efforts were <a href="https://www.kff.org/policy-watch/medicaid-work-requirements-at-u-s-supreme-court/">quickly blocked in court</a>. Most were never even piloted before the Biden administration rescinded them.</p>
<p>One exception is Arkansas. </p>
<p>Arkansas began imposing work requirements on Medicaid recipients on adults ages 30 to 49 starting in June 2018. As a result, about <a href="https://www.cbpp.org/research/health/states-experiences-confirm-harmful-effects-of-medicaid-work-requirements">1 in 4 Arkansans</a> subject to that policy ended up <a href="https://www.doi.org/10.1056/NEJMsr1901772">losing their coverage by the end of that year</a> before <a href="https://www.kff.org/medicaid/issue-brief/an-overview-of-medicaid-work-requirements-what-happened-under-the-trump-and-biden-administrations/">courts deemed it unlawful</a>.</p>
<p>The <a href="https://theconversation.com/medicaid-work-requirements-where-do-they-stand-after-the-blue-wave-107762">Arkansas experience</a>, which was particularly burdensome for beneficiaries, reaffirmed many concerns of those who oppose work requirements. Importantly, the reason many lost coverage was not that they failed to complete the required hours of paid work, job training or community service, but that they struggled to <a href="https://abcnews.go.com/Health/wireStory/congress-eyes-work-rules-millions-covered-medicaid-98967684">overcome bureaucratic challenges</a>.</p>
<p>Efforts are also underway in <a href="https://www.commonwealthfund.org/blog/2023/far-reaching-implications-georgia-medicaid-work-experiment">Georgia to impose work requirements</a> on Medicaid beneficiaries despite legal hurdles and the Biden administration’s objections. With President Joe Biden in office, it’s going to remain difficult to experiment with this policy unless Congress approves a measure like the one in the House package.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/524626/original/file-20230505-17-jus7is.jpg?ixlib=rb-1.1.0&rect=71%2C58%2C2910%2C1886&q=45&auto=format&w=1000&fit=clip"><img alt="A white woman with short brown hair with her hands holding her face looks sad." src="https://images.theconversation.com/files/524626/original/file-20230505-17-jus7is.jpg?ixlib=rb-1.1.0&rect=71%2C58%2C2910%2C1886&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524626/original/file-20230505-17-jus7is.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524626/original/file-20230505-17-jus7is.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524626/original/file-20230505-17-jus7is.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524626/original/file-20230505-17-jus7is.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524626/original/file-20230505-17-jus7is.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524626/original/file-20230505-17-jus7is.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Elizabeth Cloinger lost access to Medicaid in Arkansas despite her eligibility when the state adopted work requirements.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/elizabeth-cloinger-was-tossed-off-of-the-arkansas-works-news-photo/1175367574?adppopup=true">Michael S. Williamson/The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<h2>What would be different this time?</h2>
<p>States had to actively seek out those waivers that Republicans embraced when former President Donald Trump was in the White House. That meant that Medicaid beneficiaries in states with Democratic leadership, such as California, were unlikely to ever confront them. </p>
<p>The proposed changes in the <a href="https://www.congress.gov/bill/118th-congress/house-bill/2811/text">House legislation would force all states</a> to implement work requirements for adults from 18 to 55 without dependents. Failure to comply would put states at risk of losing federal funding, so even Democratic-led states would have to adopt these rules. The proposed changes would also circumvent many of the legal concerns that previously prevented the widespread implementation of Medicaid work requirements.</p>
<p>Importantly, this policy change would coincide with <a href="https://osf.io/xzaf4">ongoing upheaval for Medicaid beneficiaries</a>. This is because millions of Medicaid beneficiaries are already losing coverage because of the expiration of the COVID-19 <a href="https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/">public health emergency declaration</a> on May 11 and states’ restarting eligibility determinations of Medicaid beneficiaries <a href="https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/">on April 1</a>. As long as the government’s continuous enrollment policy was in effect, <a href="https://osf.io/xzaf4">states couldn’t kick anyone off of Medicaid</a>.</p>
<p>The number of people covered by the program soared to <a href="https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html">93 million as of January 2023</a>.</p>
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<h2>Is this policy compatible with the purpose of Medicaid?</h2>
<p>The point of Medicaid has always been providing eligible low-income people with <a href="https://www.ssa.gov/OP_Home/ssact/title19/1901.htm">access to comprehensive health coverage</a> for as long as they need it. That is, <a href="https://doi.org/10.1215/03616878-10637708">Medicaid is exclusively a health insurance program</a>.</p>
<p>Some other safety net programs are supposed to achieve multiple goals. For example, the official mission of <a href="https://www.acf.hhs.gov/ofa/programs/tanf/about">Temporary Assistance for Needy Families</a> is to “end the dependence of needy parents on government benefits by promoting job preparation, work and marriage,” rather than just to help those needy parents make ends meet.</p>
<p>At the same time, there is evidence that <a href="https://www.kff.org/medicaid/issue-brief/the-relationship-between-work-and-health-findings-from-a-literature-review/">Medicaid leads to greater workforce participation</a>, because it provides affordable health coverage as well as access to needed medical care. If you have an illness, it can be much easier to stay on the job if you’re getting the treatment your condition requires. Indeed, <a href="https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-work-a-look-at-what-the-data-say/">most able-bodied adults on Medicaid are employed</a>.</p>
<p>Ironically, pushing people off Medicaid, either for failing to fulfill work requirements or because they struggle with navigating the bureaucracy, would likely <a href="https://www.kff.org/medicaid/issue-brief/the-relationship-between-work-and-health-findings-from-a-literature-review/">reduce the number of people who work</a>.</p>
<h2>Why is this significant?</h2>
<p>It seems unlikely that Medicaid work requirements will become law in 2023 or 2024, because <a href="https://doi.org/10.1215/03616878-8802198">Democrats have steadfastly opposed</a> their implementation and the party commands a majority in the Senate. However, given the <a href="https://www.whitehouse.gov/cea/written-materials/2021/10/06/life-after-default/">potentially dramatic implications of defaulting on the federal debt</a>, some Democrats may be willing to compromise.</p>
<p>For now, I think it’s far more likely that the Republicans in Congress are setting the stage for future efforts to make more public assistance programs contingent on complying with work requirements, especially the next time a Republican becomes the president of the United States.</p>
<p>If measures like the one the House passed as part of the Republican debt-ceiling package were to become law, even states with entrenched Democratic leadership could have little recourse to fight back.</p><img src="https://counter.theconversation.com/content/204731/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon F. Haeder receives funding from the Robert Wood Johnson Foundation and the Commonwealth of Pennsylvania.</span></em></p>Adults insured by Medicaid who are 19 to 55 years old and don’t have children or other dependents would need to spend 80 hours a month doing paid work, job training or community service.Simon F. Haeder, Associate Professor of Public Health, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2042572023-04-28T12:46:52Z2023-04-28T12:46:52ZSNAP work requirements don’t actually get more people working – but they do drastically limit the availability of food aid<figure><img src="https://images.theconversation.com/files/523084/original/file-20230426-1034-acwsi3.jpg?ixlib=rb-1.1.0&rect=0%2C108%2C6573%2C3935&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">These benefits make it easier for millions of Americans to buy groceries.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/unrecognizable-woman-marvels-at-grocery-bread-royalty-free-image/1041147560?phrase=grocery%20shopping&adppopup=true">SDI Productions/E+ via Getty Images</a></span></figcaption></figure><p>The House of Representatives has passed a bill that would cut spending, in part by <a href="https://www.cnn.com/2023/04/19/politics/mccarthy-debt-limit-bill/index.html">expanding work requirements</a> for the Supplemental Nutrition Assistance Program, through which nearly <a href="https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap">43 million low-income Americans get help buying groceries</a>. The House bill calls for this policy to apply to <a href="https://www.cnn.com/2023/04/26/politics/work-requirements-food-stamps-medicaid-debt-ceiling/index.html">adults as old as 55</a>, while today this policy only applies to adults under 50. Some Democrats, in contrast, are <a href="https://lee.house.gov/news/press-releases/reps-lee-adams-introduce-improving-access-to-nutrition-act">seeking to eliminate work requirements altogether</a>.</p>
<p>The <a href="https://www.nytimes.com/2023/04/26/us/politics/debt-limit-vote-republicans.html">bill passed by a 217-215 vote</a>, with <a href="https://clerk.house.gov/Votes/2023199">all but four Republicans in favor</a> and every Democrat opposed, on April 26, 2023. Tied to a <a href="https://www.vox.com/policy/2023/4/19/23688022/debt-ceiling-2023-kevin-mccarthy-medicaid-work-requirement">standoff over raising the debt ceiling</a>, the bill would also make Medicaid – the U.S. program that helps low-income and disabled people get health care – contingent on work requirements for some eligible Americans. It’s not clear whether that’s possible, since <a href="https://theconversation.com/medicaid-work-requirements-is-there-a-path-forward-that-could-help-the-poor-not-harm-them-114497">a federal court</a> has <a href="https://www.kff.org/medicaid/issue-brief/an-overview-of-medicaid-work-requirements-what-happened-under-the-trump-and-biden-administrations/">struck down similar measures</a> enacted in some states previously. </p>
<p><a href="https://www.politico.com/story/2018/08/22/clinton-signs-welfare-to-work-bill-aug-22-1996-790321">Since the Clinton administration, the government has required</a> that at least some people getting SNAP, commonly known as food stamps, <a href="https://www.fns.usda.gov/snap/work-requirements">do paid work, get job training or volunteer</a> – otherwise they can’t continue receiving benefits. Those <a href="https://www.brookings.edu/research/who-stands-to-lose-if-the-final-snap-work-requirement-rule-takes-effect/">requirements were paused in 2020</a> because of the COVID-19 pandemic. They are set to <a href="https://www.fns.usda.gov/snap/ffcra-impact-time-limit-abawds">return</a> in <a href="https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html">July 2023</a> regardless of the fate of the House bill – which is <a href="https://apnews.com/article/speaker-mccarthy-debt-biden-republicans-d4995f10a26d6c8bfa89a2bbfd1de93c">unlikely to pass in the Democratic-controlled Senate</a>.</p>
<p>I’m a member of a team of economists <a href="https://doi.org/10.1257/pol.20200561">studying the social safety net and work</a>. Because the <a href="https://clintonwhitehouse4.archives.gov/WH/Accomplishments/welfare.html">rationale for work requirements</a> is that they encourage adults who are able to work to earn more money and become more economically self-sufficient, we wanted to determine whether this policy boosts employment and earnings. We also looked into whether SNAP work requirements lead low-income adults to lose their benefits.</p>
<p>We found that the policy doesn’t make people more likely to find a job or make more money, but it does make Americans who could use help buying groceries less likely to get it. </p>
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<h2>Tracing a similar case study</h2>
<p>Adults with SNAP benefits who are subject to work requirements must document at least 80 hours per month of paid work, job training or volunteering. Otherwise, they can get the benefits for only three months within a three-year period. </p>
<p>Before the pandemic, these rules applied to most so-called “able-bodied” adults without children who were under 50, and that policy will again apply in July. <a href="https://www.fns.usda.gov/snap/work-requirements">There are some exceptions</a>, such as if the person with benefits is caring for kids younger than 6, has disabilities incompatible with holding a steady job or is in a drug or alcohol rehabilitation program.</p>
<p>To determine this policy’s impact, we studied SNAP, employment and earnings data in Virginia from both the period of the state’s previous suspension of work requirements and afterward.</p>
<p>Virginia, like many other states, <a href="https://www.cbpp.org/research/food-assistance/states-have-requested-waivers-from-snaps-time-limit-in-high-unemployment">suspended work requirements for several years</a> beginning in the Great Recession. During this period, adults could enroll in the program and continue to receive benefits regardless of their employment status.</p>
<p>In October 2013, however, Virginia reinstated work requirements, and they remained in effect in most counties for several years. In those areas, adults under the age of 50 without dependents who were considered able to work needed to either satisfy work requirements or receive an individual exemption to keep their SNAP benefits, while similar adults over the age of 50 did not.</p>
<p>We followed both age groups over time, comparing whether they worked and were getting SNAP benefits both before and after work requirements returned.</p>
<h2>No employment boost</h2>
<p>By comparing older and younger adults previously getting SNAP benefits, we found that work requirements did not increase employment or earnings 18 months after their reinstatement.</p>
<p>We also detected nearly identical patterns of employment before and after work requirements were reinstated for people in both age groups.</p>
<p>Adults without dependents, whether or not they lost their SNAP benefits to the resumption of work requirements, were earning at most an additional US$28 per month.</p>
<h2>Many lost their benefits</h2>
<p>But we did find that work requirements dramatically reduced the number of people enrolled in SNAP. Among the adults subject to work requirements once they were restored in 2013, over half lost their benefits because of the policy. </p>
<p>We also found that work requirements disproportionately led people who had faced great economic hardships, such as those without housing or earned income, to lose benefits. </p>
<p>Only 44% of the currently or formerly homeless people getting benefits remained enrolled in SNAP 18 months after work requirements were reinstated, compared with 64% of everyone else, our estimates suggest. Similarly, only 59% of those with no earned income remained enrolled, relative to 73% of those with prior earnings. </p>
<p>Because they are likely to qualify for an individual exemption to work requirements, adults with a history of a disability were more likely to retain benefits compared with others.</p>
<p>Adults kicked out of SNAP because of work requirements typically stood to lose $189 in benefits per month – the most a single person could obtain at the time. It also amounted to about two-thirds of their gross income.</p>
<p>We studied work requirements in Virginia because of the availability of detailed data on both earnings and SNAP benefits. </p>
<p>Although work requirements enforcement varies across states, we believe that our results are likely to be representative of the impacts of this policy, since SNAP recipients in Virginia <a href="https://www.fns.usda.gov/snap/characteristics-snap-households-fy-2020-and-early-months-covid-19-pandemic-characteristics">look similar</a> to nationwide averages on most demographic characteristics except race. </p>
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<p>Our findings do suggest that work requirements restrain federal spending by reducing the number of people getting SNAP benefits.</p>
<p>But our work also indicates that in today’s context, these savings would be at the expense of already vulnerable people facing additional economic hardship at a time when a <a href="https://www.cnbc.com/2023/04/26/how-long-a-recession-could-last-according-to-economists.html">new recession could be around the corner</a>.</p><img src="https://counter.theconversation.com/content/204257/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kelsey Pukelis receives funding from the National Science Foundation's Graduate Research Fellowship Program under Grant No. DGE1745303. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation.
</span></em></p>A team of economists looked at what happened after Supplemental Nutrition Assistance Program work requirements were reinstated in Virginia in 2013.Kelsey Pukelis, Ph.D. Student in Public Policy, Harvard Kennedy SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2001582023-04-14T12:16:52Z2023-04-14T12:16:52ZSocial Security may be failing well over a million people with disabilities – and COVID-19 is making the problem worse<figure><img src="https://images.theconversation.com/files/520945/original/file-20230413-367-pgvlmu.jpg?ixlib=rb-1.1.0&rect=46%2C124%2C3410%2C2192&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social Security has two programs aimed at helping those with disabilities. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/social-security-royalty-free-image/1214329962?phrase=social%20security%20disability">Kameleon007/iStock via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>More than half of U.S. adults over the age of 50 with work-limiting disabilities – likely over 1.3 million people – do not receive the Social Security disability benefits they may need, according to <a href="https://doi.org/10.1017/S0047279422000745">new peer-reviewed research I conducted</a>. In addition, those who do receive benefits are unlikely getting enough to make ends meet. </p>
<p>The <a href="https://www.ssa.gov/disability">Social Security Administration operates two programs</a> intended to provide benefits to people with disabilities: Disability Insurance and Supplemental Security Income, the latter of which hinges on financial need. Their shared goal is to ensure that people with work-limiting disabilities are able to maintain a decent standard of living.</p>
<p>I think it’s fair to say that if a disability benefit is truly available to those who need it, then a large portion of people with work-limiting disabilities should actually receive the aid. </p>
<p>To learn if that is true for the disability programs, I analyzed data over time from a long-running survey of adults older than age 50 called the <a href="https://hrs.isr.umich.edu/about">Health and Retirement Study</a>. The survey included information on disabilities and finances for tens of thousands of people from across the country and was linked to disability benefit records from the Social Security Administration. As the disability programs primarily serve those in their working years, I only looked at people who hadn’t yet hit <a href="https://www.nasi.org/learn/social-security/retirement-age/">the full retirement age</a>.</p>
<p>The data showed that the share of people with substantial work-limiting disabilities who received Disability Insurance, Supplemental Security Income benefits or both rose from 32% in 1998 to 47% in 2016, which was the last year the data was available. This is just a little above the average among <a href="https://share-eric.eu">27 high-income countries</a> I compared the data with. </p>
<p>Using the most recent <a href="https://www.census.gov/data/tables/time-series/demo/popest/2020s-national-detail.html">Census data</a>, I estimate that more than half of those with work-limiting disabilities between the ages of 50-64 — about 1.35 million people — likely need these benefits but aren’t getting them.</p>
<p>I also examined the generosity of disability benefits in the U.S. by using <a href="https://corporatefinanceinstitute.com/resources/data-science/regression-analysis/">regression analysis</a>, a statistical tool that allowed me to compare the relationship between multiple variables. This helped me identify whether disability benefit recipients experience greater difficulty achieving financial security compared with adults who are not on benefits but have similar social and demographic backgrounds. </p>
<p>I found that those receiving benefits, and particularly Supplemental Security Income, struggled more and experienced less financial security than their peers. </p>
<h2>Why it matters</h2>
<p><a href="https://doi.org/10.1016/j.dhjo.2013.12.001">Nearly a quarter of U.S. adults</a> who head a household will report a severe disability that limits their ability to work at some point in their lives. </p>
<p>Many will look for financial support from Social Security’s disability programs, which <a href="https://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/">together provide benefits</a> to more than 12 million people in 2023. </p>
<p>The Disability Insurance program, established in 1956, provides benefits to those who meet a specific <a href="https://www.ssa.gov/OP_Home/cfr20/404/404-1505.htm">definition of disability</a> and have paid Social Security payroll taxes. The <a href="https://www.ssa.gov/oact/STATS/dib-g3.html">average payment as of February 2023</a> was $1,686 per month. </p>
<p>The Supplemental Security Income program, established in 1972, pays cash benefits to adults and children who also meet the definition of disability and who have financial need. The <a href="https://www.ssa.gov/oact/cola/SSI.html">maximum payment as of 2023</a> was $914, though <a href="https://eligibility.com/state-disability-insurance">some states supplement this</a> with their own programs. </p>
<p>My research suggests that well over 1 million people with disabilities who face substantial barriers to employment are not getting the assistance they need. But what’s more, even those who receive benefits are likely not getting enough. <a href="https://www.ssa.gov/policy/docs/rsnotes/rsn2022-01.html">Past research</a> shows that more than 20% of Disability Insurance recipients and 52% of Supplemental Security Income recipients live in poverty despite receiving these benefits.</p>
<h2>What still isn’t known</h2>
<p>This research looked at data from 2016 and earlier, but a lot has changed since then. </p>
<p><a href="https://www.washingtonpost.com/politics/2022/12/05/social-security-disability-benefit-offices-backlog-breaking-point/">Chronic understaffing</a> at benefit offices — long-running but worse since the COVID-19 pandemic began — are making benefits harder to get at a time of growing need. An <a href="https://www.nber.org/papers/w30435">estimated 500,000 people</a> are experiencing disabilities as a result of long COVID. And those experiencing it report having <a href="https://www.cnn.com/2023/02/25/business/long-covid-workforce-issues-disability-claims/index.html">even more trouble receiving benefits</a>. </p>
<p>So the problem is probably worse today.</p><img src="https://counter.theconversation.com/content/200158/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zachary Morris received funding for this research from the Steven H. Sandell Grant Program for Retirement and Disability Research funded by the U.S. Social Security Administration (SSA) through the Retirement and Disability Research Consortium. </span></em></p>More than half of working-age adults over 50 with a work-limiting disability didn’t receive any benefits from Social Security in 2016.Zachary Morris, Assistant Professor of Social Welfare, Stony Brook University (The State University of New York)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2008932023-03-27T12:23:01Z2023-03-27T12:23:01ZExtra food assistance cushioned the early pandemic’s blow on kids’ mental health<figure><img src="https://images.theconversation.com/files/516734/original/file-20230321-20-u5z17m.jpg?ixlib=rb-1.1.0&rect=51%2C25%2C5668%2C3782&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The pandemic-era expansion of SNAP benefits ended in all U.S. states by March 2023.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-woman-wearing-protective-face-mask-hold-paper-royalty-free-image/1253665535?adppopup=true">aogreatkim/iStock/Getty Images Plus via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Despite the <a href="https://theconversation.com/snap-benefits-cost-a-total-of-85-6b-in-the-2020-fiscal-year-amid-heightened-us-poverty-and-unemployment-148077">heightened poverty and unemployment</a> seen when the COVID-19 pandemic got underway, many low-income U.S. children <a href="https://doi.org/10.1016/j.ypmed.2023.107456">did not experience a decline in their emotional and mental health</a>, we found in a new study. </p>
<p>We looked specifically at kids whose families were participating in the <a href="https://theconversation.com/how-snap-can-help-people-during-hard-economic-times-like-these-133664">Supplemental Nutrition Assistance Program</a> – commonly known as SNAP – the government program that helps low-income Americans afford food. </p>
<p>The government began to boost SNAP benefits in early 2020 to help offset pandemic-driven food insecurity for participating families, which now <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-199929">number around 41 million</a>.</p>
<p>As a result, <a href="https://www.fns.usda.gov/snap/covid-19-emergency-allotments-guidance">families got an extra US$95</a> or more per month for groceries to <a href="https://www.ers.usda.gov/webdocs/publications/100820/ap-089.pdf?v=5555.5">replace the meals children were missing</a> at schools that had closed. <a href="https://healthyeatingresearch.org/research/snap-waivers-and-adaptations-during-the-covid-19-pandemic-a-survey-of-state-agency-perspectives-in-2020/">Some eligibility rules were loosened</a> to expand the program’s reach, and for the first time, <a href="https://www.usda.gov/media/press-releases/2019/04/18/usda-launches-snap-online-purchasing-pilot">people could buy groceries online</a> with their SNAP benefits.</p>
<p>To learn whether these extra benefits affected children’s mental and emotional health, we analyzed five years of data collected by the <a href="https://www.nschdata.org/">National Survey of Children’s Health</a> on 30,748 low-income families with children aged 6 to 17 years. The data, which included both families who were and were not getting SNAP benefits, covered the four years prior to the pandemic, as well as 2020. </p>
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<p>Among the 8,680 families getting SNAP benefits during this period, 38% had at least one child with problems such as doctor-diagnosed mental, emotional, developmental or behavioral health issues – including anxiety and depression.</p>
<p>To assess whether the temporarily expanded benefits had an impact on these children, we conducted a “<a href="https://www.sciencedirect.com/topics/economics-econometrics-and-finance/difference-in-differences">difference in differences</a>” analysis: We compared data regarding children whose families enrolled in the SNAP program over time with children whose families didn’t get those benefits. In addition, we considered the potential influence of several factors that could play a role, such as parents’ mental health.</p>
<p>We found that children in families getting SNAP benefits in 2020 did not generally experience any change in their mental or emotional health compared to prior years, despite the heavy stress of the pandemic.</p>
<h2>Why it matters</h2>
<p>Typically, <a href="https://www.apa.org/topics/socioeconomic-status/poverty-hunger-homelessness-children">low-income children are more at risk</a> of developing mental health or emotional problems, compared with high-income children. Our study adds to earlier evidence that SNAP benefits can lower that risk by <a href="https://dx.doi.org/10.2105/AJPH.2014.302480">reducing psychological distress and improving food security</a>.</p>
<p>While 2020’s extra SNAP benefits protected children’s mental and emotional health, they did not improve it. This suggests that actually reducing food insecurity for low-income families would have required additional steps. </p>
<p>In March 2023, <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-19992">the federal government ended</a> the pandemic-era SNAP expansions in 35 states and territories that hadn’t yet rolled them back. With inflation driving the <a href="https://www.ers.usda.gov/data-products/food-price-outlook/summary-findings/">cost of groceries up 11.4%</a> in 2022, we believe that <a href="https://www.cbpp.org/research/food-assistance/temporary-pandemic-snap-benefits-will-end-in-remaining-35-states-in-march#_ftn2">losing these benefits</a> threatens the well-being of millions of families.</p>
<h2>What’s next</h2>
<p>We are now studying the <a href="https://texaswic.org/">effects of pandemic-related changes</a> to the Special Supplemental Nutrition Program for Women, Infants and Children, better known as WIC. </p>
<p>We are looking at, for example, how expanding WIC benefits to cover canned, frozen and dried fruits and vegetables in addition to fresh produce has affected the low-income families’ purchasing behavior. Our team for this research also includes public health and nutrition scholars <a href="https://scholar.google.com/citations?user=d4_yu0YAAAAJ&hl=en&oi=ao">Alexandra MacMillan Uribe</a> and <a href="https://scholar.google.com/citations?hl=en&user=UKvdw94AAAAJ">Elizabeth Racine</a>, </p>
<h2>What is not known</h2>
<p>When we did our study, data from the years after 2020 wasn’t yet available, so we couldn’t investigate the potential impact of subsequent pandemic-related changes to SNAP benefits. Notably, in 2021, the federal government increased maximum benefit levels by 15% and <a href="https://www.cbpp.org/research/food-assistance/temporary-pandemic-snap-benefits-will-end-in-remaining-35-states-in-march">extended the extra $95 or more</a> in monthly food assistance for the lowest-income households.</p><img src="https://counter.theconversation.com/content/200893/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grace Melo's research related for this article was supported by funding from the Texas A&M AgriLife Institute for Advancing Health Through Agriculture.</span></em></p><p class="fine-print"><em><span>Pourya Valizadeh receives funding from the U.S. Department of Agriculture's Economic Research Service. </span></em></p><p class="fine-print"><em><span>Rodolfo M. Nayga Jr. receives funding from U.S. Department of Agriculture.</span></em></p>Expanding SNAP helped shield low-income children from some of the harm caused by economic upheaval when the COVID-19 pandemic began.Grace Melo, ACES Faculty Fellow, Texas A&M UniversityPourya Valizadeh, Research Assistant Professor of Agricultural Economics, Texas A&M UniversityRodolfo M. Nayga Jr., Professor of Agricultural Economics, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2013602023-03-16T12:37:05Z2023-03-16T12:37:05ZWhy it’s hard for the US to cut or even control Medicare spending<figure><img src="https://images.theconversation.com/files/515188/original/file-20230314-3582-48y9sf.jpg?ixlib=rb-1.1.0&rect=77%2C94%2C5673%2C2862&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The number of Americans covered by Medicare is growing.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-friends-walking-with-nordic-walking-poles-in-royalty-free-image/1339068107">OR Images/DigitalVision via Getty Images</a></span></figcaption></figure><p>President Joe Biden’s 2024 proposed budget includes plans to <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2023/03/07/fact-sheet-the-presidents-budget-extending-medicare-solvency-by-25-years-or-more-strengthening-medicare-and-lowering-health-care-costs/">shore up the finances of Medicare</a>, the <a href="https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo">federal health insurance program</a> that covers Americans who are 65 and up and some younger people with disabilities.</p>
<p>His administration aims to increase <a href="https://crsreports.congress.gov/product/pdf/IF/IF11820">from 3.8% to 5%</a> an existing Medicare tax that’s collected on the labor and investment earnings of <a href="https://www.cnbc.com/2023/03/08/what-to-know-about-proposed-biden-tax-on-the-wealthy-to-fund-medicare.html">Americans who make more than US$400,000 annually</a>. It also aims to reap some savings from having the government <a href="https://www.politico.com/newsletters/politico-pulse/2023/03/10/the-white-houses-health-care-wish-list-00086344">negotiate prices on more prescription drugs</a>.</p>
<p>The White House projects that these changes would generate an additional <a href="https://www.whitehouse.gov/wp-content/uploads/2023/03/budget_fy2024.pdf">$650 billion</a> in revenue over a decade. <a href="https://budgetmodel.wharton.upenn.edu/issues/2023/3/10/president-bidens-proposal-to-extend-medicare-trust-fund">Some independent experts</a> concur.</p>
<p><a href="https://scholar.google.com/citations?hl=en&user=CwMgD5QAAAAJ">As economists</a> who have long <a href="https://scholar.google.com/citations?user=y0lrTOoAAAAJ&hl=en&oi=ao">researched</a> the <a href="https://scholar.google.com/citations?user=y0lrTOoAAAAJ&hl=en">Medicare and Social Security programs</a>, we believe the president’s proposal is an important first step in opening the necessary debate on strengthening Medicare’s finances.</p>
<h2>Part A’s precarious funding</h2>
<p>Medicare consumes more than <a href="https://www.cbo.gov/publication/58848">15% of the federal budget</a>. The program cost $975 billion in 2022, out of the government’s <a href="https://usafacts.org/state-of-the-union/budget/">$6.5 trillion in total federal spending</a>.</p>
<p>As anyone who has enrolled in it can tell you, the program itself is rather complicated. It’s divided into three parts, known as A, B and D, each of which relies on revenue from a different mix of sources.</p>
<p>Medicare Part A covers care delivered at hospitals and nursing homes, as well as home health care. Part B pays for doctor’s visits and outpatient procedures, and Part D pays for prescription drugs. There’s also Part C, a private insurance option, known as Medicare Advantage. However, its costs are included in the accounting for Parts A and B. </p>
<p>Part A is primarily funded by a <a href="https://www.irs.gov/publications/p80">1.45% Medicare payroll tax</a> on both employees and employers. When that tax and the program’s other tax revenues don’t raise enough money to cover Part A’s costs, the program dips into the <a href="https://www.crfb.org/our-work/projects/medicare-hospital-insurance-trust-fund">Medicare Hospital Insurance trust fund</a> to make up the difference. The trust fund, amassed from past surplus payroll taxes, currently stands at around <a href="https://www.ssa.gov/oact/TRSUM/tr22summary.pdf">$143 billion</a>.</p>
<p>Without spending cuts, funding increases or a combination of the two, the Medicare program’s trustees have predicted in their annual report that the <a href="https://www.cms.gov/files/document/2022-medicare-trustees-report.pdf">Medicare trust fund</a> will be exhausted by 2028. The <a href="https://home.treasury.gov/system/files/136/TR-2022-Fact-Sheet.pdf">trustees are the secretaries</a> of the Treasury, Labor and Health and Human Services departments, plus the Social Security commissioner. There can be up to two additional trustees, but those seats are vacant.</p>
<p>Medicare’s expenses are rising rapidly with the <a href="https://www.investopedia.com/articles/personal-finance/032216/are-we-baby-boomer-retirement-crisis.asp">retirement of baby boomers</a>, the large generation of Americans born between 1946 and 1964, and <a href="https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical">rising health care costs</a>. </p>
<p>Should the trust fund be emptied out, the trustees predict that hospital benefits would have to be cut by 10%. But those cuts are widely considered to be politically unacceptable, as illustrated by <a href="https://www.whitehouse.gov/state-of-the-union-2023/">statements from Biden</a> and his predecessor, former President <a href="https://www.pbs.org/newshour/politics/read-the-full-text-of-trumps-2020-state-of-the-union">Donald Trump</a>.</p>
<p>In addition to proposing an increase in the tax levied on the <a href="https://www.irs.gov/newsroom/questions-and-answers-on-the-net-investment-income-tax">investment earnings of high-income Americans</a>, Biden also proposes that these revenues be fully dedicated to the trust fund. Currently the <a href="https://www.cms.gov/files/document/2022-medicare-trustees-report.pdf">government treats that money as general revenue</a> that can be used for <a href="https://www.thebalancemoney.com/net-investment-income-tax-3192936">any government program</a>.</p>
<h2>2 very different scenarios</h2>
<p>Unlike Medicare Part A, Parts B and D are funded largely by general federal revenue and by premiums paid by retirees.</p>
<p>Because the government is allowed to use general revenue to pay for them, the funding of Parts B and D isn’t jeopardized by the depletion of their trust fund – no matter how fast those costs rise.</p>
<p>Even without Biden’s proposed changes, official Medicare spending projections rise rapidly through the mid-2030s and then plateau as a percentage of gross domestic product.</p>
<p>However, those projections are based on a presumption that payments to <a href="https://www.cms.gov/files/document/2022-medicare-trustees-report.pdf">hospitals are constrained as specified in the Affordable Care Act</a> and that other spending constraints on <a href="https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs">physician payments</a> are realized.</p>
<p>Unfortunately, <a href="https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2015/02/02/a-primer-on-medicare-physician-payment-reform-and-the-sgr/">history provides little assurance</a> that lawmakers will maintain all of these requirements to restrain future payments to health care providers. </p>
<p>We say this because of what happened after 1997, when Congress approved the sustainable growth rate system, which was intended to limit the annual increase in cost per Medicare beneficiary to the rate of economic growth. Starting in 2002, Congress passed legislation year after year to override it – and only stopped doing that once it <a href="http://doi.org/10.1001/journalofethics.2015.17.11.pfor1-1511">did away with the system altogether in 2015</a>.</p>
<p>Reflecting this uncertainty, the annual <a href="https://www.cms.gov/files/document/2022-medicare-trustees-report.pdf">trustees report</a> features an alternative projection that is arguably more credible and more scary. It indicates that Medicare costs will grow much faster than the economy starting in 2036.</p>
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<h2>Competing demands</h2>
<p>The Social Security program, a national pension program that primarily supports older Americans, faces similar funding shortfalls.</p>
<p>Its trustees anticipate that the <a href="https://www.ssa.gov/OACT/tr/2022/tr2022.pdf">Social Security trust fund will be depleted</a> by 2035 without changes in funding, promised benefits – or both. In that event, Social Security benefits <a href="https://www.cnn.com/2023/03/08/politics/social-security-benefit-cut/index.html">may have to fall by about 20%</a> from anticipated levels. </p>
<p>Medicare and Social Security are the nation’s largest <a href="https://www.aarp.org/politics-society/government-elections/national-debt-guide/glossary/entitlements-definition.html">entitlement programs</a>. Almost all Americans, if they live long enough, will eventually be eligible to obtain these benefits – regardless of their income or wealth. </p>
<p>While Americans do not yet agree on how to put these programs on a steadier fiscal footing, the math is clear.</p>
<p>Our elected representatives cannot avoid making hard decisions that involve increasing taxes, reducing benefits or both.</p><img src="https://counter.theconversation.com/content/201360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dennis W. Jansen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p><p class="fine-print"><em><span>Andrew Rettenmaier does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond his academic appointment.</span></em></p>The program’s expenses are rising rapidly as baby boomers retire and health care costs grow.Dennis W. Jansen, Professor of Economics and Director of the Private Enterprise Research Center, Texas A&M UniversityAndrew Rettenmaier, Executive Associate Director of the Private Enterprise Research Center, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1999292023-02-17T13:24:15Z2023-02-17T13:24:15ZExtra SNAP benefits are ending as US lawmakers resume battle over program that helps low-income Americans buy food<figure><img src="https://images.theconversation.com/files/510712/original/file-20230216-466-mfpujx.jpg?ixlib=rb-1.1.0&rect=43%2C359%2C3194%2C1796&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some Americans, the decline will be quite sharp.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/clark-resident-jen-valencia-still-works-part-time-for-news-photo/1363541115">Michael Loccisano/Getty Images</a></span></figcaption></figure><p>Millions of Americans will find it harder to put enough food on the table starting in March 2023, after a <a href="https://www.fns.usda.gov/snap/covid-19-emergency-allotments-guidance">COVID-19 pandemic-era boost</a> to <a href="https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program">Supplemental Nutrition Assistance Program</a> benefits comes to an end. Congress mandated this change in <a href="https://www.fns.usda.gov/snap/ea-provision-consolidated-appropriations-act-2023">budget legislation</a> it passed in late December 2022.</p>
<p><a href="https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap">Roughly 41 million Americans</a> are currently enrolled in this program, which the government has long used to ease hunger while <a href="https://theconversation.com/how-snap-can-help-people-during-hard-economic-times-like-these-133664">boosting the economy during downturns</a>.</p>
<p>Many families enrolled in the program, commonly known as SNAP but sometimes called food stamps, stand to <a href="https://www.cbpp.org/research/food-assistance/temporary-pandemic-snap-benefits-will-end-in-remaining-35-states-in-march#_ftn2">lose an average of roughly US$90 per person a month</a>.</p>
<p>While researching SNAP <a href="https://news.richmond.edu/releases/article/-/16856/ur-political-science-professor-awarded-funding-to-advance-book-project-on-history-of-americas-food-stamp-program.html">for an upcoming book</a>, I’ve observed that this program has provided critical assistance to struggling families over the last three years. The extra benefits, which Americans can use to purchase food at the <a href="https://ncoa.org/article/where-can-i-use-snap-benefit">roughly 250,000 stores that accept them</a>, have helped millions of people weather the pandemic’s economic fallout and high inflation rates.</p>
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<h2>SNAP benefits grew during the pandemic</h2>
<p>In the early days of the COVID-19 pandemic, <a href="https://www.nbcnews.com/news/us-news/covid-19-crisis-heaps-pressure-nation-s-food-banks-n1178731">lines at food banks grew</a> and <a href="https://www.bls.gov/opub/mlr/2021/article/unemployment-rises-in-2020-as-the-country-battles-the-covid-19-pandemic.htm">millions lost their jobs</a>. One way that <a href="https://www.congress.gov/bill/116th-congress/house-bill/6201/text">Congress responded was with legislation</a> that let the states, which administer this federally funded program, expand SNAP benefits during the public health emergency.</p>
<p>Under this temporary arrangement, all families who were eligible for SNAP could get the maximum allowable benefit amount for the size of their household. Otherwise, that maximum amount would only be available to people with no income at all. But starting in March 2023, SNAP benefits will once again be distributed everywhere on a sliding scale based on income levels.</p>
<p>Some states began to drop the extra benefits in the spring of 2021. <a href="https://www.fns.usda.gov/snap/2023-benefit-changes">But 32 states</a> and the District of Columbia were still offering the extra help in February 2023. </p>
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<p>A <a href="https://www.urban.org/research/publication/effect-reevaluated-thrifty-food-plan-and-emergency-allotments-supplemental">study from the Urban Institute</a>, a think tank, estimated that the extra benefits kept 4.2 million people out of poverty at the end of 2021 and had reduced overall poverty in states still offering the benefits by 9.6% and child poverty by 14%. </p>
<p>Although the unemployment rate has recently fallen to the <a href="https://www.cnbc.com/2023/02/03/jobs-report-january-2023-.html">lowest level since 1969</a>, the extra SNAP benefits have continued to help low-income families deal with soaring prices that <a href="https://www.bls.gov/news.release/cpi.nr0.htm">increased the cost of food consumed at home by 11.3%</a> in the 12 months ending in January 2023.</p>
<p>With more people enrolled in the program today than before the COVID-19 pandemic, and the distribution of extra benefits, SNAP spending reached a <a href="https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap">record $114 billion</a> in the 12 months that ended in September 2022. </p>
<h2>Looming hunger cliff</h2>
<p>Many <a href="https://www.brookings.edu/blog/up-front/2021/08/19/a-healthy-reform-to-the-supplemental-nutrition-assistance-program-updating-the-thrifty-food-plan/">experts on food insecurity</a> have long argued that <a href="https://www.cbpp.org/research/food-assistance/more-adequate-snap-benefits-would-help-millions-of-participants-better">SNAP benefits have historically been too low</a>.</p>
<p>The Biden administration has already tried to boost them by adjusting the “<a href="https://theconversation.com/snap-benefits-are-rising-for-millions-of-americans-thanks-to-a-long-overdue-thrifty-food-plan-update-167876">Thrifty Food Plan</a>” – the standard the U.S. Department of Agriculture uses to set SNAP benefits based on the cost of a budget-conscious and nutritionally adequate diet.</p>
<p>As a result, benefits rose an average of $36 a month, a <a href="https://www.fns.usda.gov/news-item/usda-0179.21">21% increase</a>, in October 2021. That increase more than offset the expiration of a <a href="https://www.usda.gov/media/press-releases/2021/03/22/usda-increases-snap-benefits-15-funding-american-rescue-plan">temporary seven-month boost</a> in benefits that Congress had approved earlier that year.</p>
<p>SNAP benefits automatically adjust every October based on the increase in food prices in July as compared with the previous year. In 2022, they increased <a href="https://www.gobankingrates.com/saving-money/food/food-stamps-cola-update-increases-snap-ebt-benefits-starting-oct-1">12.5%</a>. But when prices are rising quickly, as is currently the case, SNAP benefits can lose a lot of ground in the months before the next adjustment.</p>
<p>Many <a href="https://frac.org/blog/close-snap-benefit-gaps">advocates for a stronger safety net</a> say that SNAP benefits are too low to meet the needs of low-income people. They are warning of a <a href="https://blog.ucsusa.org/alice-reznickova/a-hunger-cliff-is-looming-time-to-rethink-nutrition-assistance/">looming hunger cliff</a> – meaning a sharp increase in the number of people who don’t get enough nutritious food to eat – in March 2023, when the extra help ends.</p>
<p>At that point, the lowest-income families will lose <a href="https://www.fns.usda.gov/snap/changes-2023-benefit-amounts">$95 in benefits a month</a>. But some SNAP participants, such as <a href="https://www.washingtonpost.com/dc-md-va/2023/01/25/snap-emergency-allotments-seniors/">many elderly and disabled people</a> who live alone and on fixed incomes and who only qualify for the minimum amount of help, will see their benefits plummet from $281 to $23 a month.</p>
<p>Most people on SNAP who get Social Security benefits will see their <a href="https://www.fns.usda.gov/snap/changes-2023-benefit-amounts">SNAP benefits fall</a>. That’s because of the <a href="https://faq.ssa.gov/en-us/Topic/article/KA-01951#">8.7% cost of living increase</a> in Social Security benefits implemented in January 2023, which increases their income and lowers the amount of nutritional assistance they can receive. And some of these Americans may even have enough income that they no longer qualify for SNAP at all.</p>
<p>For an average family of four on SNAP, benefits will <a href="https://www.cbpp.org/research/food-assistance/a-quick-guide-to-snap-eligibility-and-benefits">fall from the maximum of $939</a> to $718, according to an estimate by the Center for Budget and Policy Priorities, an anti-poverty research group.</p>
<p><a href="https://www.usatoday.com/story/news/nation/2022/11/23/us-food-banks-pantries-struggle/10671432002/">Food banks, already under stress</a> because of higher food costs and falling donations, are <a href="https://www.cbsnews.com/news/food-stamps-snap-benefits-cut-in-32-states-emergency-allotments-march-2023/">bracing for higher demand</a>. Food banks in some states that ended the emergency boost in benefits early have seen a <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2022/07/19/more-states-are-forgoing-extra-federal-food-aid">30% increase</a> in need. </p>
<p>More people on SNAP also <a href="https://www.joinpropel.com/in-depth-pandemic-food-benefit-ending">reported skipping meals</a> in the states that dropped extra benefits than those that did not.</p>
<h2>Lawmakers poised to resume a longtime fight</h2>
<p>Several <a href="https://www.congress.gov/bill/117th-congress/house-bill/4077/text">Democrats have proposed legislation</a> to increase SNAP benefits over the long term. But many <a href="https://thefern.org/ag_insider/snap-costs-too-much-program-needs-revisions-say-house-republicans/">Republicans want to reduce spending on SNAP</a> and put more limits on who can get the program’s benefits. </p>
<p>Debate centers around whether unemployed adults deemed capable of working should be able to get SNAP. This argument, <a href="https://www.fns.usda.gov/snap/short-history-snap">almost as old as the program</a> itself, was largely set aside during the pandemic. </p>
<p>Legislation enacted in early 2020 suspended a requirement that limited benefits for adults under 50 who meet the government’s definition of able-bodied and have no dependents. They can receive no more than three months of SNAP <a href="https://www.cbpp.org/research/food-assistance/a-quick-guide-to-snap-eligibility-and-benefits">benefits every three years</a> – unless they work or participate in a work-training program at least 20 hours a week. </p>
<p>This time limit will come back when the <a href="https://www.usnews.com/news/national-news/articles/2023-02-09/biden-administration-releases-covid-19-public-health-emergency-transition-road-map">public health emergency ends</a> in May 2023. </p>
<p>But many critics of SNAP have argued the <a href="https://theconversation.com/scaling-back-snap-for-self-reliance-clashes-with-the-original-goals-of-food-stamps-128839">work requirements were never effectively enforced</a>. A <a href="https://www.agri-pulse.com/ext/resources/2023/02/08/Rep.-Gaetz-SNAP-BUDGET-LETTER-to-WH-2.7.23.pdf">few Republicans</a> want to make <a href="https://thefern.org/ag_insider/snap-costs-too-much-program-needs-revisions-say-house-republicans/">tightening restrictions on SNAP benefits</a> a condition for raising the debt ceiling. At this point, it isn’t clear if they will succeed.</p>
<p><a href="https://www.axios.com/2023/02/15/snap-food-benefits-end-covid">Debate over SNAP reforms</a> is likely to come up when Congress considers the program as part of broad food and agriculture <a href="https://theconversation.com/what-the-2018-farm-bill-means-for-urban-suburban-and-rural-america-89605">legislation known as the farm bill</a>. Congress must act to <a href="https://www.npr.org/2023/02/02/1151727273/congress-gears-up-for-another-farm-bill-heres-whats-on-the-menu">renew the program before October 2023</a>.</p>
<p>But with the <a href="https://pressgallery.house.gov/member-data/party-breakdown">House narrowly controlled by Republicans</a> and the <a href="https://ballotpedia.org/United_States_Senate_elections,_2022">Senate controlled by a slim Democratic majority</a>, I believe it will be hard to make big changes to the Supplemental Nutrition Assistance Program.</p><img src="https://counter.theconversation.com/content/199929/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracy Roof does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More than 41 million people rely on the Supplemental Nutrition Assistance Program to buy their groceries. When the COVID-19 pandemic began, the program ramped up.Tracy Roof, Associate Professor of Political Science, University of RichmondLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1904942022-09-20T15:21:32Z2022-09-20T15:21:32ZMedicaid enrollment soared by 25% during the COVID-19 pandemic – but a big decline could happen soon<figure><img src="https://images.theconversation.com/files/485409/original/file-20220919-376-q3sx0f.jpg?ixlib=rb-1.1.0&rect=211%2C50%2C6498%2C4194&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Growth outpaced new enrollment from the Affordable Care Act's Medicaid expansion.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-wearing-surgical-mask-examining-royalty-free-image/1349349174">bymuratdeniz/E+via Getty Images</a></span></figcaption></figure><figure class="align-center zoomable">
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<p>Medicaid, the government-funded U.S. health insurer for people with low incomes, <a href="https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-data/index.html">grew by about 25%</a> between February 2020 and May 2022 as <a href="https://www.kff.org/medicaid/issue-brief/medicaid-maintenance-of-eligibility-moe-requirements-issues-to-watch/">policies adopted at the outset of the COVID-19 pandemic</a> expanded the program’s reach.</p>
<p>All told, the number of people enrolled in Medicaid and the <a href="https://www.cms.gov/newsroom/news-alert/cms-releases-latest-enrollment-figures-medicare-medicaid-and-childrens-health-insurance-program-chip">Children’s Health Insurance Program</a>, or CHIP, which serves kids in families with low to moderate incomes, <a href="https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-data/index.html">increased from 71 million to 89 million</a>. That’s roughly 27% of all Americans.</p>
<p>The pandemic-related increase in Medicaid enrollment was slightly larger than the <a href="https://www.macpac.gov/subtopic/medicaid-enrollment-changes-following-the-aca/">24.7% increase seen after the Affordable Care Act</a> (ACA) expanded Medicaid for adults, starting in 2014.</p>
<p>But unlike Medicaid expansion under the ACA, these pandemic policies are temporary. They will end once the federal government’s COVID-19 public health emergency expires. Some experts predict Medicaid enrollment could fall by as many as <a href="https://www.urban.org/sites/default/files/publication/104785/what-will-happen-to-unprecedented-high-medicaid-enrollment-after-the-public-health-emergency_0.pdf">15 million</a> people when this happens, <a href="https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/index.html">disrupting health care</a> for many Americans.</p>
<p>In a new article we published in the <a href="http://doi.org/10.1001/jama.2022.14791">Journal of the American Medical Association</a> on Sept. 20, 2022, we examine how Medicaid serves Americans, analyze the program’s importance for health equity, and assess how Medicaid grew and changed during the COVID-19 pandemic. </p>
<p>As <a href="https://scholar.google.com/citations?hl=en&user=I6Sh5rEAAAAJ">health policy</a> <a href="https://scholar.google.com/citations?user=PunTAhEAAAAJ&hl=en&oi=ao">researchers</a>, we believe that Medicaid’s growth since 2020 highlights the program’s importance during economic and public health crises. It also underscores how painful the unwinding of these pandemic policies is likely to be to those who may end up uninsured.</p>
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<h2>Federal changes</h2>
<p>In March 2020, Congress passed the first of several large spending packages, called the <a href="https://theconversation.com/why-states-didnt-go-broke-from-the-pandemic-157471">Families First Coronavirus Response Act</a>. To help states shoulder increased Medicaid costs associated with the pandemic, that measure increased the share of Medicaid spending the federal government pays for by 6.2 percentage points in all states.</p>
<p>This aid has made a big difference for states, which <a href="https://www.kff.org/wp-content/uploads/2013/01/8352.pdf">split the costs of Medicaid with the federal government</a>. Before the pandemic, the federal government was paying about 65% of Medicaid’s costs overall, with the precise share varying based on a state’s average income. States picked up the other 35% of Medicaid costs. These costs accounted for <a href="https://www.nasbo.org/reports-data/state-expenditure-report/state-expenditure-archives">more than one-fourth</a> of state budgets before the pandemic.</p>
<p>The extra federal money for Medicaid came with an important requirement: states accepting funds <a href="https://www.kff.org/medicaid/issue-brief/medicaid-maintenance-of-eligibility-moe-requirements-issues-to-watch/">could not remove anyone from Medicaid</a> who was enrolled as of March 2020 or gained Medicaid afterwards – as long as the official public health emergency, <a href="https://www.federalregister.gov/documents/2020/03/18/2020-05794/declaring-a-national-emergency-concerning-the-novel-coronavirus-disease-covid-19-outbreak">first declared on Jan. 31, 2020</a>, remained in effect. These <a href="https://aspe.hhs.gov/sites/default/files/documents/404a7572048090ec1259d216f3fd617e/aspe-end-mcaid-continuous-coverage_IB.pdf">policies also applied to CHIP</a>. </p>
<p><a href="https://www.urban.org/sites/default/files/publication/104785/what-will-happen-to-unprecedented-high-medicaid-enrollment-after-the-public-health-emergency_0.pdf">All 50 states and the District of Columbia </a> accepted the higher federal payments in exchange for keeping Medicaid enrollment stable during the pandemic.</p>
<h2>Greater stability</h2>
<p>These changes helped to address longstanding instability in Medicaid coverage for many people. Before the pandemic, <a href="https://www.kff.org/medicaid/issue-brief/unwinding-the-phe-what-we-can-learn-from-pre-pandemic-enrollment-patterns/">nearly 25%</a> of those with Medicaid would enter or exit the program each year as their short-term circumstances changed.</p>
<p><a href="https://www.kff.org/medicaid/issue-brief/unwinding-the-phe-what-we-can-learn-from-pre-pandemic-enrollment-patterns/">People would lose Medicaid coverage</a> when their income ticked up, their family circumstances changed, they aged out of CHIP, or they failed to complete required paperwork. Losing Medicaid coverage can lead to someone ending up <a href="https://aspe.hhs.gov/sites/default/files/migrated_legacy_files/199881/medicaid-churning-ib.pdf">without any health insurance</a> at all, which increases the likelihood they will postpone or never get needed care. Having the same people frequently entering and exiting the program also increases the program’s administrative costs over time.</p>
<p>Changes to Medicaid policy in response to the pandemic made it much easier for everyone enrolled in Medicaid to keep their coverage. To illustrate, just over half of Wisconsin’s Medicaid growth in 2020 came from that state <a href="http://doi.org/10.1001/jamahealthforum.2021.4752">keeping existing enrollees in the program</a> who might otherwise have lost coverage for at least a few months.</p>
<p>Young adults, especially those <a href="http://doi.org/10.1001/jamahealthforum.2022.1996">aged 18 and 19</a>, and Americans who <a href="http://doi.org/10.1377/hlthaff.2016.1241">recently gave birth</a> are two groups that benefited from this change in Medicaid policy.</p>
<h2>What’s next</h2>
<p>Even with many aspects of daily life getting back to normal, and <a href="https://www.cbsnews.com/news/biden-covid-pandemic-over/">President Joe Biden’s comments to the media</a> about the pandemic being “over,” the official public health emergency that spurred Medicaid enrollment growth still remains in force.</p>
<p>When the <a href="https://aspr.hhs.gov/legal/PHE/Pages/covid19-15jul2022.aspx">government renewed the declaration for the 10th time</a> in July 2022, it set a <a href="https://www.asha.org/news/2022/federal-public-health-emergency-updates-for-2022/">new expiration date of Oct. 13, 2022</a>. The administration also said it would provide states with 60 days notice before it would end the federal emergency declaration, which suggests the declaration will be renewed at least one more time.</p>
<p>When the emergency ends, states will have to reevaluate eligibility for everyone with Medicaid within <a href="https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/index.html">12 months</a>. Extra federal funding for states will also end.</p>
<p>These changes will have profound consequences. Millions of people will have to reestablish their eligibility for Medicaid and are at risk of losing coverage if they do not complete the required paperwork on time.</p>
<p>The administration may ultimately decide to renew the COVID-19 emergency declaration again, as <a href="https://covid.cdc.gov/covid-data-tracker/#trends_dailydeaths_select_00">hundreds of Americans are still dying</a> daily from the disease. Keeping it in place would prevent a massive drop in Medicaid enrollment and make it easier to continue other COVID-19 public health policies, such as making <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/what-happens-when-covid-19-emergency-declarations-end-implications-for-coverage-costs-and-access/">free COVID-19 testing and vaccinations</a> <a href="https://www.cnbc.com/2022/09/03/how-you-can-still-get-at-home-covid-tests-for-free.html">widely available</a>.</p>
<p>Beyond extending the public health emergency, we believe that states and the federal government can seek new ways to <a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2788765">minimize disruptions</a> in coverage and to make Medicaid <a href="https://aspe.hhs.gov/sites/default/files/migrated_legacy_files/199881/medicaid-churning-ib.pdf">more accessible</a> to the millions of Americans who depend on it for health insurance.</p><img src="https://counter.theconversation.com/content/190494/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Donohue receives funding from the Pennsylvania Department of Human Services. </span></em></p><p class="fine-print"><em><span>Eric T. Roberts does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pandemic-related policies made it easier for states to afford to cover more people and made that coverage more stable for millions of Americans who rely on the program for health care.Julie Donohue, Professor and Chair of Health Policy and Management, University of PittsburghEric T. Roberts, Assistant Professor of Health Policy and Management, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1878172022-09-15T12:22:25Z2022-09-15T12:22:25ZIn states where abortion is banned, children and families already face an uphill battle<figure><img src="https://images.theconversation.com/files/482819/original/file-20220905-14-wr41ei.jpg?ixlib=rb-1.1.0&rect=21%2C26%2C3540%2C2344&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Of the 10 most child-friendly states, only one has attempted to ban abortion.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/katherine-merlos-a-pre-k-3-student-centron%C3%ADa-gives-a-thumbs-news-photo/1239430403">Sarah L. Voisin/The Washington Post via Getty Images</a></span></figcaption></figure><p>Some proponents of abortion bans and restrictions say they are concerned about “supporting not just life,” but what they call “<a href="https://missouriindependent.com/2022/07/06/states-with-strong-antiabortion-laws-have-high-maternal-and-infant-mortality-rates/">quality of life worth living</a>,” saying they want to <a href="https://www.theatlantic.com/politics/archive/2022/06/anti-abortion-movement-dobbs-roe-overturned/661393/">promote laws and policies that help families</a>. Three authors from Brigham Young University, for instance, have noted that the overturning of Roe v. Wade provides a “<a href="https://www.thepublicdiscourse.com/2022/06/82906/">genuine opportunity for pro-lifers to work with people of diverse political persuasions</a> to seek a more just and compassionate world. This world would be not only pro-life, but also pro-child, pro-parent and pro-family.”</p>
<p>U.S. Sen. Mitt Romney of Utah is one of three Republicans in the Senate who have sponsored a bill called the <a href="https://www.romney.senate.gov/romney-family-security-act-2-0-one-of-the-most-important-efforts-to-support-the-family-in-nearly-thirty-years/">Family Security Act</a>, billed as a “pro-family, pro-life and pro-marriage plan” that would provide a monthly cash benefit starting at pregnancy and continuing through the child turning 17.</p>
<p>But so far, these are <a href="https://www.theatlantic.com/politics/archive/2022/06/anti-abortion-movement-dobbs-roe-overturned/661393/">minority voices</a> in the anti-abortion movement. </p>
<p>As a law professor who <a href="https://scholar.google.com/citations?user=gCJEShUAAAAJ&hl=en&oi=ao">studies reproductive care</a>, policies that affect families and political partisanship, I have been following the relationship between <a href="https://www.urban.org/urban-wire/research-shows-access-legal-abortion-improves-womens-lives">abortion restrictions and family well-being</a> for decades. It turns out that states taking the strictest stands against abortion tend to have among the <a href="https://www.nytimes.com/2022/07/28/upshot/abortion-bans-states-social-services.html">worst statistics</a> on child and family well-being in the nation.</p>
<h2>Unintended pregnancy and infant mortality</h2>
<p>Take Mississippi, the state that enacted the abortion restriction law that was at the center of the Supreme Court’s June 2022 opinion in <a href="https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf">Dobbs v. Jackson Women’s Health Organization</a>, which struck down federal protection for the right to get an abortion. </p>
<p>In 2019, Mississippi had the <a href="https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/unintended_pregnancy/state/U.S">highest rate of unintended pregnancy</a>, defined as the percentage of women who recently gave birth but whose pregnancies were either <a href="https://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/index.htm">unwanted or happened at an unwanted time</a>. In Mississippi, 47% of women who recently had a child did not want to become pregnant or wanted to become pregnant later in life.</p>
<p>By contrast, Vermont had the nation’s lowest rate of unintended pregnancy in 2019, with <a href="https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/unintended_pregnancy/state/U.S">just 20% of women who recently had a child</a> saying they would have preferred not to get pregnant or wanted to do so at some point in the future. That state already protects abortion rights. If Vermont’s <a href="https://www.wcax.com/2022/06/23/will-vermont-become-abortion-haven-if-scotus-upends-roe-v-wade/">upcoming referendum on abortion</a> passes, the state’s constitution will protect “<a href="https://legislature.vermont.gov/Documents/2022/Docs/BILLS/PR0005/PR0005%20As%20adopted%20by%20the%20Senate%20Official.pdf">an individual’s right to personal reproductive autonomy</a>.”</p>
<p>Mississippi also has the <a href="https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm">highest infant mortality rate</a> in the country. Five of the other nine states with the highest infant mortality <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">also have abortion bans</a>. At the other end of the spectrum, of the 10 states with the lowest infant mortality rates, <a href="https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm">only one – Iowa</a> – has a law restricting abortions, <a href="https://www.kcci.com/article/governor-kim-reynolds-announces-legal-actions-regarding-abortion-in-iowa/40449729">although a court has prevented its enforcement</a>.</p>
<h2>Childhood poverty and teen birth rates</h2>
<p>Mississippi has the <a href="https://www.census.gov/acs/www/data/data-tables-and-tools/ranking-tables/">highest rate of child poverty in the country</a>. Six of the other 10 states with the country’s highest child poverty levels also have <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">abortion bans in effect</a>: Louisiana, Arkansas, Kentucky, Alabama, Oklahoma and Tennessee.</p>
<p>Mississippi also had the <a href="https://www.cdc.gov/nchs/pressroom/sosmap/teen-births/teenbirths.htm">highest teen birth rate in the country</a>, and eight of the other nine states with the highest teen birth rates also <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">ban abortions or have a ban blocked</a>.</p>
<p>In all 10 states with the lowest teen birth rates, <a href="https://www.washingtonpost.com/politics/2022/06/24/abortion-state-laws-criminalization-roe/">abortion is legal</a> and likely to be protected for the foreseeable future.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/482820/original/file-20220905-18-djghzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A pregnant person has a written message on the skin of her belly: 'My daughter deserves a choice'" src="https://images.theconversation.com/files/482820/original/file-20220905-18-djghzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/482820/original/file-20220905-18-djghzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/482820/original/file-20220905-18-djghzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/482820/original/file-20220905-18-djghzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/482820/original/file-20220905-18-djghzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/482820/original/file-20220905-18-djghzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/482820/original/file-20220905-18-djghzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A pregnant activist calls for abortion rights in Chicago on June 25, 2022.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/pregnant-woman-takes-part-in-a-protest-in-downtown-chicago-news-photo/1241562432?adppopup=true">Vincent D. Johnson/Xinhua via Getty Images)</a></span>
</figcaption>
</figure>
<h2>Supporting families</h2>
<p>The well-being of children also depends on the availability of support for their parents.</p>
<p>For instance, <a href="https://www.ncsl.org/research/labor-and-employment/state-family-and-medical-leave-laws.aspx">11 states plus the District of Columbia legally require employers</a> to offer workers paid time off after the birth or adoption of a child. None of those jurisdictions <a href="https://www.washingtonpost.com/politics/2022/06/24/abortion-state-laws-criminalization-roe/">bans abortions</a>.</p>
<p>Another federal effort to support families came in the Affordable Care Act, enacted in 2010, with <a href="https://www.healthcare.gov/glossary/affordable-care-act/">sweeping changes</a> to the nation’s health insurance marketplace. One provision allowed states to <a href="https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/">expand Medicaid eligibility</a> to more adults, with financial support from the federal government. If Medicaid were expanded, <a href="https://www.urban.org/research/publication/3-7-million-people-would-gain-health-coverage-2023-if-remaining-12-states-were">reproductive-aged women</a> would be among the groups to experience the largest coverage gains.</p>
<p>As of August 2022, <a href="https://www.urban.org/research/publication/3-7-million-people-would-gain-health-coverage-2023-if-remaining-12-states-were">12 states</a> had not adopted the expansion: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming. <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">Eight of those states</a> have either a full ban on abortion or a ban after six weeks – before many people realize they are pregnant.</p>
<p>Two of those states, <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">South Carolina and Wyoming</a>, have abortion <a href="https://www.npr.org/2022/08/04/1115542013/wyomings-new-ban-on-abortions-has-been-temporarily-blocked">laws that are tied up in the courts</a>, and Florida bans abortions after 15 weeks. </p>
<p>In a June 2022 <a href="https://www.brookings.edu/blog/up-front/2022/06/30/the-end-of-roe-will-create-more-inequality-of-opportunity-for-children/">Brookings Institution study</a> of the states that are considered most child-friendly – measured by state expenditures per child and children’s overall well-being – the authors found that among the top 10, only Wyoming was <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">even trying to ban abortion</a>. For the 10 states Brookings rated least child-friendly, nine either had a trigger ban or other abortion restriction.</p>
<p>The overall pattern is clear: A strong social safety net and other anti-poverty programs <a href="https://www.nytimes.com/2022/07/13/opinion/abortion-romney-child-tax-credit.html">are more likely to be available</a> in states that also support abortion access, while actual measures of child and family well-being are often worse in states that restrict abortions.</p><img src="https://counter.theconversation.com/content/187817/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naomi Cahn does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>States taking the strictest stands against abortion tend to have among the worst statistics in the nation on child and family well-being.Naomi Cahn, Professor of Law, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.