The House-passed budget resolution, at the encouragement of President Trump, seeks $880 billion in cuts over ten years from a committee with jurisdiction over Medicaid. This program, jointly funded by the federal and state governments, supports preventive services, primary care hospitals, specialty, and emergency care, and long-term services and supports for roughly 80 million Americans.
In addition to the likely disaster this budget would be for the health, economic security, and well-being of millions of Americans, it could impact children, families, and the child care sector in a variety of alarming ways.
- Children’s health: Children could lose health insurance, which could impact their health outcomes and spread illnesses.
- Sandwich generation caregivers: Parents caring for their own children and for their own aging parents or disabled dependents could also be impacted by potential cuts to long-term supports and services/home and community-based services.
- Child care workforce: Many early educators could lose their health coverage.
- State budgets: The loss of federal Medicaid dollars could be a cost shift to states, causing significant cuts to state budgets, which could mean less money for child care.
Children’s Health
Thirty-one million children rely on Medicaid nationwide, and reductions in coverage could worsen the health of those children and their communities. TCF has estimated that the proposed GOP cuts of $880 billion over ten years would be the equivalent of eliminating Medicaid for all of those children. Health care matters in the short term to support children’s physical and emotional health, growth, and development and in the long term to support their capacity to reach their full potential as adults.
Child care programs—as with most congregate settings with young children, such as elementary schools—would be particularly affected by the preventable spread of disease. While state child care standards work to mitigate this through important health and safety rules, more children without health insurance will lead to sicker children, undiagnosed sicknesses, and greater spread of illnesses.
Sandwich Generation Caregivers
About one in four adults, according to Caring Across Generations, are members of the “sandwich generation”—those managing caring for children as well as an adult family member. If deep Medicaid cuts force cutbacks in long-term services and supports, parents in the sandwich generation would likely have to fill the gap, limiting their time with children. The proposed cuts are the equivalent of taking health care away from the 4.7 million older people and 3.7 million disabled people who rely on Medicaid nationally. It could translate into cutting 79 percent of home and community-based services or all of nursing home and institutional care.
Child Care Workforce
Child care staffing shortages are already limiting parents’ choices in child care arrangements and raising the prices they pay for child care. Data from the Center for the Study of Child Care Employment shows that 43 percent of all early childhood education (ECE) providers rely on at least one public assistance program, such as Medicaid. At least 230,000 child care workers, roughly one in four providers, rely on Medicaid for their health insurance. The potential cuts to Medicaid in the House bill would increase the child care staffing shortage, as early educators would lose their health care and would need to find better-paying jobs or jobs where they could get coverage.
State Budgets
Medicaid cuts the size of those proposed in the budget bill could devastate state budgets, leading to impossible decisions, including likely cuts to child care in the states that have invested funds in child care. Federal funding, including from federal Medicaid dollars, makes up approximately $1 out of every $3 spent by states. States cannot run deficits, and so they must adopt balanced budgets. As they lose their federal Medicaid dollars, alongside other cost shifts to states such as cuts in federal public education, food assistance (SNAP), and emergency assistance, policymakers could be forced to choose among health care, child care, and other critical services for families as they wield the budget-cutting knife.
States are already struggling to pay for the child care that children and families need. In recent years, many states have invested in child care to shore up their economies and ensure parents have the affordable child care options they need. Given that eleven states and Washington, D.C. invested additional state dollars into child care specifically to help stabilize their sectors, and many more invested additional funds to supplement their CCDBG programs, federally induced strain on state budgets could put child care funding at risk. In addition, the budget squeeze will be a barrier to new state investments in child care that are needed to serve children, families, and communities.
What Happened to Promoting the General Welfare?
The preamble to the U.S. Constitution says:
We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.
Nothing in these founding words suggests that our government should force citizens to choose between the nation’s fiscal health and care for their children. In fact, the preamble helps us imagine what we could be: a nation that prioritizes care for all of its citizens—whether it’s their health and well-being or the nurturing of young minds. We can create a more caring America, but our current leaders are choosing the welfare of billionaires over that of the majority of Americans, especially its children.
The author would like to thank Jeanne Lambrew, Carole Johnson, Ruth Friedman, and Mario Cardona for their insights.
Tags: child care, medicaid cuts, health care
Threats to Medicaid Funding Would Endanger Child Care Too
The House-passed budget resolution, at the encouragement of President Trump, seeks $880 billion in cuts over ten years from a committee with jurisdiction over Medicaid. This program, jointly funded by the federal and state governments, supports preventive services, primary care hospitals, specialty, and emergency care, and long-term services and supports for roughly 80 million Americans.
In addition to the likely disaster this budget would be for the health, economic security, and well-being of millions of Americans, it could impact children, families, and the child care sector in a variety of alarming ways.
Children’s Health
Thirty-one million children rely on Medicaid nationwide, and reductions in coverage could worsen the health of those children and their communities. TCF has estimated that the proposed GOP cuts of $880 billion over ten years would be the equivalent of eliminating Medicaid for all of those children. Health care matters in the short term to support children’s physical and emotional health, growth, and development and in the long term to support their capacity to reach their full potential as adults.
Child care programs—as with most congregate settings with young children, such as elementary schools—would be particularly affected by the preventable spread of disease. While state child care standards work to mitigate this through important health and safety rules, more children without health insurance will lead to sicker children, undiagnosed sicknesses, and greater spread of illnesses.
Sandwich Generation Caregivers
About one in four adults, according to Caring Across Generations, are members of the “sandwich generation”—those managing caring for children as well as an adult family member. If deep Medicaid cuts force cutbacks in long-term services and supports, parents in the sandwich generation would likely have to fill the gap, limiting their time with children. The proposed cuts are the equivalent of taking health care away from the 4.7 million older people and 3.7 million disabled people who rely on Medicaid nationally. It could translate into cutting 79 percent of home and community-based services or all of nursing home and institutional care.
Child Care Workforce
Child care staffing shortages are already limiting parents’ choices in child care arrangements and raising the prices they pay for child care. Data from the Center for the Study of Child Care Employment shows that 43 percent of all early childhood education (ECE) providers rely on at least one public assistance program, such as Medicaid. At least 230,000 child care workers, roughly one in four providers, rely on Medicaid for their health insurance. The potential cuts to Medicaid in the House bill would increase the child care staffing shortage, as early educators would lose their health care and would need to find better-paying jobs or jobs where they could get coverage.
State Budgets
Medicaid cuts the size of those proposed in the budget bill could devastate state budgets, leading to impossible decisions, including likely cuts to child care in the states that have invested funds in child care. Federal funding, including from federal Medicaid dollars, makes up approximately $1 out of every $3 spent by states. States cannot run deficits, and so they must adopt balanced budgets. As they lose their federal Medicaid dollars, alongside other cost shifts to states such as cuts in federal public education, food assistance (SNAP), and emergency assistance, policymakers could be forced to choose among health care, child care, and other critical services for families as they wield the budget-cutting knife.
States are already struggling to pay for the child care that children and families need. In recent years, many states have invested in child care to shore up their economies and ensure parents have the affordable child care options they need. Given that eleven states and Washington, D.C. invested additional state dollars into child care specifically to help stabilize their sectors, and many more invested additional funds to supplement their CCDBG programs, federally induced strain on state budgets could put child care funding at risk. In addition, the budget squeeze will be a barrier to new state investments in child care that are needed to serve children, families, and communities.
What Happened to Promoting the General Welfare?
The preamble to the U.S. Constitution says:
We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.
Nothing in these founding words suggests that our government should force citizens to choose between the nation’s fiscal health and care for their children. In fact, the preamble helps us imagine what we could be: a nation that prioritizes care for all of its citizens—whether it’s their health and well-being or the nurturing of young minds. We can create a more caring America, but our current leaders are choosing the welfare of billionaires over that of the majority of Americans, especially its children.
The author would like to thank Jeanne Lambrew, Carole Johnson, Ruth Friedman, and Mario Cardona for their insights.
Tags: child care, medicaid cuts, health care