By Ilan Shapiro
For the first time in more than a decade, the nation is experiencing a decline in children enrolled in Medicaid and Children’s Health Insurance Program coverage. Overall, a report from Georgetown University found that more than 828,000 fewer children, or 2.2 percent, were enrolled in Medicaid and CHIP, combined, at the end of 2018 than in the previous year.
Researchers attribute the decline in coverage to the actions of the White House administration, which include cuts to the safety-net health insurance program Medicaid, a repeal of the individual mandate penalty and the delayed extension of the Children’s Health Insurance Program for many months in 2017.
As a pediatrician, I not only worry about the health of the children I care for, but also the health of their parents and caregivers. I trained in Mexico City and spent years working in Chicago and Fort Myers. Now working in East Los Angeles, I’m acutely aware of the challenges that impact families in underserved communities.
Studies have shown that children fail to reach their full health and developmental potential when their health and social needs are unmet.
Unfortunately, disparities in the wellbeing of children in the United States are climbing. Income inequalities continue to widen, putting added pressure on working-class families. Housing costs have soared and homelessness has reached epidemic levels in California.
Cuts to federal programs such as Medicaid, the Supplemental Nutrition Assistance Program and housing assistance can have devastating impacts on families, particularly immigrant children.
When children experience food insecurity due to federal cuts to meal programs or lose access to benefits, they are impacted in a number of ways. Hunger hinders a child’s ability to focus in class, which affects their school performance. Children might binge on fast food meals or packaged snacks to fill their hunger, which can lead to nutritional deficiencies and obesity.
Children who experience unhealthy levels of stress can also experience behavioral or emotional problems. Studies have shown that children who live in households that are food insecure are likely to be sick more often, recover from illness more slowly, and be hospitalized more frequently.
When the Department of Homeland Security proposed an expanded public charge rule, it sent a chilling effect through our community-health-center patients. For months, we heard stories of patients telling us it would be their last visit because they were afraid to receive health care services for fear it would lead to deportation. Even though federal judges issued temporary injunctions against the rule a couple of months ago, the rhetoric around it has already created irreparable damage in immigrant communities.
Data from state programs like Medi-Cal, CalFresh and the Special Supplemental Nutrition Program for Women, Infants, and Children show there has been a decline in enrollment since early 2018. Between January 2018 and December 2018, overall Medi-Cal enrollment declined statewide, from 13.3 million to 12.9 million enrollees.
During that same period, child-only enrollment in CalFresh declined statewide by more than 40,000 child-only households, which affected more than 85,000 children. The drop was especially pronounced in Southern California. In Los Angeles, Orange, Riverside and San Bernardino counties alone, approximately 45,000 children who were on CalFresh in January 2018, were no longer on it a year later.
The American Academy of Pediatrics recognizes that racial, ethnic, gender and class-based disparities have far-reaching consequences for the welfare of children and their future. Inequities in children’s health lead to disparities in adult health, which contribute to chronic illnesses and perpetuate poverty.
Improving health equity for children should be among our highest priorities as a nation, because it will impact our future. As pediatricians, we should advocate for federal and local policies that address the social determinants of health and provide families with resources to raise healthy children.
Ilan Shapiro is a pediatrician with AltaMed Health Services in East Los Angeles and a fellow of the American Academy of Pediatrics.
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