*Name has been changed for privacy protection
Family finances affect children’s minds and bodies. As a pediatrician and a medical student, we witness every day how poverty makes kids sicker. The 2021 American Rescue Plan put a dent in this harsh reality by expanding the Child Tax Credit. But the credit’s expansion expired in December, and 35% of families with children then reported struggling to cover usual household expenses again, with downstream health implications for kids.
Congress has the tools to stop this regression: extend the Child Tax Credit and adequately fund childcare.
Child Tax Credits, Healthier Kids
When the Child Tax Credit was expanded last year, it increased the maximum credit amount, removed some income and tax liability requirements, and allowed recipients to get advance monthly payments. Most people use the tax credit to pay for basic needs like food, rent, and utilities, so its expansion pulled 3 million children out of poverty virtually overnight and thereby improved their health.
That’s why Beatrice*, a 55-year-old part-time cashier who earns $7,000 a year at McDonald’s and is the sole caretaker of her 3-year-old grandson, Avery*, celebrated by calling her closest friends the day she received a $2,400 tax refund from the U.S. government. It was a lifeline: she paid her landlord and bought the Spider-Man nightlight Avery had been eyeing for months.
As doctors, we’ll be better able to help children if the Child Tax Credit is extended. After all, the similar Earned Income Tax Credit is linked to higher infant birth weights, K-12 school performance, employment for single moms, and future family earnings. And recent research shows that providing $333 monthly to low-income mothers — a bit more than that provided through the expanded Child Tax Credit ($250-300 depending on age) — increases infants’ brain activity as early as their first birthday. In addition, extending the Child Tax Credit would advance health equity; more than 70% of the kids in poverty in 2020 were children of color.
Childcare Funding, Long-Term Health
Federal legislators must also help states expand access to high-quality, affordable childcare — which has long been underfunded — to strengthen families’ financial well-being and overall health. As of the start of this year, over 25% of families with young children found themselves without childcare, often because it was unavailable or unaffordable.
Consider Mariana*, a mother of two children we recently met. Now experiencing homelessness, Mariana had to choose between a childcare provider she could afford but didn’t trust or a certified provider she trusted but couldn’t afford. “I had no choice, actually,” she told us.
So, Mariana decided to stay home to care for her children instead of working, thereby forfeiting income and, eventually, her ability to pay rent. She and the kids had to “couch-surf” (crash with different people week to week), then live in her car, and now stay in a homeless shelter, where she worries her children will get sick and fall behind in school. For Mariana, access to safe, affordable childcare is the difference between a stable life and homelessness.
Subsidized high-quality childcare would benefit over 13 million kids under age 6, like Mariana’s children. In fact, more than 60% of America’s 4-year-olds lack access to publicly funded pre-K, mostly in racial and ethnic minority communities, even though investing in high-quality pre-K improves children’s physical, cognitive, and socioemotional development.
Food insecurity worsens health and learning in more than 10% of America’s children, especially in rural areas and communities of color with low income. Universal pre-K programs and greater funding for free school meals would improve educational achievement, encourage earlier screening for developmental disabilities and other medical conditions, and promote better overall health, especially in low-resource communities. Investment in school nutrition is especially timely with pandemic-related measures, like universal free lunches, set to expire in June and ongoing supply chain and workforce shortages.
The Affordable Care Act, which passed 12 years ago in March, was a critical first step in promoting the health and financial well-being of low-income families, by making health insurance more accessible and affordable and having “spillover” financial benefits for low-income families: better credit scores, less food insecurity, fewer evictions. But more than a decade later, children still have poorer health outcomes in the U.S. than in other developed countries.
Extending the Child Tax Credit and expanding childcare, pre-K education, and school lunches would substantially improve the health and learning of America’s future workforce while leveling the playing field for vulnerable families like Beatrice’s and Mariana’s. Doctors’ orders: urge elected officials to pass these commonsense, evidence-based solutions quickly. Our children deserve better.
Michael Hole, MD, MBA, is a physician and policy professor at The University of Texas at Austin, where he is executive director of the Impact Factory, a hub for social entrepreneurship. He also co-founded StreetCred, a nonprofit helping low-income families file taxes and build wealth in medical clinics. Mathew Alexander is a medical student at Virginia Commonwealth University.