Disclaimer: Moving Health Care Upstream is a collaborative effort originally co-led by Nemours Children’s Health and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative.

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Authors:

• Joshua Ogburn, Manager of Policy
• Katie Boyer, Senior Advisor, Legislative & Regulatory Affairs
• Daniella Gratale, Director, Office of Child Health Policy & Advocacy

Poverty is the single largest driver of health according to the World Health Organization. A 2019 National Academies of Sciences report noted, “on average, a child growing up in a family whose income is below the poverty line experiences worse outcomes than a child from a wealthier family in virtually every dimension.”[i] Congress has an opportunity to ensure that children have a strong start in life by maintaining crucial anti-poverty provisions in the Build Back Better Act.

Nemours Children’s Health supports whole child health – going Well Beyond Medicine – by positively impacting the social, economic, behavioral and environmental conditions that affect children and their families. In our recent letter to Congress, we outline numerous proposals federal policymakers should include in the Build Back Better Act (also known as Budget Reconciliation) and urge Congress to include these provisions.

Chief among our recommendations is to address poverty, a condition that affects more than 10 million, or one in seven, children.[ii] Specifically, Congress should:

• Extend the post-American Rescue Plan Act (Rescue Plan; P.L. 117-2) Child Tax Credit through 2025 and make it permanently refundable.
• Permanently extend the Rescue Plan improvements to the Child and Dependent Care Tax Credit and the Earned Income Tax Credit.
• Support access to healthy foods and address food insecurity by:

» Making more schools eligible for the Community Eligibility Provision (CEP), which allows schools to provide free and reduced-price meals to all students, and allowing states to implement CEP statewide.

» Allowing all states to directly certify students to receive free or reduced price school meals if they participate in Medicaid, receive Supplemental Security Income benefits, guardianship, or adoption assistance payments, or are in kinship care.

These provisions would build upon investments and policy changes from the Rescue Plan and the Families First Coronavirus Response Act (P.L. 116-127). Making critical anti-poverty policy improvements permanent will sustain recent child poverty and food insecurity reductions and put the next generation on a path towards better health and well-being.

Income Supports

Prior to Rescue Plan, the Child Tax Credit allowed eligible taxpayers to reduce their federal tax liability for dependent children under 17 years old. The Rescue Plan made several changes to the Child Tax Credit: increased the maximum age for eligible children to 17 years; made the credit fully refundable (to include families which earned no income); increased the credit amount; and allowed taxpayers to receive advance monthly Child Tax Credit payments instead of annually with tax filing.

Estimates are that these changes will reduce childhood poverty by nearly half. As shown in Table 1, these benefits will accrue across all races and ethnicities, with the greatest impact on Hispanic and Black families with children. In addition, families with the lowest incomes will receive the greatest benefit.

Table 1 – Estimated Child and Overall Poverty Rates Before and After the Rescue Plan Expansion of the Child Credit by Race/Ethnicity
	Race or Ethnicity
	Hispanic	Black	Asian	Two or More Races	White
Before Rescue Plan	20%	18%	11%	10%	7%
After Rescue Plan	12%	10%	8%	4%	4%
Percentage Point Change	– 8%	– 8%	– 3%	– 6%	– 3%
Percentage Change	– 40%	– 44%	– 27%	– 60%	– 43%
Source: Crandall-Hollick, M. L., Carter, J. A., & Boyle, C. F. (2021, July 13). The Child Tax Credit: The impact of the American Rescue Plan Act (Rescue Plan; P.L. 117-2) expansion on income and poverty. Congressional Research Service. https://crsreports.congress.gov/product/pdf/R/R46839

In addition to the Child Tax Credit, the Child and Dependent Care Tax Credit and Earned Income Tax Credit also have strong anti-poverty effects.[iii]

Nutrition Supports

Food insecurity is closely linked with poverty and worse health outcomes. Families below the federal poverty line are significantly more likely to experience food insecurity. Federal nutrition programs like the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the National School Lunch Program (NSLP) kept an estimated 3.9 million individuals out of poverty in 2019.[iv] By the end of 2021, SNAP alone is projected to lift 7.9 million people out of poverty, including 2.8 million children.[iv] This is due in part to increased SNAP benefits under the Families First Coronavirus Response Act.

In fact, Federal nutrition programs have a long history of anti-poverty impacts. A recent report from the Food Research & Action Center (FRAC) highlights that:

• SNAP lifted 3.9 million out of poverty in 2011.
• Data from 2013-2016 indicate that the School Breakfast Program (SBP) kept 620,000 individuals out of poverty each year, and reduces food insecurity among elementary students by 15 percent.
• The NSLP reduces food insecurity among all students by 6 percent.
• The Child and Adult Care Food Program (CACFP) helps reduce food insecurity for children in child care by 4.2 percent.

These programs work, and policies to expand them have significant, positive anti-poverty impacts.

Conclusion

The Build Back Better Act offers a critical opportunity to strengthen investments in our nation’s children and ultimately put them on a healthier trajectory. As Congress and the Biden Administration negotiate to finalize the legislation, Nemours Children’s urges them to invest in children and families by including crucial income and nutrition supports. Together we can support the healthiest generations of children.

[i] National Academies of Sciences, Engineering, and Medicine. (2019). A roadmap to reducing child poverty. The National Academies Press. https://doi.org/10.17226/25246

[ii] U.S. Census Bureau. (2020). Income & poverty data tables. https://www.census.gov/topics/income-poverty/data/tables.html

[iii] National Academies of Sciences, Engineering, and Medicine. (2019). A roadmap to reducing child poverty. The National Academies Press. https://doi.org/10.17226/25246

[iv] Lacko, A. M., & Henchy, G. (2021). Hunger, Poverty, and Health Disparities During COVID-19 and the Federal Nutrition Programs’ Role in an Equitable Recovery. Washington, DC: Food Research & Action Center.