Who’s Child Matters?
Just days after the end of Children’s Week, Sen. Steve Daines (R-MT) and Rep. Marianette Miller-Meeks (R-IA) introduced the Child Tax Credit for Pregnant Moms Act (S. 2092/H.R. 4258). This bill, as explained in the accompanying press release, “allows pregnant moms to claim the Child Tax Credit for their unborn children.”
After a closer examination and evaluation of the bill’s implications for children and pregnant women, it becomes evident that the legislation is deeply flawed. Despite being cloacked in seemingly well-intentioned rhetoric, it ultimately fails millions of our nation’s children and pregnant women.
While these statements above highlight genuine concerns for the economic and health issues of pregnant women and children, the legislative proposal is highly problematic. It creates an environment where certain children and now pregnant women are seemingly “valued” through eligibility for the Child Tax Credit, while other children and pregnant women are left behind. In fact, the legislation disproportionately excludes low-income families and their newborns in rural communities like those represented by Sen. Daines and Rep. Miller-Meeks.
Inequities Exacerbated by the Daines/Miller-Meeks Bill
Currently, nearly one-third of our nation’s children are ineligible for the full Child Tax Credit of $2,000 per child because the credit is not fully refundable. Consequently, nearly one-third of children are ineligible for the full Child Tax Credit because their parents make too little.
More effective alternative proposals (H.R. 3899 and S. 1992) by Rep. Rosa DeLauro (D-CT) and Sen. Sherrod Brown (D-OH), respectively, would make the Child Tax Credit fully refundable. This would dramatically reduce child poverty and positively impact the health, education, safety, and well-being of millions of children. The DeLauro and Brown bills also expand the Child Tax Credit from $2,000 to $3,600 for children under the age of 6 and to $3,000 for all other children.
Consequently, over 60 million of our nation’s children would tremendously benefit from the DeLauro/Brown bills, including the 3–4 million who would be lifted out of poverty. By a 72–21% margin, the American people support making “the credit fully refundable for all families with low incomes.”
In sharp contrast, the bill introduced by Sen. Daines and Rep. Miller-Meeks, whether by oversight or design, would primarily benefit middle class and affluent families. Consequently, the legislation values a family’s wealth over need and leaves behind over 23 million children who presently do not qualify for the full Child Tax Credit.
For instance, under the Daines/Miller-Meeks bill, a married pregnant woman with household earnings of $400,000 a year would receive the full $2,000 Child Tax Credit to overcome “financial hurdles”. In comparison, a child in a single parent household making less than $25,000 or a child of a married couple earning less than $40,000 would earn either no credit or only a partial credit.
That is nonsensical.
If the genuine intention is to assist pregnant women with prenatal care, baby supplies, and overcoming “financial hurdles,” why would the policy provide $2,000 to a married woman with $400,000 of income but nothing or only a partial credit to nearly one-third of low-income pregnant women and children in this country?
In support of the bill, Penny Nance of Concerned Women for America argues “parents must buy diapers, clothes, and furniture” before a baby is born. However, once again, if that is your concern, the Daines/Miller-Meeks would provide $2,000 to help pregnant mothers making up to $400,000 to help with these essentials, while excluding low-income families who are most in need.
And who are the children are being ignored and “left behind”? According to the Center on Poverty and Social Policy at Columbia University, the kids who either do not qualify for the full Child Tax Credit are: (1) children under the age of 6 (40% receive only partial or no credit); (2) Black and Hispanic children; (3) children in single parent households (“70% of children in families headed by single parents who are female do not receive the full credit”); and, (4) children in rural communities.
To keep from exacerbating these inequities and to not punish children for the zip codes in which they live and the circumstances of their parents, I would urge Sen. Daines and Rep. Miller-Meeks to, at the very least, make sure the Child Tax Credit is fully refundable.
Moreover, as Nance acknowledges, some pregnant women “take time off from work” and others are put on bed rest to protect the health of the mother and child. These parents lose wages. Adding insult to injury, under the Daines/Miller-Meeks approach, they may also be deemed ineligible for the Child Tax Credit for earning too little money due to their pregnancy.
This represents a catastrophic failure for both the economic and physical health of millions of pregnant women and children.
Instead of creating a tax credit to help wealthy families while penalizing pregnant women who must leave the workforce to have their baby and families and children with lower incomes, we should be focusing our efforts on addressing tragic outcomes related to infant and maternal mortality.
Consequently, public policy concerning children, including the Child Tax Credit, family medical leave, and health care, should expand opportunities to all children and not perpetuate and exacerbate inequalities.
And, at the very least, the Child Tax Credit should not serve as a means to benefit affluent adults while simultaneously leaving millions of children in poverty. As a point of reference, the National Bipartisan Commission on Children that issued its recommendation to establish a Child Tax Credit back in 1991 proposed making it fully refundable. This was finally achieved as part of the American Rescue Plan Act (ARPA) in 2021 — thirty years later. It had a significant positive impact on our nation’s children, but unfortunately, the language was temporary and has since expired.
The bills proposed by Rep. DeLauro (H.R. 3899), the American Family Act with 209 cosponsors, and Sen. Brown (S. 1992), the Working Families Tax Relief Act with 41 cosponsors, would extend these ARPA improvements to the Child Tax Credit and significantly cut child poverty in the long-term. If enacted, those proposals would benefit all future generations and our nation’s future.
In addition, with respect to maternal and child health, there are several initiatives that would be far superior to the Daines/Miller-Meeks approach, including:
- The Preemie Reauthorization Act of 2023 (H.R. 3226) by Reps. Anna Eshoo (D-CA), Michael Burgess (R-TX), Robin Kelly (D-IL), Miller-Meeks (R-IA), Lisa Blunt Rochester (D-DE), and Jen Kiggans (R-CA), which as the House Energy and Commerce (E&C) Committee explains, “would include the renewal of research, education, and intervention activities and programs at the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) that focus on preventing preterm births and reducing infant mortality.”
- The Preventing Maternal Deaths Reauthorization Act of 2023 (H.R. 3838) by Reps. Burgess (R-TX), Diana DeGette (D-CO), Buddy Carter (R-GA), Kelly (D-IL), Kat Cammack (R-AZ), and Kathy Castor (D-FL) would, as the House E&C Committee explains, “would reauthorize federal support for states to address disparities in maternal health outcomes and preserve the health of mothers during pregnancy, childbirth, and the postpartum period.”
- The Black Maternal Health Momnibus Act (H.R. 3305/S. 1606) by Rep. Lauren Underwood (R-IL) with 187 House cosponsors and Sen. Cory Booker (D-NJ) with 27 Senate cosponsors includes language from 13 individual bills that offers a comprehensive approach to address aspects of maternal mortality, morbidity, and health disparities.
- Bills introduced in the 117th Congress by Reps. Nanette Barragan (D-CA) entitled the Children’s Health Insurance Program Permanency (CHIPP) Act (H.R. 1791) and by Rep. Vern Buchanan (R-FL) entitled the Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act (H.R. 66) would protect the health coverage of millions of low-income children and pregnant women in this country by making CHIP permanent. Despite proving to be an incredibly successful program that helped cut the uninsured rate for children in this country by two-thirds, CHIP remains the only federal insurance program in the country that is temporary and has a built-in funding cliff that threatens its future viability.
- States should take the option to provide 12-months postpartum coverage in Medicaid and the Children’s Health Insurance Program (CHIP): There is a state option to provide for a full year of postpartum coverage for women in Medicaid and CHIP to help address preventable maternal deaths of millions of women after delivery.
- States should take the option to expand income eligibility for pregnant women coverage in Medicaid and CHIP: Under current law, states are required to cover pregnant women in Medicaid with household income below 138% of poverty and who meet certain immigration requirements. However, states have the option to increase eligibility to more pregnant women beyond the federal minimums. This includes the option to cover pregnant women both the low-income pregnant women option that was created in the CHIP Reauthorization Act of 2009 and based on legislation by Sens. Jeff Bingaman (D-NM) and Richard Lugar (R-IN) and the “unborn child” option. To ensure prenatal care coverage and the automatic coverage of newborns, states should adopt all available options to expand coverage to pregnant women to help reduce both maternal and infant mortality. (It is important to note that states which take only take up the “unborn child” option (which provides coverage to immigrant pregnant women) in CHIP cannot provide postpartum coverage to women unless payments for prenatal care, labor and delivery, and postpartum care are included in a “bundled payment of global fee,” according to the Centers for Medicare and Medicaid Services (CMS). Therefore, some states take both the pregnant women and unborn child options.)
- Remove barriers to Medicaid and CHIP coverage for immigrant-related pregnancy: As part of the CHIP Reauthorization Act of 2009, states were given the option to waive the 5-year waiting period for legal immigrant children and pregnant women from receiving Medicaid and CHIP coverage. This was adopted from legislation entitled the Immigrant Children’s Health Improvement Act (ICHIA). Frankly, children in need of cancer treatment, asthma prevention and treatment, vaccines, or antibiotics for infectious diseases cannot wait five years for care. Furthermore, it is fundamentally nonsensical to ask pregnant women to wait five years for care. According to the Kaiser Family Foundation, as of January 2023, 35 states had taken up the option to cover “lawfully-residing immigrant children without the 5-year wait” and 26 states have taken the option to cover “lawfully-resident immigrant pregnant women.”
- States should expand Medicaid for all low-income adults: The option to expand Medicaid to low-income adults that was created by the Affordable Care Act (ACA) has been adopted by 40 states and has been demonstrated to expand coverage for women of childbearing age. In a study published in the American Journal of Public Health, the authors found that the decline in infant mortality rates was 50% greater in Medicaid expansion states versus non-expansion states between 2010 and 2016. This reduction in mortality was even more profound among African American newborns. Furthermore, according to a study published in Women’s Health Journal, Medicaid expansion states experienced lower maternal mortality rates in compared to non-expansion states. According to the study author, “The decrease in the maternal mortality ratio is greater when maternal mortality estimates include late maternal deaths, suggesting that sustained insurance coverage after childbirth as well as improved preconception coverage could be contributing to decreasing maternal mortality.”
Refocusing on the Needs of Children and Pregnant Women
Far too often, the needs and concerns of children and pregnant women are overshadowed by other adult interests and political debates surrounding abortion. Children are frequently treated as an afterthought in public policy debates, even when policies are specifically centered on children (e.g., the Child Tax Credit, education policy, child welfare, and reauthorization of CHIP). And when it comes to pregnant women, the focus tends to revolve around political debates rather than the well-being of women and children.
In the case of the Child Tax Credit, it is more than just a line on a tax return. It symbolizes the nation’s commitment to the well-being of its children and that should always be the primary focus. As a society, we have a responsibility to ensure that policies and resources are guided by principles of failure, justice, and compassion, especially toward children. That is why the Child Tax Credit should be rebalanced so that it no longer deny or reduces it for 23 million low-income children because their parents make too little.
Similarly, CHIP has always had strong bipartisan support at both the federal and state levels of government and should be made permanent (and no longer singled out as the only federal health insurance program to be temporary). CHIP has successfully played a critical role in providing health coverage to millions of children and pregnant women over its 25-year history and its stability should be guaranteed.
Furthermore, in light of the expiration of the COVID-19 public health emergency and what is called Medicaid unwinding (see also HERE) and the Dobbs decision (see also HERE), there are new threats the health and well-being of children and pregnant women that Congress should be addressing on a bipartisan basis.
Unfortunately, as with so many policies of importance to children and pregnant women, the House E&C Committee recently held a hearing on the “Medicare Access and CHIP Reauthorization Act (MACRA) Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors” that focused exclusively on the Medicare provisions. The hearing overlooked critically important issues regarding CHIP and its coverage for children and pregnant women, including the fact that Congress continues to subject CHIP to repeated program expirations and a funding cliff that threatens the future health coverage and well-being of millions of our nation’s children and pregnant women.
On a bipartisan basis, our nation’s policymakers should put the financial security and well-being of ALL children and families first and no longer treat their concerns and needs as an afterthought. Their lives matter and investing in them has enormous positive impacts that can also have life-saving consequences.
