Shetal Shah, MD, FAAP
Dr. Shetal Shah MD, FAAP is neonatologist at Maria Fareri Children’s Hospital and Immediate Past President of the NYS AAP-Chapter 2. He is Chair of the Pediatric Policy Council. This op-ed was published in Tampa Bay Times on December 28, 2021.
Build Back Better is a Child Health Bill in Disguise
The recent setback to the Senate’s consideration of President Joe Biden’s Build Back Better Plan is a major loss for America’s children. As pediatricians, we see the social spending proposal for what it really is: a child health bill. While reluctance to support the measure imperils the overall plan, parents, grandparents, teachers and those who care about children’s well-being should hope the individual and uncontroversial, child-friendly aspects of the bill receive strong legislative support.
Lacking health insurance is a major reason children become sicker than necessary. Countless times, I’ve seen children come to the emergency room simply because they are uninsured and waited until a small cut became a massive, infected wound or an annoying cough became a major asthma attack now requiring intensive care. The Build Back Better Plan would make the Children’s Health Insurance Program (CHIP) permanent – preventing 9.6 million kids from losing health coverage and eliminating the need for Congress to haggle periodically over reauthorizing a critical child health insurance program.
The plan also continues coverage for children in Medicaid and CHIP for a full year, so children can see a doctor through the first 12 months of life, a time when children develop rapidly and also receive most standard vaccinations, along with preventive health tests like lead screening. This would be especially helpful in Florida, which has roughly 330,000 uninsured children.
It also means parents will not got to a pharmacy and be denied lifesaving medicine like insulin for their first year because they didn’t navigate the tortuous, bureaucratic process of reauthorizing their children’s health insurance. If you think that’s easy, I have personally helped patients through the process, and it takes a doctor, care coordinator and social worker hours on the phone to simply renew insurance for which our patients were already eligible.
The proposal would also fix loopholes in health insurance for new mothers by extending Medicaid coverage to low-income women for a year after birth, instead of the usual 60 days. Since this cost is shared with states, this extension is an inexpensive way to increase rates of breastfeeding- which benefits mothers and babies – reduce maternal smoking and provide access to contraception.
It will also save mothers’ lives. Among developed countries the U.S. has the highest rates of maternal mortality. New moms in the United States die at double the rate of French moms and triple the rate of Australian mothers. If enacted, this fix to Medicaid would reduce Florida’s rate of maternal death from 22 to 15 per 100,000.
Other bipartisan programs include historic investments in pre-K, childcare and school nutrition programs. Federal and state support for Pre-K program would provide financial relief for millions of families, allow both parents to continue to participate in the workforce and provide the early education pivotal to later school success. The brain achieves 90% of its growth in the first 6 years and early education improves comprehension, memory, emotional regulation, information processing and language.
For more than a decade, less than half of children born into low-income families had access to Pre-K, creating a generation of educationally-disadvantaged early learners. Investments in early child education yield 2-10 times the cost savings through adulthood. The preterm infants we care for, all have under-developed brains and would all benefit from Pre-K, but for too many of my babies’ parents, it’s unaffordable, compounding the handicaps these infants will face across child and early adulthood.
Growing childhood brains takes nutrition and energy. Children simply cannot learn if they are hungry. The pandemic has sharpened the national focus on child food insecurity, and aspects of the Build Back Better plan provide long-sought after bolsters to school nutrition programs. Pediatricians know school meal programs, like free breakfast and lunch are a lifeline for low-income students and families. But every summer, we look out for “summer hunger” cause by disconnecting these kids from those meals. Enhancing grocery benefits for families who qualify for these meals would prevent kids from going hungry from June to September. The bill also allows states to give free meals to all students in high-risk areas, reducing the stigma of free school meals and unburdening school districts of the need of qualifying each individual student and allowing them to spend those resource directly on education.
While other key supports for children such as tax credits and paid family leave are hotly deliberated, we should not miss the bipartisan opportunities to make historic leaps for children. These programs should not be collateral damage to contested debates on these policies.
Congress has asked for more time to debate the overall measure, but the kids cannot wait.