Community Support for Veterans and their Families

Yesterday, we paid tribute to those Service men and women who have given their lives defending their country and also to the families, especially those with young children, to whom these Service members were husbands and wives, fathers and mothers, sons and daughters. Today, we want to focus on those who have served their country and have come home, or will be coming home, to rejoin their families and communities. The withdrawal of troops from Iraq and the promise of the withdrawal of troops from Afghanistan will create a surge in men and women retiring from active duty and returning to civilian life as veterans. Infants and toddlers will certainly be part of this “coming home” picture.

One thing we know for sure about these returning veterans: overall, they are young, with many returning home to young families and others likely to start families. The active duty force is largely composed of young men and women: in 2009, 45 percent were age 25 or younger; 67 percent were age 30 or younger. Almost three-quarters of enlisted men and women were age 30 or younger. Many of our troops are already young parents.  In 2009, 42 percent of the 1,224,556 children of active duty service members were under the age of 6. And, of those children, more than half were under the age of 3.

The lessons of the last decade tell us that we need to prepare for the stresses of reintegration on families and be especially attuned to the effects of these stresses on young children. Those lessons are twofold:

First, when warriors come home, often recovering from physical and psychological injuries, the challenge of reintegrating into family life, connecting with family supports, finding civilian employment, and redefining their roles in their families and in their communities can be overwhelming. Combat related injuries such as Traumatic Brain Injury (TBI) and Post Traumatic Stress Syndrome (PTSD) increase the likelihood of other emotional problems. The percentage of women veterans is expected to rise significantly over the next two decades, creating unique health care needs and raising other issues, including sexual trauma, that need to be addressed.

Second, just as we know more about the impacts of prolonged deployments on the mental health of Service members themselves, the science of early brain development tells us that the impacts of deployment and reintegration extend beyond the veteran to young children. While short-term stress is part of everyday life for young children as they encounter new situations, long-lasting or chronic stress can be damaging to developing brains, particularly to the child’s developing executive function. Not just the stress of the veteran, but also the stress experienced by caregivers of injured veterans who must cope with multiple responsibilities, can adversely affect veterans’ young children.

The Veterans Administration (VA) has long provided for many of the needs of its members, but today’s veterans may require a different type of response.  Issues of unemployment, homelessness, and access to healthcare are among the many concerns that we share as a nation on behalf of those veterans and their families who have served and sacrificed.  Timing is of the essence if we wish to reach these families early in their re-integration process to achieve the best outcomes.  The goal should be to enhance the resilience of veteran families with young children, and support them where they live.

The VA recognizes this need and is open to providing more support for families, yet VA health and mental health services traditionally have been designed for the veterans themselves. Only recently have mental health services begun to include veterans’ spouses, and current VA services do not have sufficient resources or the capacity to address the needs of all family members. As veterans begin reintegrating into family and community life, civilian services have not been prepared to work with military and veterans’ families. Civilian community organizations need additional knowledge and programmatic capacity to effectively serve these families. They need education on military culture and military family life, fiscal agencies and referrals, and training on the proven, evidenced-based strategies that can best support young children in military and Veterans’ families. (The National Center on Homelessness, 2011)

The VA is beginning to take on this task. The VA recently created a regional family and caregiver system with regional case manager coordinators as a resource for veterans’ families. These regional case managers make referrals to regional and local community organizations for caregivers and families from Vietnam era, Gulf, and Afghanistan and Iraq conflicts. This is a promising new and developing program for the VA. Clearly the agency does not have the capacity to reach local communities alone, but needs strategic national and local partnerships to accomplish its goal. One way to give these efforts a leg up is to build on the strong partnerships fostered by the Department of Defense and the White House to better support children—especially the youngest—in active duty Service members’ families.

What are some of the necessary steps to meet the increased needs of young children in veteran families? There is a need for greater resources and concerted efforts to build community connections to create supports, including:

1.     Increased capacity for VA family support programs built around the needs of  young children—especially the youngest children—and developed with evidence-based approaches for practice.

2.     Building local capacity by strengthening knowledge, skills, and resources on    the unique needs of young children in military and veterans’ families, including the impact of trauma, grief, and loss on brain development, and by strengthening community collaborations among service providers.

3.     Support for caregivers of injured veterans in supporting their young children.

4.     Increased capacity to support the unique needs of women veterans, including ensuring that appropriate family, maternal, and infant healthcare facilities are available to meet the medical needs of Services members, their families, and their children.

Honoring the Fallen and Those They Leave Behind

On this Memorial Day, remembrances in the media frequently have featured an iconic photograph of a young widow curled up on an air mattress beside her fallen husband’s casket, a Marine solemnly standing guard nearby through the night.  As our nation pauses to remember those who paid the ultimate sacrifice on behalf of freedom, this photograph calls us to reflect as well on the sacrifices and losses faced by military families and the impact of the loss of a parent on young children. For adding to the poignancy of this image is the fact that the young widow is also pregnant with their first child. Her baby would become one of the nearly 5000 children who have lost a parent in the Iraq and Afghanistan wars. The Tragedy Assistance Program for Survivors (TAPS) reports that nearly 6500 military personnel, many of whom were parents, have died in these wars since 2001. (Tragedy Assistance Program for Survivors (TAPS) 2012)

With almost half of all military children under age 5 years, we must strive to honor the experiences of the young children whose parents have been lost in wars by acknowledging and accepting that even babies and toddlers experience grief. They require respectful, attuned caregiving to support their grief process. 

Infants and young children respond differently to death and grief than do older children. They do not comprehend the finality of death. They may be confused by the reactions of others in their family who are struggling with their own grief, and therefore may have difficulty understanding and making sense of the loss. Young children cannot sustain prolonged emotional responses and are prone to be very sad, angry or upset in one moment and playful and silly in the next. This mercurial behavior may lead surviving family members or caregivers to mistakenly think that the loss does not mean anything to them. Young children who have lost a parent to death will grieve this loss over the different developmental stages of their life cycle so that the experience of grief is extended when it occurs early in life. 

For surviving parents and other family members, coping with their own grief and loss while also being available to those infants and toddlers who demand so much time and attention can be a great struggle. Finding support through family, friends, and the military can help these young families cope through tragedy. 

Infants and young children need to feel supported and safe in their grief. They need to be given opportunities to express their feelings, questions, and concerns through words, play and behavior. They need to maintain routines as much as possible and have opportunities to remain connected to the legacy and memory of their lost parent.

Military children, especially those who live on military installations, are exposed to the formal and informal communications around the death of a service member, memorial services, and other military related rituals. These occurrences may be interesting and supportive or confusing and frightening to young children who have lost a parent. Caring adults need to be attentive to what a young child is exposed to through conversation, experiences, and media so they can help the child process and buffer the information in age appropriate ways. (Cozza & Lieberman, 2007)

On this Memorial Day—and every day—ZERO TO THREE acknowledges the strength of military families and the resilience of their young children and celebrates their dedication and spirit in contributing to the fabric of our country. To learn more about how to support a young child in a family of the fallen, download our guide “Honoring Our Babies and Toddlers: Supporting Young Children Affected by a Military Parent’s Death.”

References:

Cozza, S.J. & Lieberman, A.F. (July 2007) The young military child: Our modern Telemachus. Zero To Three, 27(6). 27-33.

Tragedy Assistance Program for Survivors (TAPS). May 19, 2012. http://www.taps.org/uploadedFiles/TAPS/RESOURCES/Documents/Factsheet.pdf (accessed May 2012).

National Foster Care Month - What You Can Do To “Change a Lifetime”

Every seven minutes in America, a baby or toddler is removed from her parents’ care and placed in the home of someone else, often a stranger. Children under age 3 make up 31% of children entering foster care. At this time in life, their brains are developing rapidly, creating 700 new neural connections every second. Maltreatment can have a significant impact on this development, as can foster care practices that aren’t calibrated to a very young child’s developmental needs.

May is National Foster Care Month. It provides a prime opportunity for infant and toddler advocates to raise awareness and visibility of the very youngest children in care and how to help them reach their potential. This year, the theme is “Achieving Well-Being With Children and Youth in Care,” with a focus on supporting child welfare professionals as they seek to build well-being postpermanency.

For infants and toddlers, this means child welfare professionals, together with community stakeholders, must do all that they can to understand, promote, and protect these young children’s ability to develop and sustain secure attachments. When very young children are formally separated from their caregivers, they face challenges in maintaining and healing relationships. All babies need at least one adult in their lives who is just crazy about them. Without this attachment, their development can deteriorate rapidly, resulting in delays in cognition and learning, relationship dysfunction, and difficulty expressing emotions.

Just keeping babies safe is not enough. Negative foster care experiences, such as moving from placement to placement, also can have a profound effect on young children. Infants in out of home care are particularly vulnerable to delays in emotional, social, and cognitive development, placing them at high risk for negative outcomes later in life.

Yet, the rapid brain development that creates this vulnerability also opens a window of great potential. Intervening early and effectively can prevent or minimize negative effects that become more difficult to address later in life. Thus, it is crucial that child welfare systems infuse guiding principles for infant and toddler development into practices and policies.

Several developments suggest that Washington is attuned to these needs. Last September, Congress passed the Child and Family Services Improvement and Innovation Act, creating a new requirement for states to describe in their child welfare state plans how they promote permanency for and address the developmental needs of young children in their care. Recently, the Administration for Children and Families issued detailed guidance to states on promoting child wellbeing.

Now it’s time to build momentum in the states. These developments offer an opportunity for states to be more intentional in their efforts to meet the unique needs of infants, toddlers, and their families. We all have a stake in helping vulnerable young children beat the odds.

So, what can you do?

·  Read A Call to Action on Behalf of Maltreated Infants and Toddlers and pass it on to other stakeholders and child welfare officials.
A Call to Action represents the collective vision of leading child welfare and early childhood development organizations on the key elements for policies, programs, and practices to address the needs of vulnerable infants and toddlers in the child welfare system. It can provide a starting point for policymakers at all levels to create a response to young children’s special needs.

·  Spread the word on our new state planning tool, A Developmental Approach to Child Welfare Services for Infants, Toddlers, and their Families: A Self-Assessment Tool for States and Counties (to be released at the end of May).
Urge your state or county-based child welfare agencies to use the tool to undertake a comprehensive look at young children in the child welfare system AND offer to help them do this.

·  Register and watch our webinar on the planning tool on May 30th at 2pm Eastern.
The webinar will help child welfare agencies and stakeholders understand how they can use the state child welfare planning tool. It will discuss using data on infants, toddlers, and their families for a clearer picture of strengths and gaps in child welfare systems. Representatives from Iowa and Connecticut will describe initiatives to ensure a developmental approach to child welfare services for very young children, identify challenges, and share how they plan to use the tool.

·  Watch the Safe Babies Court Teams DVD trailer: Safe Babies Court Teams: Building Strong Families and Health Communities.
Check out the newest video release from the Safe Babies Court Teams (and order a copy of the DVD!). The video features a fresh look at the Safe Babies Court Teams initiative, as well as videos focusing on parents of maltreated infants and toddlers, planning the transition to foster care at removal, and understanding the complexities of Fetal Alcohol Spectrum Disorders (FASD) in young children.

Once Again, What It Means When Babies Must Share the Burden

The House of Representatives voted today to slash several entitlement programs important to low-income families and individuals. The Sequester Replacement and Reconciliation Act of 2012 (H.R. 5652) also shredded last year’s agreement on discretionary spending levels for domestic and defense programs, cutting spending for FY 2013 by an additional $19 billion. The ostensible purpose of this bill is to replace the automatic sequester, or across-the-board cut, included in the deficit reduction/debt ceiling agreement last summer as an inducement to the “Super Committee” to find additional budget savings. In reality, it shifts deficit reduction more squarely onto the shoulders of those Americans—including young children—for whom shared sacrifice means going without food or medical care. It also sets the stage to cut domestic discretionary programs more deeply and increase defense spending when the FY 2013 appropriations process reaches its end game.

To review the cuts: The bill would cut $309 billion over 10 years from mandatory funding, with $128 billion (42%) of those savings coming from programs such as Supplemental Nutrition Assistance (SNAP), Medicaid, Children’s Health Insurance Program, the Child Tax Credit, and the elimination of the Social Services Block Grant (SSBG). The bill also would reduce the discretionary spending level agreed upon in the bitter battle last summer over raising the debt ceiling. It breaks down the firewall between domestic and defense spending, designed to ensure that cuts would affect both sides of the federal budget, and paves the way for shifting more cuts to domestic spending while increasing defense programs. A Democratic alternative would have replaced the sequester with cuts to agricultural subsidies, closing oil and gas tax breaks, and raising taxes on millionaires, but was not allowed to come up for a vote.

Once again, we are left to ponder what it means when the most vulnerable babies (as well as their parents, low-income seniors, and other disadvantaged individuals) are asked to do their “fair share” to reduce the deficit. What do they have to give up because the consequences of sacrifices from other segments of society apparently are too distressing to contemplate?

Sadly, we’ve been here before, so we drew from a blog we posted last year to show what happens when babies share the burden…

More will be born too soon and too small.

Two of every five births in the U.S. are to women on Medicaid. Less access to prenatal care most likely means more preterm and low birthweight births.

• In 2005, the Institute of Medicine estimated that preterm births cost society at least $26.2 billion annually, or $51,000 for every preterm infant. Considering special education costs associated with the disabilities more common among preterm infants another $2,200 per infant—or $53,200 total.
• Low birthweight children are 30 percent less likely to be in excellent or very good health in childhood. They also score significantly lower on reading, passage comprehension, and math achievement tests.

More will go hungry.

Many SNAP recipients are families with children, meaning SNAP helps children get the food they need for healthy physical and mental development.

• Research by Children’s HealthWatch found that the increase in SNAP benefits in the stimulus bill, which the bill approved today would roll back, had a positive impact on the health of young children, with children receiving benefits more likely to be classified as “well” than those who did not receive benefits, but were eligible for them.
• A lack of nutritious food during pregnancy increases the risk of low birth weight babies; infant mortality; cleft palate; spina bifida; brain, neural, and physical defects; and adverse effects on long-term health, growth, and developmental trajectories.

• Infants and toddlers in food insecure households are at greater risk of damaging effects in the areas of brain and cognitive development in the perinatal period, school readiness, and physical, mental, and social development.

Fewer will have stable, caring families.

One-quarter of SSBG funds go to services for children who have been subjected to abuse or neglect and support many who have been placed in foster care. Sometimes these funds help provide the supportive services families need so that children don’t have to be removed from their homes.

• Infants and toddlers who have been maltreated are at risk for psychological difficulties, including cognitive delays, poor self-regulation, and difficulty in paying attention. Intervening early can help support healthy, positive development in maltreated babies.
• Very young children need nurturing relationships to develop, relying on their closest caregivers for security and comfort. Preserving and supporting that relationship with parents is critical. At a Congressional Baby Caucus briefing last year, psychologist Brenda Jones Harden described the experience of maltreated babies being removed from their parents’ care and being placed in foster care as “major surgery without an anesthetic.” Child welfare agencies need the ability to work with families in their own homes, if at all possible, to preserve that bond.

Fewer will be ready for school.

Early Head Start, child care, and Part C Early Intervention Services are all funded through the discretionary side of the budget, which would see more cuts under this bill. These programs help give low-income infants and toddlers more positive early learning experiences and reduce the developmental gaps they face early in life.

• Low-income infants and toddlers are at greater risk than middle- to high-income infants and toddlers for a variety of poorer outcomes and vulnerabilities, such as later school failure, learning disabilities, behavior problems, mental retardation, developmental delay, and health impairments.
• Early Head Start has positive impacts on cognitive and language development and increases positive interactions between parents and children.
•  High quality child care can have positive effects that endure into the early adult years, particularly for children from the poorest home environments.

Happy Children’s Mental Health Awareness Day!

Happy Children’s Mental Health Awareness Day 2012!  Each year, Congress and the Administration set aside a day to learn more about children’s mental health: to hear from clinicians, advocates, and survivors of childhood trauma about promising practices, advances in research, and the troubling stories of the most vulnerable children.  You can learn more about what happens on CMHAD here. 

To recognize the day and further the conversation on this critical issue, the ZERO TO THREE Policy Center is pleased to announce the release of a new resource, Making It Happen: Overcoming Barriers to Providing Infant-Early Childhood Mental Health.  Making It Happen illuminates the scientific evidence for infant-early childhood mental health (I-ECMH) policies; examines issues faced by national, state, and local program directors and mental health practitioners in providing I-ECMH services; and proposes a set of recommendations for policy improvements at the federal level.  Additionally, it provides a context for the issues and barriers states face when financing services for those most in need and during a time of life when those services would have the highest rate of return. 

Here at ZERO TO THREE, we wanted to know: What prevents states and communities from delivering mental health services to infants, young children and families? And what can be done to overcome these obstacles? With the help of infant-early childhood mental health and policy experts from across the country, we gathered some answers. 

The bottom line? States and communities don’t have the I-ECMH services that infants and young children need, don’t have the people to provide them, and don’t have a system that will pay for them.  Federal and state decision-makers must take up these issues so that the early foundational development of all infants and young children will enable them to realize their full potential.  Read the paper to learn more about what needs to be done to make early childhood mental health services happen for America’s babies! 

Budget and Appropriations Update

Congress will not be producing a budget blueprint this year, as the two houses will not come to an agreement on funding levels.  The Senate has announced that it will abide by the spending limits in last summer’s debt ceiling bill (Budget Control Act or BCA) and call it a day. Meanwhile, the House has taken a step further, not only adopting a budget that calls for more spending cuts than the BCA, but also going through its own reconciliation process to achieve those lower spending targets. While the prospects for a reconciliation bill in the Senate are unclear, the House proposals give an alarming picture of where priorities lie on that side of the Hill. The bottom line is that vulnerable children and families will lose out to tax cuts and shoulder the burden of deficit reduction.

A refresher on reconciliation: When both Houses of Congress agree on a budget that includes new spending targets for programs with mandatory funding, they include “reconciliation instructions” to Committees to pass legislation that will adjust mandated spending to those new targets. Because there will be no real joint budget resolution this year, there will be no real reconciliation process. The House process shows what they would do to alter priorities in the federal budget. The plan is presumably to package the handiwork of the various committees into one big bill and pass it through the House, after which it could stall in the Senate.

While several committees have been acting on these instructions, three are particularly important to programs serving young children and their families.

Agriculture Committee Cuts the Supplemental Nutrition Assistance Program (SNAP): This Committee was first to act and had to meet the House-approved budget requirement to produce $33 billion in savings over the next decade. On April 18^th, the Committee approved a proposal that would take the entire amount from cuts to SNAP, formerly known as food stamps. The cuts would reduce or eliminate benefits for all SNAP households, including the poorest. According to the Center on Budget and Policy Priorities (CBPP), some 2 million individuals would lose SNAP entirely. The remaining 44 million individuals who receive SNAP would see their benefits cut. The proposal would increase poverty and hardship and could affect the economy adversely. CBPP shows that in 2010, SNAP lifted about 4 million people out of poverty, including about 2 million children. The proposed cut in SNAP benefits would push some households into poverty and deepen the extent of poverty for millions of others.

Committee on Ways and Means Cuts Social Services: The House budget instructed this Committee, which oversees major social services programs, to find $53 billion in savings. The committee eliminated the Social Services Block Grant, which helps over 11 million kids through funding to states for services such as child abuse prevention and intervention, foster care, child protective services and child care.Its bill, approved on April 18, also would deny access to the child tax credit to parents who pay federal income taxes using an Individual Taxpayer Identification Number instead of a Social Security number. This provision is aimed mainly at American-born children whose parents are low-income working immigrants. The Center for American Progress shows that this change would take $1,800 away from the families of 5.5 million children in working families with incomes below the poverty level.

Energy and Commerce seeks to roll back health care reform: The Energy and Commerce Committee was instructed to find $3.8 billion in savings this year, and $96.8 billion over 10 years. This action doesn’t include the budget’s proposal to actually block grant Medicaid. To achieve this goal, they have targeted the health care overhaul. Their measure, approved on April 25, would eliminate the Prevention and Public Health Fund, the nation’s first mandatory funding stream dedicated to enhancing community-based preventive health programs. For example, one 2010 initiative related to children included nutrition, physical activity, and screen time standards in child care settings, and broader obesity prevention in early childhood programs.

The measure would repeal the maintenance of effort (MOE) requirements on states for Medicaid and the Children’s Health Insurance Program, allowing states to apply more restrictive eligibility standards for programs (thus allowing states to drop hundreds of thousands of children from Medicaid and CHIP). It also would reduce the federal Medicaid match, shifting more program costs to the states.

Appropriations Levels Differ in House and Senate: The final piece of the budgetary puzzle is discretionary spending, which must be approved by the Appropriations Committees every year. The BCA agreement, reached after much debate and brinksmanship over sending the country into credit default, set limits for multiple years, reducing discretionary spending by $900 billion over 10 years. The Senate is using the 2013 overall limit for its Appropriations bills, but the House budget reduced that limit by an additional $19 billion, thereby pretty much assuring there will be no resolution of final funding levels until after the November election. Adding to concerns is the fact the House bill that funds the Departments of Health and Human Services and Education would receive one of the largest cuts, coming in at $7.7 billion less than in the Senate. Most of the programs that help support infants and toddlers are in this bill.

One rationale for all these cuts is to forestall the across-the-board cut, or sequester, built into the BCA if Congress failed to come up with additional savings. Those cuts were split between defense and domestic spending. The cuts laid out by the House Committees would help shift the burden of the cuts away from defense and more heavily on domestic programs. At this point, the Senate isn’t likely to go along with the cuts or the shift, setting up another big issue until after the election. Yet, just having these proposals moving through one House of Congress is an alarming development.

But the House budget doesn’t direct all of its savings toward deficit reduction. It also envisions major new tax cuts as well as the extension of all of the Bush-era tax rates which expire at the end of 2012. These tax issues complete the triad of unresolved budget questions that will be on the table for a lame duck session of Congress. To paraphrase Bette Davis, strap your babies tightly into their car seats, it’s going to be a bumpy ride.

Senator Harkin Makes a Powerful Statement for Babies

A couple of weeks ago, the Baby Monitor reported the introduction of a bill, the Rebuild America Act (S. 2252) authored by Senator Tom Harkin (D-IA). This sweeping legislation would support families who are striving to work and build a future for their children—families commonly referred to as the “middle class” as well as those who aspire to join them. Tucked into this large bill is a pretty significant statement, not only about child care’s role in allowing families to work, but also about infants’ and toddlers’ needs for high quality services.

The Rebuild America Act covers a broad range of issues that affect the prosperity of our nation and the economic engine that working families provide. Its strategies include investing to create jobs through rebuilding schools, supporting teachers, and increasing manufacturing power; creating financial stability and a better future for middle class families as well as seniors; and restoring fairness to the tax code and ensuring fiscal responsibility.

A prominent feature is a substantial investment in child care—and not just any child care, but care that meets high levels of quality. The proposed bill would pump $5 billion a year for 10 years into an enhanced “CCDBG Plus” program provided to states through a formula. Ten percent of those funds would be directed at improving the child care workforce; another 10 percent would support quality improvements. The remainder would be used to fund high-quality early care and learning services, with recognition of parents who work non-traditional hours and children with special needs. Services under the Rebuild America Act would have to meet the Head Start/Early Head Start program performance standards, the top tier of a state’s Quality Rating and Improvement System, or be accredited by a national accrediting body.

But here’s the big news for babies: two-thirds of the funds for services are directed at high quality programs for infants and toddlers. Senator Harkin’s efforts on behalf of quality services for very young children will not be unfamiliar to those who have followed the Early Head Start program as it has grown over the years. The child care proposal in this new bill carries that commitment further.

As ZERO TO THREE Executive Director Matthew Melmed said in a letter to Senator Harkin prior to the bill’s introduction, “By directing such a significant proportion of funds to services for very young children, this bill makes a powerful statement that the earliest years are an important time for public investment and that society has a strong interest in ensuring that families can provide positive developmental experiences for their infants and toddlers.”

To be clear, all ages of children need a continuum of high quality early childhood experiences. Yet the biggest gaps are for infants and toddlers, the most likely to be in lower quality care. Senator Harkin’s bill takes to heart three things we know: First, babies’ earliest experiences form the foundation for all learning that follows. Second, with 60% of U.S. mothers with infants working, a significant portion of these early experiences unfold in a child care setting. And third, parents of infants and toddlers—especially at the lower rungs of the economic ladder—often can’t find good quality care at any price, much less care they can afford.

The need for more, better, and financially feasible child care for young children is a major piece of the economic puzzle for families now and for their children in the future, when they will form the backbone of the American workforce. Senator Harkin’s overall bill comes with a high price tag, and its prospects in the current stringent budgetary environment are daunting. Still, as Melmed’s letter said, even “in these times of economic insecurity and budgetary distress, it is important that we not lose sight of the priorities necessary to meeting our current challenges while laying the foundations of a vigorous future for our nation.”

For babies, it is a vital step just to have a champion so clearly put down a marker for their essential needs as their parents go off to work. While it is a way from introducing a bill to realizing change—in this case having more high quality services in place—it is important to start. After all, no vision is ever realized if someone doesn’t first give it voice.

Babies and the Affordable Care Act

Last week, two years after the law’s passage, the Supreme Court heard oral arguments on the constitutionality of four elements of the Affordable Care Act (ACA):

• Monday, the first day of arguments, simply sought to decide whether the case could be heard at all before certain provisions of the ACA have been implemented.  (The Anti-Injunction Act of 1867 states that a tax cannot be challenged in court until it has been charged.  The charges in question under the ACA will not go into effect until 2014, leading some to question whether arguments on the constitutionality of the ACA could be heard until then.) 
• On Tuesday, the Justices heard arguments around the key question: is the individual mandate constitutional?  In other words, they discussed whether Congress can require people to purchase insurance. 
• And on Wednesday, they considered two final questions: If the individual mandate is repealed, can the rest of the Act stand without it? Or would all benefits for children and families, such as those featured below, be lost as well? This question is referred to as “severability.”  And, is the expansion of Medicaid to a broader population constitutional?  This issue is frequently referred to as “expansion.” 

Throughout the week, the Policy Baby Blog covered the story while exploring the law’s impacts on infants, toddlers, and families.  Now Americans will have to wait three months for the Justices’ verdicts, expected by the end of June.    

In the meantime, advocates for infants and toddlers can continue to educate the public about the ACA’s benefits for infants, toddlers, and families.  Here is just a handful that we’ve been exploring at the Baby Blog over the past two weeks:

The ACA expands health care coverage to more children. 

Today, Medicaid is the largest source of health care coverage for children in America, and starting in 2014, the ACA will expand Medicaid to include more families in need.  (Due in large part to Medicaid, the national rate of uninsured low-income children of all ages fell from 28% in 1998 to 10.4% in 2010; and the ACA will lower that number further.)  Medicaid is critical to ensuring that the youngest children have access to high quality, affordable, and consistent health care.  And research demonstrates that Medicaid’s impact on the health outcomes of very young children is especially pronounced.  Here are a few things you should know about babies, Medicaid, and the ACA:

• Medicaid currently pays for 40% of births in America. 
• Medicaid is the largest source of health care coverage for children with special health care needs, and starting in 2014, the ACA will expand Medicaid to include more families in need. 
• Children make up more than half of all Medicaid beneficiaries but only 20% of Medicaid costs. 
• Because of the ACA, 17 million kids with pre-existing conditions can no longer be denied health coverage.

The ACA provides preventive care that is critical to healthy development. 

In the past two years, an additional 14 million children have already benefitted from preventive services without their families having to pay a co-pay or premiums under their insurance plans.  That means access to well-child visits, immunizations, regular screenings, and other services as laid out by the U.S. Preventive Services Task Force.  These services are critical to young children’s healthy development, and all too often babies grow up without them.  In 2010, 25% of two-year-olds in the U.S. have not received crucial immunizations, and in 2009 more than 10% of children age four and younger had not received a well-child visit in the past year.  (That number jumps to almost 60% for uninsured children.)  These unacceptable numbers are and will continue to be addressed by the preventive care provisions of the ACA. 

• Every dollar spent on vaccinations for children saves $16 down the line. 
• Childhood conditions like obesity, asthma, developmental delays, and mental health disorders can be successfully prevented or treated when identified early.  Left untreated, however, they necessitate costly medical treatment in the future. 

The ACA provides preventive care to women and mothers. 

Section 1302 of the ACA includes maternity and newborn care in its list of Essential Health Benefits – services to be covered by Medicaid and other plans by 2014.  In addition, Section 2713 requires that all non-grandfathered health plans cover preventive health care services – including preconception care, well woman visits, and perinatal care – with no cost-sharing.  That means that, as the law is implemented, millions of women will gain access to these preventive health care services for themselves and their babies. 

• Mothers’ physical and mental health – as well as their lifestyle choices and environmental exposures – are central to babies’ pre- and postnatal development. 

The ACA provides new federal funds for home visiting services. 

The ACA’s home visiting services will give at-risk parents and children improved access to family preservation services that seek to decrease child maltreatment and families’ child welfare involvement. 

• By helping parents to understand and address their children’s physical, social-emotional, and cognitive development needs, home visiting cultivates families’ protective factors, nurtures parent-child attachment, and helps to ensure that parents have the resources necessary to caring for their children. 
• Home visiting is a particularly critical tool in serving infants and toddlers, who are difficult or impossible to reach through other programs. 

For more detailed information about the ACA’s impacts on infants and toddlers, read our posts, Happy Birthday to the Affordable Care Act (3/19/12), The ACA Toddles Toward Mothers, (3/23/12), Updates on the Supreme Court Oral Arguments on the Affordable Care Act (3/28/12), and Dispatch from the Supreme Court (3/28/12). 

Dispatch from the Supreme Court

Today, the Supreme Court hears two final arguments on the Affordable Care Act: severability (If the individual mandate is repealed, can the rest of the Act stand without it?) and Medicaid expansion (Is the expansion of Medicaid to a broader population constitutional?).  And on this final day of oral arguments, crowds of ACA supporters gathered in front of the Supreme Court, holding signs, marching, chanting, and sharing stories about how the ACA has affected their families. 

As promised, this Baby Blogger trekked down to the Supreme Court at 8 o’clock this morning to survey the scene and report back.  The area was filled with demonstrators, media, and police, the Supreme Court building looming in the background.  A swarm of blue signs reading “Protect Your Care!  Protect the Law” filled the sidewalk and surrounded a podium where supporters were testifying to the law’s importance.  A small group of opponents gathered to one side.  Speakers included a representative from Ohio, a Native American tribal leader, and grandparents with legal custody of their granddaughter, who has multiple health conditions that demand ongoing care.  Each of these individuals’ stories gave voice to different arguments for the law’s necessity. 

When the speeches ended, a small band struck up with “When the Saints Go Marching In,” prompting the formation of a picket line that stretched the length of the sidewalk.  Chants of “ObamaCare is here to stay,” “Health care is good for you, health care is good for me, health care is good for every American family,” and “We love Obama Care” rang out uninterrupted between the Supreme Court and the eastern face of the Capitol for the next hour.  (The term ObamaCare, first coined by opponents of the ACA, has been reappropriated by supporters and has figured largely in recent advocacy efforts.) 

Here are a few highlights from the morning:

• Rep. Jan Schakowsky (IL-9) made a surprise appearance on the sidewalk, shouting into the mic that the passage of the ACA two years ago was one of the proudest moments of her life – and then breaking into the “ObamaCare is here to stay” chant. 
• In passing groups of middle and high school students, teachers could be heard thanking the demonstrators and telling their kids, “Take a look: this is democracy in action!” 
• One ACA supporter travelled to DC to celebrate her 66^th birthday in front of the Supreme Court and attest to all that the law has done not only for her but for her children, grandchildren, and great grandchildren! 

While supporters came representing a range of interests – children, women, Native Americans, civil rights, reproductive rights, families, the nation’s poor, and others – they coalesced around this landmark law, which they believe will become central to our country’s operation and character.  As defenders of the wellbeing of babies, we have seen the law’s impacts on America’s youngest children and their parents as well as its potential.  And we will continue to lend a voice for babies to this historic national debate. 

Scroll down to read more about how the ACA serves babies and their families, and stay tuned to the Baby Blog next week for a wrap-up of our coverage of the ACA’s 2^nd birthday and the Supreme Court oral arguments. 

Updates on the Supreme Court Oral Arguments on the Affordable Care Act

If you’ve seen the news, you’ve seen the photos and video of proponents and opponents of the Affordable Care Act (ACA) crowding the Supreme Court building Monday as Justices heard the first hour and a half of oral arguments on this law which has sparked such controversy among some and fervent support among others.  This first day of arguments simply sought to decide whether the case could be heard at all before certain provisions of the ACA have been implemented.  (Specifically, the Anti-Injunction Act of 1867 states that a tax cannot be challenged in court until it has been charged.  The charges in question under the ACA will not go into effect until 2014, leading some to question whether arguments on the constitutionality of the ACA could be heard until then.)  But here’s a spoiler alert: at the end of the day, few were surprised to hear that the justices seemed to think that the law’s fate could be decided in 2012. 

On Tuesday, the Justices heard arguments around the key question: is the individual mandate constitutional?  In other words, they will decide whether Congress can require people to purchase insurance.  And on Wednesday, they will consider two final questions: If the individual mandate is repealed, can the rest of the Act stand without it? Or would all benefits for children and families, such as those described below, be lost as well? This question is referred to as “severability.”  And, is the expansion of Medicaid to a broader population constitutional?  This issue is frequently referred to as “expansion.”  Because Medicaid expansion would gain health care coverage for approximately 7-8 million additional children, efforts on this final day – Wednesday the 28^th – will focus on children and families. 

What’s at stake for babies? Over the past week, we have been discussing the effects of the ACA on young children here in the Baby Policy Blog.  We’ve discussed the impacts of Medicaid on young children up to now and the potential for the ACA to expand coverage starting in 2014.  We’ve explored the ways in which the ACA’s provisions for preventive care will improve children’s health and development.  And we’ve talked about the provisions both for women’s preventive care and for maternal and newborn care that will affect children’s health beginning prenatally and extending through childhood.  (Feel free to scroll down and read last week’s posts for a refresher!)  Today, let’s consider a few more important impacts of the ACA thus far.  Because of the ACA,

• 17 million kids with pre-existing conditions can no longer be denied health coverage.

• Approximately 14 million children have received basic preventive care at no additional cost.

• An additional 2.5 million young adults up to age 26 can stay on their parents’ health plans.

And what’s more, the ACA provides new federal funds for home visiting services so that at-risk parents and children have improved access to family preservation services.  These services seek to decrease child maltreatment and families’ child welfare involvement.  By helping parents to understand and address their children’s physical, social-emotional, and cognitive development needs, home visiting cultivates families’ protective factors, nurtures parent-child attachment, and helps to ensure that parents have the resources necessary to caring for their children.  Home visiting is a particularly critical tool in serving infants and toddlers, who are difficult or impossible to reach through other programs. 

Here at the Baby Blog, we’ll continue to reflect on the ACA’s impacts on America’s infants and toddlers.  And Wednesday morning, this Baby Blogger will join the throngs in front of the Supreme Court.  Stay tuned for reports from that historic scene.  In the meantime, you can share stories about how the ACA has impacted infants and toddlers you know!