Many middle-class and wealthy families will see benefits from the new legislation, but programs that help low-income families keep babies healthy have been cut back. While state money funds public schools and preschool in some cases, programs supporting the youngest children are largely backed by the federal government.
Still, advocates say they do not make up for what children are likely to lose under the new law. And they fear what comes next, as the next Trump budget proposes more cuts to programs that help parents and babies.
Over 10 million Americans rely on Medicaid for health care. About 40% of births are covered by Medicaid. Newborns, too, qualify for it when their mothers have it.
The new law doesn’t take little kids or their parents off Medicaid. It institutes Medicaid work requirements for childless adults and adults with children over the age of 13. But pediatricians warn the cuts will be felt broadly, even by those who do not use Medicaid.
The Medicaid cuts are expected to put a financial strain on health care providers, forcing them to cut their least profitable services. That’s often pediatrics, where young patients are more likely to use Medicaid, said Lisa Costello, a West Virginia pediatrician who chairs the federal policy committee for the American Association of Pediatrics.
The ripple effects could exacerbate an existing shortage of pediatricians and hospital beds for children.
“Any cuts to that program are going to trickle down and impact children, whether that’s pediatric practices who depend on Medicaid to be able to stay open or children’s hospitals,” Costello said.
States also use Medicaid to pay for programs that go beyond conventional medical care, including therapies for young children with disabilities. Under the new law, states will foot a greater portion of the bill for Medicaid, meaning optional programs are at risk of getting cut.
Advocates worry that if an adult loses Medicaid coverage, it could ratchet up household stress and make it more difficult for parents to make ends meet, both of which can negatively impact youngsters. And parents who lose their health insurance are less likely to take their children to the doctor.
“When parents lose their health insurance, they often think that their children also are no longer eligible, even if that’s not the case,” said Cynthia Osborne, a professor of early education and the executive director of the Prenatal-to-3 Policy Impact Center at Vanderbilt University.
The law increases the child tax credit to $2,200 per child, up from $2,000. But parents who don’t earn enough to pay income tax will still not see the benefit, and many will only see a partial benefit.
The measure also contains two provisions intended to help families pay for child care, which in many places costs more than a mortgage. First, it boosts the tax credit parents receive for spending money on child care. The bill also expands a program that gives companies tax credits for providing child care for their employees.
Both measures have faced criticism for generally benefiting larger companies and wealthier households.
“It’s a corporate business tax break,” said Bruce Lesley, president of the advocacy group First Focus on Children. “It makes their child care dependent upon working for an employer who has the credit.”
The law launches a program that creates investment accounts for newborn children. The “Trump Accounts” are to be seeded with $1,000 from the government, and children will be able to use the money when they become adults to start a new business, put the money toward a house or go to school.
Unlike other baby bond programs, which generally target disadvantaged groups, the federal program will be available to families of all incomes.
The program’s backers have pitched the accounts as a way to give young people a boost as they reach adulthood and teach them about the benefits of investing. Critics have argued that families in poverty have more immediate needs and that their children should receive a larger endowment if the goal is to help level the playing field.
The Supplemental Nutrition Assistance Program (SNAP) faces the largest cut in its history under the law. It will, for the first time, require parents to work to qualify for the benefit if their children are 14 or older. But even households with younger children could feel the impact.
The law kicks some immigrants — including those with legal status — off food assistance. It makes it more difficult for individuals to qualify by changing how it considers their utility bills.
“When young children lose access to that healthy nutrition, it impacts them for the rest of their lives,” Bergh said. “This bill fundamentally walks away from a long-standing nationwide commitment to making sure that low-income children in every state can receive the food assistance that they need.”
