Tag Archives: disadvantaged youth

Child Health and Health Care Access

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Many celebrated outside the Supreme Court two weeks ago following SCOTUS’s decision to allow health care subsidies through the Affordable Care Act (ACA). I was among those who breathed a sigh of relief at home after reading that our coverage through the Marketplace would be continued. Now as life returns to normal and we no longer have to worry for the time being, let’s not forget the importance of health care access, especially for children, and the fact that there are still children who don’t have it. Exactly how important is health care access? Lindsey Leininger and Helen Levy joined forces in the latest Future of Children issue to tell us about the influence access has on child health.

Research on this question has had varying results, but Leininger and Levy argue that, overall, access to care does improve child health and that the influence is often more significant for those who are marginalized. The classic RAND Health Insurance Experiment, for instance, suggested that in the population as a whole, the generosity of insurance coverage did not significantly determine overall health. However for high-risk (meaning low-income) children, generosity of coverage did affect health.

Studies on Medicaid eligibility show further evidence: in the year after implementation, mortality fell among nonwhite infants, and this effect persisted for at least 10 years. Also, among children in low-income families, those who experienced more years of Medicaid eligibility were in better health. A variety of other studies have associated expansions of Medicaid eligibility with reductions in child mortality. With regard to Medicaid enrollment, positive effects have also been seen, such as increased enrollment leading to decreases in hospital admissions for conditions that could be well-managed by primary care.

Leininger’s own research has shown that lack of coverage can be a strong detriment to child health. Her study showed that each additional month without coverage was associated with a small, statistically significant decline in the probably of a child seeing a doctor for a well-visit or any other visit. A four-month spell of being uninsured, for example, resulted in a 4 percent decrease in the likelihood of any visit and a 9 percent decrease in the likelihood of a well-visit.

So insurance coverage is good for child health, especially for marginalized children. But according to our authors, although “the ACA builds on the earlier successes of Medicaid expansion and CHIP to promote children’s access to care… challenges remain.” Access to care improves child health, but it is not the only factor. For example one study cited by Leininger and Levy estimates that lack of access to medical care explains only about 10% of early mortality in the population as a whole; less than genetics (30%), social circumstances (15%), and behavioral factors (40%). To improve children’s health overall and consider policies that may do so, we must also consider the larger picture. To learn more about other factors that influence children’s health, read the full Future of Children issue on Child Health.

NYT Article about Extended Transition to Adulthood Misses Critical Issues about Disadvantaged Young People

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A recent New York Times Magazine article about today’s 20-something’s has gone viral, with countless electronically connected young people circulating the story about how their cohort is changing all the rules when it comes to transitioning to adulthood. They are in a sort of limbo, "forestalling the beginning of adult life," as they extend their schooling, jump between career paths, and delay marriage and childbearing. This article notes some of the cultural forces feeding this trend: a sluggish job market and the increasing need for post-secondary education in today’s workforce are two major reasons for the shift. But the article misses a critical part of the story: how have these changes affected low-income, disadvantaged young adults?

In fact, this elongated transition worsens already existing disparities between disadvantaged youth and their more educated, higher income counterparts.

Covered in detail in the latest volume of The Future of Children, the shift from childhood to full adulthood places great strain on both young people and their families. Although governmental programs provide some support for disadvantaged children, the burden falls primarily on private institutions or interpersonal networks for those 18 and older. Across the income spectrum, parents are spending about ten percent of their income to support young adult children, but ten percent of a lower or middle class income provides fewer opportunities than a comparable portion of an upper-middle or upper class family salary. Moreover, for a family already struggling financially, providing for an adult child can be very stressful.

More affluent parents may help children by offering them rent-free housing, monetary support, or a potential safety net while the children experiment with low-paying jobs or unpaid internships. In addition, they can help emerging adults establish themselves by providing loans or assistance towards buying a car or house. Such assets help young adults build up capital and transition more smoothly into stable careers and family life. Less wealthy parents may not be able to provide their children with the same advantages without incurring major costs. Their resources are more limited and available money may be less reliable from year-to-year. As a result, these more disadvantaged children may fall even further behind their peers.

In addition, parents assist their children by connecting them to other networks of support, including people who may help them advance their careers and institutions that facilitate transitions. One such institution is college. Private colleges, more heavily populated by more affluent youth, tend to offer extensive support to help students develop at least partial autonomy, such as on-campus housing, extensive activities and entertainment, adult and peer support, health care, and counseling or other resources to guide students into jobs and post-college life. Community colleges, which are more in reach for many lower-income families, offer their students far less support and far fewer opportunities, thus deepening disadvantages.

Another trend widening the gap between young people is the timing of having children. While young people spanning the socioeconomic range are marrying later, less affluent young people are forming families while still in their late teens and early twenties, often outside of marriage. The responsibilities that accompany parenthood – from medical needs to childcare – pose additional challenges to completing an education and maintaining a steady job. To make matters worse, many young, unmarried parents break up shortly after their child is born, and young mothers often turn to their own mothers for help. Middle and upper class youth that wait until married with a stable career to have children are much better equipped to handle these additional costs and demands without relying on overburdened families. Without parents or public programs that can assist them, more disadvantaged youth continue to struggle with the assumption of adult roles.

As this widely-experienced yet new phase of maturation becomes more studied and understood, effort needs to be made to make sure that those emerging adults who are already disadvantaged – from impoverished families, with weak family ties, exiting foster care, requiring special education, or leaving the juvenile justice system – do not fall further behind. Whether by expanding social services beyond age eighteen or increasing the counseling and lifestyle support aspects of community college, society must help provide 20-somethings the assistance they need to transition into healthy, productive adult lives.

New Census Measure Provides More Detailed View of Poverty

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The U.S. Census Bureau recently announced plans to publish a new poverty measure in conjunction with the traditional measure, a move that can shed additional light on vulnerable populations and how current policies are serving them. While the new measure will not replace the current one in policies and determining program eligibility and funding, it will reveal a more nuanced view of the experience of lower-income Americans.
The standard measure, first published in 1964 as part of Lyndon B. Johnson’s War on Poverty, calculates a federal poverty threshold based on food expenditures as determined by the “thrifty food plan” developed by the U.S. Department of Agriculture. The measure is quite simple; it presumes that food expenditures should make up a third a household’s budget, so it simply multiplies the amount allowed under the thrifty food plan by three. Families are considered poor if their household income falls below this level. While the threshold has been continually adjusted to account for inflation, it does not account for regional differences. Even more problematic is that over the past half-century food prices have dropped relative to expenses such as housing; given that housing costs have soared since the 1960’s, the current measure does not accurately capture the financial strain of some families.
The new measure is based on different calculations of necessary spending and family resources. Household spending includes the costs of food, housing, utilities, and clothing, as well as a little bit extra. Family resources include not only income, but also in-kind benefits such as food stamps. The resource measure also subtracts taxes and tax credits, work expenses such as commuting costs and childcare, and out-of-pocket medical expenses to represent the family’s actual ability to cover the expenses listed above. This more accurate and thorough measure acknowledges the complexity of resources and spending, and it allows for geographic adjustment such as greater costs in places with more expensive housing.
Scheduled to be released annually starting in fall 2011, this new measure will help policy evaluation in three major ways. First, it will help determine if all vulnerable populations are being reached. Second, by including additional measures of needs and resources, researchers and policy makers can better analyze whether assistance programs are mitigating families’ experiences of poverty, such as the difference food stamps make to a family. Third, the measure will show how much necessary expenses add to a family’s burden. By extending beyond food costs to include housing, out-of-pocket medical expenses, and utilities, policy makers can identify areas where the poor need the most help to fulfill their families’ needs.
As explored in an issue of The Future of Children that focuses on antipoverty policies, these types of governmental assistance for child care, health care, and education are critical for needy families. The Census’s new poverty measure allows a new insight into these issues and interventions and can provide a powerful new tool for analysis in the coming years.

For more details, see the federal government’s working group report from March 2010: http://www.census.gov/hhes/www/povmeas/SPM_TWGObservations.pdf

High Schools can Help Increase Post-Secondary Education

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A recent Time Magazine story, “Can Community Colleges Save the U.S. Economy,” notes the emerging White House consensus that the nation’s 1,200 community colleges may be the best place to help students – particularly disadvantaged youth — prepare and adapt for today’s marketplace. The Bill & Melinda Gates Foundation agrees and has funded initiatives to showcase community colleges as places for change (including this project).
To make this strategy work, however, high schools must help low-income students prepare for and succeed in college. A recent Future of Children policy brief , “A New Goal for America’s High Schools: College Preparation for All,” outlines steps that high schools should take to ensure that disadvantaged youth see post-secondary education as a realistic and attainable option.
First, high schools should boost students’ subject matter knowledge and study skills. As several papers in The Future of Chil­dren: America’s High Schools point out, many districts and states have changed their performance standards and course requirements to include college prepara­tory classes and passing high-stakes tests. In tandem with these initiatives, districts, states, and even the federal government should be encouraged to devise new and effective ways of convincing low-income students to take and work hard in tough courses.
Second, high schools should counsel students on how to select colleges and obtain financial aid. Every high school – particularly those serving advantaged and disadvantaged youth — should have sufficient numbers of trained counselors and teachers to help students select and apply for both college and financial aid. The current system in which schools serving predominantly low-income and minority students have more than 1,000 students per counselor does not work. States and local school districts should do everything possible to ensure that disadvantaged students have adequate access to effective counsel­ing beginning at least by the ninth grade.

Finally, to increase schools’ accountability, school districts should build data tracking systems capable of following students from kindergarten through postsecondary education. States are fully aware of the importance of account­ability for postsecondary performance and have begun taking steps toward developing the necessary achievement tests and data systems.

To meet these three goals, the authors of the FOC policy brief make a proposal. The $1.7 billion a year that the federal government currently provides for a wide range of efforts aimed at helping disadvantaged students should be re-allocated competitively (to public schools, postsecondary schools, nonprofit and for-profit organizations, and coalitions of these organizations). Priority would be given to applicants who are able to show how they will track student progress in reading and math, how they will respond with additional instruction or other assistance when students fall below grade level in either subject, and, where appropriate, how they will track their students’ progress in postsecondary education and modify their college preparation program based on the evidence. Recipients should be required to reapply for funding every three years, and programs that do not increase college enrollment and graduation rates should lose their funding. Preference would go to programs that have effective procedures for enrolling truly disadvantaged students and boosting their achievement and college enrollment and graduation rates. Similarly, preference should go to proposals that provide for rapid response as soon as disadvantaged students begin to fall below grade norms. Finally, the Statewide Longitudinal Data System should be expanded to all states while ensuring that state systems are capable of following students through the college years.