Below is an article from the Woodrow Wilson School of Public and International Affairs at Princeton, which discusses key questions of the Affordable Care Act with Princeton faculty, including Future of Children Senior Editor Janet Currie.

Keith Wailoo, Townsend Martin Professor of History and Public Affairs Woodrow Wilson School of Public and International Affairs

ACA: Lessons from the Road Taken

“The Supreme Court’s ruling on the Affordable Care Act (ACA) is surely a health care milestone, but it is also a remarkable civics lesson about the political and legal complexities involved in making policy on such a grand scale.

“The tortuous path of the health care law illustrates why major initiatives like this happen so infrequently. First, there was the brief window created by Barack Obama’s election and the unexpected Democratic take-over of both houses of Congress with a filibuster-proof majority in the Senate. The possibilities for reform were nearly snatched away many times, most notably after the death of Senator Kennedy. Even after the President and Congressional Democrats took the daring risk of resuscitating the law – knowing that it would cost them politically in the 2010 elections – the political and legal fate of the law seemed unclear. For years to come, the episode will illustrate risk-taking leadership, as well as the ugly horse-trading and imperfections of the legislative process.

“The second tortuous phase of the ACA – the legal debate – offers another lesson… about the thin line separating politics and ideology, on one hand, and constitutional reasoning on the other. Yes, the Supreme Court’s decision revolved around matters of legal interpretation: the Commerce Clause (the limits of the federal government’s power to regulate interstate commerce) and the federal government’s power to tax. But the ruling also highlighted the tensions between the so-called liberal wing of the court and conservative bloc.

“In the interplay of politics and law, the most important civics lesson to emerge from the court phase of the ACA was the tension between two conservative justices – Antonin Scalia and John Roberts.

“Scalia rarely favors expanding federal power, but this time he seemed to be swayed by the political milieu. He echoed the libertarian objections to the ACA mandate, noting that ‘everybody has to buy food sooner or later, so you define the market as food, therefore, everybody is in the market; therefore, you can make people buy broccoli.’ By contrast, Chief Justice Roberts tried hard to mark the line between politics and law. In his opinion, ‘Members of this Court are vested with the authority to interpret the law: we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them.’ With these words, Roberts walked the high court back from the political precipice. Had he sided with the dissenters, commentators would have questioned the High Court’s partisan politicization – seeing them as nothing more than politicians in black robes – for decades to come. Robert’s ruling saved the court from this fate.

“Looking ahead, what can we expect as the legal dust settles?

“Calls for repeal will continue, but they will fade. The legal imperative to implement the law pushes elected officials beyond repeal. Governors, even those from the 26 states who argued against the law, must make tough policy decisions, getting into the weeds of coverage and setting up insurance exchanges. Some will continue to resist, at least until the November elections. All along the tortuous path, there has been an irony – the states whose citizens will benefit most from the law’s provisions are often those where the elected leaders are most whipped into frenzy over the laws unconstitutionality. How long that frenzy will last is difficult to say – surely it will dissipate, but perhaps not until after Election Day 2012.

“Of course, the most important effect of the Supreme Court decision – punctuating the nearly four-year fight – will be on the people’s health. Now that the political and the constitutional law phases have played out, we have an opportunity to refocus, finally, on health and health care. Perhaps Americans will shift to the underlying story of health care reform that started us down this path in the first place – the people with pre-existing conditions, the young adults without insurance, the small businesses looking for affordable ways into the health insurance market, and the many others for whom a new world of possibilities has just opened. When the dust of this sandstorm has settled, this will be the lasting story of the ACA. But after so many years of political and legal saturation, it may be a while before we can focus again on the people whose lives will be improved.”

Keith Wailoo is author of “The Troubled Dream of Genetic Medicine,” “Dying in the City of the Blues: Sickle Cell Anemia,” the “Politics of Race and Health; How Cancer Crossed the Color Line,” and other studies on the history and politics of health care in America. He is co-editor of “Three Shots at Prevention: The HPV Vaccine and the Politics of Medicine’s Simple Solutions.” At Princeton, he teaches courses on history and health policy; on race, drugs, and drug policy; and (in the fall 2012 with Princeton University President Shirley M. Tilghman) Modern Genetics and Public Policy.

Uwe Reinhardt, James Madison Professor of Political Economy and professor of economics and public affairs, who is recognized as one of nation’s leading authorities on health care economics:

“It may seem that the Supreme Court’s decision to uphold the Affordable Care Act of 2010 hinged on semantics: whether the letter sequence ‘p e n a l t y’ is in the nature of punishment for a misdemeanor or a tax. In fact, from an actuarial perspective, one might construe the penalty as a crude approximation to the actuarial average cost uninsured, individuals as a group might visit on hospitals in the form of unpaid bills. Therefore the revenue from penalties should be paid hospitals through disproportionate share moneys.

“In fact, however, the Supreme Court decision is the outcome of just one more skirmish in a decade’s long fight over the question: to what extent must healthier and more fortunate Americans be their poorer and sicker brothers’ and sisters’ keepers in health care?

“The supporters of the ACA deserve a moment of joy over the Courts decision, but for them it is just a short ‘R and R,’ as soldiers call it. The next big battle will be fought in the upcoming presidential and congressional elections. It will be fierce and tenacious, supported by huge sums of money on both sides.

“Should Governor Romney win the White House and bring with that victory a Republican Congress, attempts will be made to repeal the entire Act, although that probably would not survive a filibuster by Democrats. But portions of the bill – especially the subsidies and Medicaid expansion – might be gutted through a budget reconciliation vote.

“In the end, though, the bluster that ‘I (or we) will repeal the entire ACA’ always evokes in me the image of a dog chasing a car. What will the dog do when the car stops?

“In this case, what alternatives to coping with the large number of uninsured and poor Americans who cannot pay out of pocket for health care do the opponents of the ACA have in mind?

“An answer to that question will be even more interesting that the Supreme Courts historic decision.

“So, stay tuned.”

Janet Currie, professor of economics and public policy; director, Center for Health and Wellbeing (CHW). The Center runs a program in U.S. Health Policy:

“This historic ruling removes the uncertainty about the constitutionality of the Affordable Care Act. The next test will come in November. In the meantime states have much to do setting up health care exchanges and preparing to expand their Medicaid programs. The ruling did allow states to opt out of the Medicaid expansion, but to do so would leave billions of federal dollars ‘on the table’ and would leave poor adults few options for health insurance coverage. There is likely to be great pressure on states to implement the Medicaid expansion from their own hospitals and medical providers.

“All we have learned from previous expansions of public health insurance programs to the previously uninsured suggest that it will make people happier and healthier — the recent expansion of Oregon’s Medicaid program also reduced the probability that people faced medical debt. But higher numbers of people with health insurance coverage generally means more medical spending rather than less.

‘Bending the cost curve’ is the next policy frontier, and this requires understanding the drivers of medical spending and variations in medical spending that are unrelated to health outcomes.”

Adel Mahmoud, Senior Policy Analyst Lecturer with the rank of Professor, Woodrow Wilson School and Molecular Biology

“The Supreme Court decision may open the way for the United States to join the rest of the world in offering ALL of its citizens a system that guarantees some form of healthcare coverage. I hope it adds strength to the Administration and those who care to focus on what matters for the future of the country without the diversionary tactics of politics as usual. The road ahead is still treacherous and needs thoughtful involvement of a lot of those planning or implementing one of the most complicated healthcare systems in the world. It is one step forward!”

Heather Howard, lecturer in public affairs at the Woodrow Wilson School and director of the State Health Reform Assistance Network*

“Today the Supreme Court affirmed the constitutionality of the Affordable Care Act, which would extend health insurance coverage to 32 million Americans. In a divided opinion, a majority of the court found that the individual mandate would be unconstitutional under the Commerce Clause, but surprisingly Chief Justice Roberts joined the liberal members to uphold it under Congress’ taxing authority. The court also affirmed the constitutionality of the Medicaid expansion, but in an interesting wrinkle held that Congress cannot withhold a state’s entire Medicaid funding if the state refuses to adopt the ACA expansion.

“The focus will now turn to state implementation, as states build health insurance exchanges, institute new insurance reforms to strengthen private insurance markets and ensure the availability of affordable insurance products, and prepare for the Medicaid expansion. Some states may still wait until after the election to start moving, while others are likely to build on planning work to date, jumpstarting their implementation work in an effort to meet the aggressive timelines in the ACA. While states appear now to have flexibility to reject the Medicaid expansion, there will be tremendous pressure from consumers, hospitals and other providers to take advantage of full federal funding in the initial years and to avoid gaps in coverage for lower-income Americans.”

*The State Health Reform Assistance Network is focused on setting up insurance exchanges, instituting insurance market reforms, expanding Medicaid to newly eligible populations, and streamlining eligibility and enrollment systems. Funded by The Robert Wood Johnson Foundation, it is providing states with essential resources to implement key health insurance coverage provisions of the Affordable Care Act.

Anne-Marie Slaughter, Bert G. Kerstetter ’66 University Professor of Politics and International Affairs at Princeton and former dean of Princeton’s Woodrow Wilson School of Public and International Affairs, writes about the challenges of work and family balance in a recent piece in the The Atlantic, Why Women Still Can’t Have it All.

The article presents several observations, which echo the Future of Children’s Work and Family issue findings:

–The rising shares of women in the workforce and of families headed by single parents have made work-family issues especially prominent and challenging, as more employees face care responsibilities at home and fewer have a stay-at-home spouse to manage them.

–For high-income families, often the problem is too many hours of work; for low-income families, the problem is often too few hours of work, too little control over those hours, and insufficient income. Families in the middle not only face insecurity about their jobs and financial situation, but also have limited resources to meet their families’ needs. Their incomes are too low to purchase high quality care for their dependents, but too high to qualify for help from public programs.

–Workplace flexibility is a promising approach to easing work-family conflict. For employees, it is linked with job engagement, satisfaction, retention, and better health; for employers, with higher productivity.

–School-aged children require care and supervision before and after school and during school vacations. Schools, out-of-care providers, and employers can ease work-family conflicts by taking account of changes in working families. In today’s economic climate, workplace flexibility options may have the most potential for meeting families’ diverse scheduling needs.

As Slaughter urges, “ultimately, it is society that must change, coming to value choices to put family ahead of work just as much as those to put work ahead of family. If we really valued those choices, we would value the people who make them; if we valued the people who make them, we would do everything possible to hire and retain them; if we did everything possible to allow them to combine work and family equally over time, then the choices would get a lot easier.”

For more on work and family, go to the Future of Children’s issue on Work and Family.

In a recent New Jersey Star Ledger article, guest columnist and Future of Children author Neal Halfon writes about the shift in disabilities from physical disorders to mental health disorders.

“The latest issue of Princeton/Brookings, Future of Children adds to the growing number of studies documenting that childhood disability rates are not only unexplainably increasing, but also that the way disabilities manifest is significantly changing,” Halfon writes. “Where the poster child of disability in the 1960’s was on crutches, the new face is a child with autism, attention deficit hyperactivity disorder, or other problems affecting the brain.”

“Growing rates and shifting patterns of childhood disability challenge notions that U.S. children are generally healthy and suggest substantial changes in the risks children encounter. While disabilities are more common in children from lower-income households, a lack of family resources, education, or other forms of social deprivation don’t explain all of what’s going on. Some risk-hunting epidemiologists are considering whether any of the thousands of new chemicals in our environment are to blame,” Halfon continues, “while others are examining the role that toxic stresses may play in jolting developing nervous systems onto an aberrant path.” A recent Future of Children blog post further explores this topic, pulling research from the Children with Disabilities article on the prevention of disability in children.

The Future of Children’s Children with Disabilities volume explores various possible reasons for the shift in disabilities from physical to mental health disorders while emphasizing that regardless of the cause of the disability, “large numbers of children must live with a diagnosed disability, (and) these children merit attention.”

This is particularly true for children with mental health disorders. Both the Delaney and Smith and Stabile and Allin articles in the Children with Disabilities volume highlight the significant lifetime costs of mental health disorders for children. In fact, mental health disorders in childhood generally have larger impacts than childhood physical health problems in terms of adult health, years of schooling, participation in the labor force, marital status, and family income. Identifying the best ways to support these children is clearly important.

To read more about the ways to support children with disabilities’ education and health, go to the Future of Children’s Children with Disabilities volume. You may also be interested in reading about our recent practitioners’ conference, “Working with Children with Disabilities: Tools for Parents and Schools.“

By Christopher Wildeman, Assistant Professor of Sociology at Yale University

This blog originally appeared on May 16, 2012 in Social Science Space. Chris received his Ph.D. in Sociology and Demography from Princeton University in 2008.

The consequences of the prison boom for poor, minority men are almost undeniable. According to recent estimates, about 25 percent of African-American men experience imprisonment by their mid-30s, with rates increasing to 60 percent to 70 percent for African-American men who did not complete high school. Lifetime risks for white men who dropped out of high school are also high–about 15 percent of them are imprisoned at some point–but not even in the same ballpark as the risks for comparable African-American men.

Much research on the costs of the prison boom focuses solely on men. In one regard, this makes good sense. These men are, after all, the ones who will be held in a local jail or a state or federal prison. Likewise, they are the ones whose labor market prospects will suffer, whose romantic relationships might fail, and whose children will inquire about them. Yet in another sense, focusing only on these men misses much of the picture, as their incarceration may also influence the well-being of the women attached to them, including their mental health. The financial well-being of their romantic partners and children suffers as well. Similarly, if men’s romantic relationships suffer or end altogether, then these women also experience the pain of breaking up or the struggle to keep their faltering relationships going. And if the time apart from children is difficult for men, imagine how difficult it is for their children–especially since many of these men might have been inconsistently involved in their children’s lives even before going away. All of these effects may add up to a partner’s incarceration having serious consequences for women’s mental health, as finances and family life strongly affect women’s well-being.

In a recent article (Christopher Wildeman, Jason Schnittker, and Kristin Turney. 2012. “Despair by Association? The Mental Health of Mothers with Children by Recently Incarcerated Fathers.” American Sociological Review 77:216-243), we considered how the incarceration of a father affects mother’s mental health utilizing data from the Fragile Families and Child Wellbeing Study–a data set that captures the experiences of about 5,000 fathers and mothers, living in American cities, who have children together.

The results were sobering. For these women, the incarceration of their children’s fathers made a bad situation worse. Already at elevated risk of poor mental health for many of the same reasons that the fathers of their children were at risk of incarceration, their mental health took an additional hit as a result of the fathers’ recent incarceration. And this hit was heavy. For the women in our study, having the father of her child incarcerated increased her risk of experiencing major depression by about 25 percent, an especially substantial increase considering how elevated these women’s risk of being depressed would have been even if the fathers of their children had not experienced incarceration. Effects on life dissatisfaction were comparable, suggesting that incarceration increases these women’s risks not just of experiencing a severe mental health condition such as major depression, but also of feeling less good about their lives even if they were not actually depressed.

So what explains this effect? According to our analysis, the very same forces that have received so much attention from those interested in the consequences of incarceration for men explained much of these damaging effects on women’s mental health. The incarceration of a father leads to greater financial instability among mothers, deterioration of their already-vulnerable romantic relationships, and increases in parenting difficulties. These effects, in turn, are associated with mental health. Interestingly, we find that changes in family life–the quality and structure of romantic relationships and the circumstances surrounding parenting their child–rather than the well-documented economic effects of incarceration explain much of this association, suggesting the loss of a father and partner hurts these women’s mental health more than the loss of a paycheck.

As we consider the various costs and benefits of incarceration, our calculator shouldn’t get turned off after we consider its crime-fighting benefits, budgetary costs, and implications for the lives of marginalized young men. Indeed, our results suggest that a potentially even greater cost of incarceration may be how it damages the women and children left in its wake. These hidden costs of the prison boom should be considered, as the mental health of the women and children who face such substantial obstacles already is important for our national wellbeing.

Dr. Christopher Wildeman

Dr. Jason Schnittker

Dr. Kristin Turney

For more research focused on fragile families, see the Future of Children’s Fragile Families volume.

At an April 25^th forum at the Ford Foundation, coordinated by the National Center for Children in Poverty (NCCP), researchers discussed the benefits of paid leave for children and parents’ wellbeing, particularly for low-income families.

“In 2012, the United States remains the only industrialized nation without a national paid family leave program that supports workers who need time off to attend to important family needs, such as caring for a new baby or sick child,” said Curtis Skinner, PhD, director of family economic security at NCCP.

“The status quo, whereby the lowest-paid workers are least likely to have paid sick leave or other leave that enables them to take care of family responsibilities, forces working parents to choose between not taking care of their family or losing their wages (or losing their job altogether),” observed Work and Family issue editor Jane Waldfogel, who presented at the forum. And many low-income workers cannot afford to take the unpaid leave provided under the Family and Medical Leave Act, even if they are eligible.

Forcing parents to choose between family and work not only strains families but also costs employers in terms of diminished employee productivity, engagement, and retention. Even in the lowest paying jobs, it costs more to train a new worker than to provide current workers paid leave options.

U.S. businesses are often resistant to discussing paid leave options – assuming that the costs of paid leave will fall to them. However, as Waldfogel explained at the forum, this is not necessarily the case. Paid leave can be provided by a social insurance fund, such as the one provided in New Jersey. New research on the impact of such policies on children and families in the United States will be critical to larger scale implementations of family leave policies in the U.S.

For more on Work and Family, go to www.futureofchildren.org. Building a Competitive Future Right from the Start: A Paid Family Leave Forum was coordinated by NCCP with the help of the New York State Paid Leave Coalition and A Better Balance, with support from the Ford, Annie E. Casey, and Hagedorn foundations.

“Though it may seem counterintuitive, providing paid family and medical leave when people cannot work due to caregiving responsibilities helps keep people employed. In the short term it keeps people away from work, but in the long term it reduces the number of people who have to quit their jobs when they need time off to care for a seriously ill family member or when they have a new child. Paid medical leave serves this same purpose for workers who have short-term but serious illnesses that prevent them from working” write Heather Boushey and Sarah Jane Glynn in a report released yesterday by the Center for American Progress.

At a time when the majority of American women are employed outside the home, many single mothers and fathers are heading families on their own, and older Americans increasingly need care from younger relatives, the challenges of meeting family responsibilities and holding down a job are more difficult than ever. As the Future of Children’s Work and Family volume documents, when U.S. families need care for children or elderly relatives, they rely primarily not on government policies and programs but on themselves and their employers. Employer supports, however, are inequitably distributed, with the best packages of benefits going to the highest-paid workers. As a result, employees who may most need employer assistance in meeting family needs may be least likely to receive it.

As Boushey and Glynn show, providing paid family and medical leave would most likely have positive effects on employment and lifetime income, with the largest impact among less-educated and lower-income families – those who currently have the least access to any form of leave.

Workers who have a new child, experience a personal medical emergency or have an ailing family member often either have to quit their jobs to provide short-term intensive care or lose their jobs because they are unable to take job-protected leave. As Boushey, an author in the Future of Children’s Work and Family volume noted at its fall release at the Brookings Institution, “we did all that work on welfare reform in the 1990’s that encouraged low income individuals, especially women, to work… and so [workplace flexibility, leave policies] must be the next step. We want that single Mom in the workplace, but we have to make sure that she can stay in the workplace, that she can hold on to her job while taking care of her children.”

Yet, as Jane Waldfogel and Sara McLanahan note in Work and Family, providing additional paid leave could be difficult for many U.S. small businesses, particularly as the nation continues to struggle with the aftereffects of the recession. Waldfogel and McLanahan suggest that it is reasonable to ask all employers to provide a minimal amount of paid sick leave and other leave time to all employees. But longer leaves, where required for parents of newborns or for caregivers of those with serious longer-term health conditions, would probably be better provided through some other mechanism, such as a social insurance fund like the one that undergirds Social Security retirement and disability programs. Boushey and Glynn describe what such a fund might look like in their recent report.

For more research-based information on work and family in the United States, go to the Future of Children’s fall 2011 volume Work and Family.

Christina Paxson, dean of Princeton University’s Woodrow Wilson School of Public and International Affairs and senior editor of the Future of Children, has been selected to serve as the next president of Brown University. The Corporation of Brown University voted on her appointment in a special session on March 2, 2012.

Paxson began her academic career at Princeton University in 1986, becoming assistant professor of economics and public affairs in 1987. She became a full professor in 1997 and was named the Hughes-Rogers Professor of Economics and Public Affairs in 2007. In 2009, she was appointed dean of the Woodrow Wilson School.

Initially working on international economic problems of labor supply, mobility, savings, inequality, and aging, Paxson focused increasingly on the relationship of economic factors to health and welfare over the life course, particularly on the health and welfare of children. In 2000, she founded the Center for Health and Wellbeing, an interdisciplinary research center in the Woodrow Wilson School. The center established multidisciplinary graduate and undergraduate certificate programs in health and health policy. She served as the center’s director until 2009.

In addition, Chris Paxson has been a senior editor at the Future of Children since the journal came from the Packard Foundation to Princeton University and the Brookings Institution in 2004. Paxson has made substantial contributions to the journal as a senior editor and as an issue editor for volumes on Childhood Obesity and Preventing Child Maltreatment.

The idea to bring the Future of Children from Packard to Princeton arose when Paxson and other leaders at Princeton wanted to begin a discussion about community health, which they felt had been hampered by Princeton’s lack of a medical school, said Cecilia Rouse, professor of economic and public affairs at Princeton and senior editor of the Future of Children. (http://www.browndailyherald.com/mobile/paxson-s-economics-cover-broad-range-of-disciplines-1.2711218)

Ron Haskins, senior fellow in economic studies at the Brookings Institution and Future of Children senior editor, said that Princeton/Brookings won the national competition to work on the Future of Children largely due to Paxson, who wrote an excellent proposal. In the crowded field of economics, Paxson has often stood out for her strong interest in issues of children’s health, Haskins added.

Sara McLanahan, a Princeton professor of sociology and public affairs and Editor-in-Chief of the Future of Children said Paxson’s research elucidates the long-term negative effects of poor childhood health and the way health disparities at early stages continue to widen. She added that Paxson’s determination and humility made her an effective collaborator.

As McLanahan notes in the Providence Journal, Paxson has the ability to “persuade people to go along with her because they trust her. They know she’s really trying to promote the common good as opposed to herself… [She] has a rare combination of great intelligence and humility.” (www.providencejournal.com)

“She’s just so smart, talented — a calm leader with vision,” Cecilia Rouse adds. “It was just a matter of time until someone saw that, and she moved on.”

To read Future of Children volumes Childhood Obesity and Preventing Child Maltreatment, both of which were edited by Christina Paxson, go to: http://www.futureofchildren.org/futureofchildren/publications/journals/.

“A society with economic opportunity is one in which all children have a good chance of success regardless of the economic status of the family into which they are born. The United States has long been viewed as such a society–a place where with hard work most people can succeed, whatever their family background. With the rewards for economic success becoming bigger, as they have in recent decades, ensuring that competition is fair and open becomes even more important.

Relatively strong economic growth through much of U.S. history has meant that each generation could do better than the previous one, even if children remained in the same relative economic position as their parents. However, in recent decades family income growth has slowed.” (Future of Children, Opportunity in America, Executive Summary)

According to the US Census Bureau, in 2010, 15 percent of Americans lived below the poverty level, the highest number since 1993. That means a household income of $22,113 for a family of four. These levels of poverty are especially concerning when understood within the context of diminishing mobility in the United States.

As FOC senior editor Belle Sawhill writes in the New York Times:

“A growing body of evidence suggests that the United States, far from being the land of opportunity celebrated in our history and our literature, is instead a country where class matters after all, where upward mobility is constrained, especially among those born into the bottom ranks.

What could be done to improve the upward mobility chances of less advantaged children?

First, it would help if more parents were ready to take on the most important responsibility any adult normally assumes, which is the decision to have a child. Unfortunately, for far too many teens and young adults, this is not a carefully planned decision. Half of all children born to women under the age of 30 are born outside of marriage, and 70 percent of all pregnancies to single women in this age group are unplanned. Research shows that access to more effective (but expensive and hard-to-get) forms of contraception could help here.

Second, low-income children enter school far behind their more advantaged peers in vocabulary and learning-related behaviors such as the ability to sit still or follow directions. High-quality early-education programs can compensate for some of these deficits, but too few children are enrolled and too few programs are high quality. These children tend to fall further behind as they progress through school. Large numbers drop out of high school, enter the criminal justice system, or end up unemployed or earning very low wages. These trajectories can be changed in part by putting better teachers in the classroom, setting higher standards and expecting students and parents to be full partners in this effort.

Third, no one should graduate from school without the specific skills needed by today’s employers. Not everyone is going to benefit from a traditional four-year college degree. But more career and technical education, on-the-job training or community college programs could produce a more highly skilled work force.

These investments have the potential to increase opportunity, economic growth, and our competitiveness with other countries. Will we make the needed changes?”

For more on opportunity in America, go to the Future of Children volume on the topic.