Low-income families struggle to access health insurance, child care and adequate wages, creating stress that can impact babies throughout their childhoods.
That’s according to a new report from the Prenatal-to-3 Policy Impact Center at the University of Texas at Austin.
“What we’ve laid out is that it’s not just about investing in child care programs or just in parenting programs alone, but some of the broader family supports like paid family leave or making sure that work pays enough to make sure children get off to a healthy start,” said Cynthia Osborne, who directs the center.
That's important because 80% of a child's brain develops in the first three years.
The inaugural Prenatal-to-3 State Policy Roadmap identifies five science-based policies that improve health outcomes for very young children.
1) Expand Medicaid eligibility
Medicaid expansion is a perennial topic in Kansas, and while Missourians voted last month to expand access to health insurance to low-income adults, the legislature hasn’t acted yet.
Without Medicaid expansion, more than a quarter of women of child-bearing age in Kansas and Missouri don’t have access to health insurance until they get pregnant.
“There’s a time lag between getting her signed up, and her prenatal care is delayed,” Osborne said. “Her birth outcomes are actually much worse.”
COVID-19 job losses have exacerbated lack of access to prenatal care. The Economic Policy Institute estimates up to 12 million American workers have lost access to their employer-sponsored insurance – and women are overrepresented in the industries making significant cuts, including retail and restaurant jobs.
2) Reduce administrative burden for SNAP recipients
This is something both Kansas and Missouri have done. SNAP, or the Supplemental Nutrition Assistance Program, provides federal dollars for families to buy food. Reducing the administrative burden – that is, making families prove they qualify less often – lowers food insecurity among children.
Still, 10.9% of eligible Kansas families with children don’t receive the food assistance they’re entitled to. In Missouri, it’s 3.2%.
3) Offer at least six weeks of paid family leave
The U.S. ranks dead last in providing paid parental leave, according to a Pew Research Center analysis of 41 countries’ policies.
Just four states – Washington, California, New York and New Jersey – and the District of Columbia offer paid family leave. Kansas and Missouri both have paid family leave programs for state employees, but that’s it.
“There are such large and persistent disparities in children’s well-being based on race and ethnicity, based on geography, based on what state they’re born in and the policy choices that have been made,” Osborne said.
Parents of all races and ethnicities are more likely to take time off to care for their baby if paid leave is available, but Black mothers really benefit. They were 10.6 percentage points more likely to take leave in states that expanded access to paid leave than in states that didn’t.
4) Increase the minimum wage to $10 or higher
Kansas’ minimum wage is $7.25, same as the federal minimum wage. Missouri’s is slightly higher, $9.45, and there is a plan in place to increase it each year until it reaches $12 in 2023.
This discussion is particularly relevant to child care workers, many of whom have worked throughout the pandemic for poverty-level wages, often without health insurance. Early in the pandemic, about a third of the nation’s child care providers told the National Association for the Education of Young Children said they would not be able to survive a closure of more than two weeks – the length of a coronavirus quarantine – without public investment.
Without child care, even middle-income parents have struggled to return to work. And although low-income families usually qualify for child care subsidies, Osborne says there’s almost always a co-pay. In both Kansas and Missouri, a family of three earning $32,580 per year – one and a half times the federal poverty level – would need to put at least 8% of their income toward child care.
For reference, $32,580 is two adults working at least 33 hours per week for minimum wage in Missouri. In Kansas, both adults would need to work more than 40 hours per week at the federal minimum wage to earn $32,580.
5) Implement a refundable earned income tax credit
The earned income tax credit is a benefit for low-wage workers that’s worth up to $6,600 for families with three or more children. Kansas offers an EITC that’s worth 17% of the federal tax credit; pushes to establish a state EITC in Missouri have been unsuccessful.
Mothers worked more in states that offered an EITC and were less likely to leave the workforce, the Prenatal-to-3 Policy Impact Center found.
“We’re not just trying to show states how they're doing,” Osborne said. “We’re trying to help them to do better. There’s a range of effective solutions that will actually make a difference in the first three years. What we need is an understanding of how to do better.”
