Health affairs
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Neighborhoods influence children's health, so it is important to have measures of children's neighborhood environments. Using the Child Opportunity Index 2.0, a composite metric of the neighborhood conditions that children experience today across the US, we present new evidence of vast geographic and racial/ethnic inequities in neighborhood conditions in the 100 largest metropolitan areas in the US. Child Opportunity Scores range from 20 in Fresno, California, to 83 in Madison, Wisconsin. ⋯ Nationally, the Child Opportunity Score for White children (73) is much higher than for Black (24) and Hispanic (33) children. To improve children's health and well-being, the health sector must move beyond a focus on treating disease or modifying individual behavior to a broader focus on neighborhood conditions. This will require the health sector to both implement place-based interventions and collaborate with other sectors such as housing to execute mobility-based interventions.
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Multicenter Study
Spreading Fear: The Announcement Of The Public Charge Rule Reduced Enrollment In Child Safety-Net Programs.
Safety-net programs improve health for low-income children over the short and long term. In September 2018 the Trump administration announced its intention to change the guidance on how to identify a potential "public charge," defined as a noncitizen primarily dependent on the government for subsistence. After this change, immigrants' applications for permanent residence could be denied for using a broader range of safety-net programs. ⋯ Applied nationwide, this implies a decline in coverage of 260,000 children. The public charge rule was adopted in February 2020, just before the coronavirus disease 2019 (COVID-19) pandemic began in the US. These results suggest that the Trump administration's public charge announcement could have led to many thousands of eligible, low-income children failing to receive safety-net support during a severe health and economic crisis.
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The coronavirus disease 2019 (COVID-19) pandemic continues to devastate US nursing homes. Adequate personal protective equipment (PPE) and staffing levels are critical to protect nursing home residents and staff. Despite the importance of these basic measures, few national data are available concerning the state of nursing homes with respect to these resources. ⋯ Rates of both staff and PPE shortages did not meaningfully improve from May to July 2020. Facilities with COVID-19 cases among residents and staff, as well as those serving more Medicaid recipients and those with lower quality scores, were more likely to report shortages. Policies aimed at providing resources to obtain additional direct care staff and PPE for these vulnerable nursing homes, particularly in areas with rising community COVID-19 case rates, are needed to reduce the national COVID-19 death toll.
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Review
Children's Health Insurance Coverage: Progress, Problems, And Priorities For 2021 And Beyond.
Expansion of Medicaid and establishment of the Children's Health Insurance Program (CHIP) represent a significant success story in the national effort to guarantee health insurance for children. That success is reflected in the high rates of coverage and health care access achieved for children, including those in low-income families. ⋯ Children continue to face coverage interruptions, and Latino, adolescent, and noncitizen children continue to face elevated risks of being uninsured. Although we note the benefits of a universal, federally financed, single-payer approach to coverage, we also offer two possible reform pathways that can take place within the current multipayer system, aimed at ensuring coverage, access, continuity, and comprehensiveness to move the nation closer to the goal of providing the health care that children need to reach their full potential and to reduce racial and economic inequalities.