HEALTH & HUMAN SERVICES

Racial and ethnic disparities in the health care system have long impeded our nation’s health and well-being. For everyone in the U.S. to achieve their full potential—and for our nation to achieve its full potential—we must ensure equitable access to high-quality health care. This report presents an anti-racist re-imagining of the Medicaid and CHIP programs that actively reckons with the racist history of health care coverage. The report offers recommendations to advance racial equity in Medicaid and CHIP. It also provides principles to guide anti-racist policy transformations that center program participants and their communities.

The latest debt ceiling agreement threatens to take away food and cash assistance from people with low incomes—especially older women—if they cannot meet harsh work reporting requirements. The latest bill would add another hurdle to accessing the Supplemental Nutrition Assistance Program (SNAP) for older Americans ages 50-54 and doubles down on existing SNAP time limits for childless adults under 50 and existing work requirements in the Temporary Assistance for Needy Families (TANF) program.

Medicaid is a core pillar of the U.S. healthcare infrastructure that helps ensure that everyone — regardless of income — can have access to quality care. But for decades, the federal government has treated Puerto Rico unequally, covering only half the share of the cost (in comparison to a maximum of 83 percent for states). And the amount of federal funding is subject to an extremely low, arbitrary and unstable cap set by Congress. The perverse result is that one of the poorest jurisdictions in the United States is treated as one of the wealthiest states for Medicaid funding — a program specifically designed to help people and families with low incomes access quality medical care.

An America where no one experiences poverty is possible. Already, the U.S. has programs with the potential to make this vision a reality, including programs that provide cash assistance, like Temporary Assistance for Needy Families (TANF). The current TANF program provides very little cash assistance and is marked by stark racial disparities, but it has the potential to reduce child poverty, increase economic security, and advance racial equity. This report offers a vision for an anti-racist approach to the TANF program, with new statutory goals and policy recommendations to advance racial justice.

Price increases for basic necessities like tampons have a real cost. Period poverty—the lack of access to sanitary products due to financial constraints—is a public health crisis deserving of a coordinated response that profit-driven private corporations are neither motivated nor prepared to provide. We need resilient supply chains that can be relied on to get basic necessities into the hands of the people who need them—and that will surely require public investment and accountability for powerful corporations.

To advance child health equity in California, The Children’s Partnership, the California Children’s Trust, and the Georgetown Center on Poverty and Inequality launched The Equity Through Engagement (ETE) project. This project examines opportunities to integrate community partnerships and interventions into California’s Medi-Cal financing and delivery systems to advance child health equity, including through addressing social drivers of health (SDOHs).

In 2020, federal policymakers took extraordinary measures to help millions of families avoid poverty and material hardship during the COVID-19 crisis. These temporary federal relief efforts—especially those boosting household incomes and ensuring people’s access to essential services—“played a central role in stabilizing our families and our nation’s economy, while pushing back on deep racial and gender inequity,” according to GCPI Co-Executive Director Indi Dutta-Gupta’s testimony before the United States House of Representatives Select Subcommittee Committee on the Coronavirus Crisis. Dutta-Gupta also argued that continuing to provide needed support to families would address pre-existing inequities and the weaknesses of social protection programs. Policies in “Build Back Better” proposals—with some crucial additions—would provide transformational investments to protect families and our economy against future threats, meet our national caregiving and job needs, and reduce poverty, hardship, and inequality for generations to come.

In 1996, the Personal Responsibility and Work Opportunity Act (PRWORA) radically transformed our system of social supports. In addition to decimating cash assistance for families, the law’s immigrant exclusions exacerbated economic and racial inequities and harmed children and families in the 25 years since. This report—published jointly with the Center for the Study of Social Policy—examines the racist roots of PRWORA’s anti-immigrant exclusions and highlights the law’s role in institutionalizing and legitimizing anti-immigrant exclusion in a range of public benefits and tax credits.

High-quality caregiving, including child care and long-term services and supports, is essential but out of reach for too many families. At the same time, care workers—who are disproportionately women of color—face poor job quality, low pay, and inadequate benefits, which undermines access to quality care. This brief offers recommendations for caregiving investments that promote the well-being of children, older adults, people with disabilities, and their families by creating and sustaining good jobs in the caregiving sector.

The COVID-19 pandemic and recession have greatly magnified existing health and economic inequities, threatening the well-being of children and families. Children, families, and communities throughout the United States urgently need bold, equitable, and anti-racist human services to meet the extraordinary challenges facing our country. This brief summarizes the key recommendations from a GCPI research project identifying, developing, and prioritizing human services-focused federal executive actions to improve economic security and well-being for children and families in the U.S.