Economic Security Polices That Support Families Generate Positive Impacts

As safety net programs that support families continue to be a topic of fierce debate in Congress, a recent report by PolicyLab at Children’s Hospital of Philadelphia (CHOP), produced in partnership with the Maternity Care Coalition, entitled "Advancing Intergenerational Mobility Through Early Childhood Economic Security," looked at the existing evidence for the impact of host of programs such as Medicaid, food and nutrition services and housing supports. Spotlight spoke with one of the report’s authors, Emma Golub, a policy analyst at PolicyLab at CHOP. The transcript of the conversation has been lightly edited for length and clarity.

‍Emma, why don’t we jump in and start with the genesis of this project and perhaps just a little bit about how you went about doing it.

Sure. This is a format that we do at Policy Lab at Children's Hospital of Philadelphia. It's called an Evidence to Action Brief, and it reviews existing policy research evidence. And so, we know that families need economic security to meet basic needs and to get through crises. But almost half of American kids experience poverty before they enter kindergarten. And we don't see this equally across groups. American Indian or Alaska native, Black, Hispanic and multiracial kids all have much higher poverty rates than their white peers. And also compared to older children, a greater proportion of children under five live in poverty. And we know that economic insecurity in pregnancy and early childhood can interfere with kids’ healthy brain development and jeopardize their long-term health.

Experiences in this early period can have lifelong consequences, so the earlier we invest in families, the greater the potential impact. There’s a growing body of research that tells us that economic security policies that support pregnant people, infants and toddlers and their families generate positive impacts. But the evidence is not broadly understood and inaccurate narratives about poverty persist that hinder policy change.

So, here in Pennsylvania, our partner organization, Maternity Care Coalition, created this project to change the narrative through an investigation and through presentation of the impact of prenatal and early childhood economic security policy for kids and their families. This report is the first part.

‍And in Pennsylvania or elsewhere, what are some of the specific reasons why you see peak economic insecurity during pregnancy?

We tend to see a mother's poverty rates begin to climb in the two months prior to birth and peak in the first three months after birth. We see about four in 10 Black and Hispanic moms, and one in five white moms are living in poverty when they give birth. And kind of what's happening here is that baby related expenses—childcare, diapers, cribs—cost approximately $20,000 on average in the first year of a child's life. And at the same time, caregivers tend to face these expenses early in their careers before their earning potential grows.

And I'm sorry, I know you asked about how it was conducted. I'm happy to go back to that.

‍If you want to, sure. It seems pretty straightforward, but if there's anything that you think our readers would be helpful to know.

I can just say we did not reinvent the wheel. There's so much great work in this area out there and we tried to build on recent efforts to review effective policies that support economic security for U.S. families. We really followed three guiding principles—we chose 10 policies based on their relevance to pregnant people and families with young kids; evidence of impact or potential for impact on long-term outcomes, especially intergenerational economic mobility; and the policy’s relevance for state level action in Pennsylvania. We were particularly interested in this kind of long-term lens, and particularly in intergenerational economic mobility. We were struck by some research from Opportunity Insights that shows that only half of kids born in the 1980s out-earn their parents, compared to 90% of children who were born in the 1940s.

‍I’m not sure we have time to go through all 10 of the issue areas you looked at, so I thought we might look at a few that are particularly noteworthy right now. Why don’t we start with Medicaid and the state of play there in Pennsylvania.

As I’m sure your readers know, Medicaid provides comprehensive healthcare coverage for 70 to 80 million low-income Americans, including about four in 10 kids and four in 10 births. To start a bit more broadly, we found economic security policies in the prenatal to early childhood period are effective tools to promote kids' wellbeing over the long term. And we affirmed, as researchers have before us, that policies that boost household income serve multiple purposes and can affect many outcomes at the same time.

Medicaid, along with four other policies we surveyed, has a really large body of research that shows positive impacts on kids' long-term health, um, educational and economic outcomes. For Medicaid specifically, there's really just a wealth of evidence that kids who are eligible have better health when they are adults and prenatal Medicaid eligibility is associated with better health across actually multiple generations, which was really cool to see. We also found that childhood Medicaid eligibility is linked to lower mortality, disability, hospitalizations, and use of public assistance in adulthood, as well as greater educational attainment and earnings. So, I think Medicaid is a great example of an area where the evidence is really strong.

‍I was interested in your take on cash transfers since that’s something that’s been very much a topic of debate in recent months.

In terms of cash transfers, what we concluded is that the evidence is somewhat mixed there. We looked across different cash transfer programs—federal programs like the Supplemental Security Income Program and TANF, but also newer innovative initiatives such as RX Kids, which folks may or may not know, but it's the first communitywide prenatal and infant cash assistance program in the US, which is really exciting.

Ultimately, we have concluded at this point that the research on cash assistance programs is mixed. We saw some positive outcomes, we saw some adverse outcomes, and we saw some papers that found no effects. The report that we just published is really more presenting the evidence, but we actually have a piece that's going to be coming out this spring in health affairs that takes a more analytic lens on cash assistance specifically.

‍Another topic very much in the news is nutrition services such as SNAP.

In terms of food and nutrition support, it's very similar to Medicaid in terms of the strength of the research. We looked at SNAP and we looked at WIC and what we found was very similar to Medicaid in terms of very strong evidence of these programs’ impact on children's health, educational and economic outcomes. We found both short-term and long-term outcomes, which is great.

‍You also noted a few policies that you would like to see put in place and paid family and medical leave was one of those, correct?

That's correct.

‍And minimum wage increases and larger tax credits?

The Earned Income Tax Credit and then child tax credits specifically.

‍And does Pennsylvania have both of those credits?

No, Pennsylvania does not have its own child tax credit. Actually, while we were finalizing this report, Pennsylvania established a state level earned income tax credit called the Working Pennsylvanians Tax Credit. That was exciting to see.

We divided our key takeaways and recommendations into 10 policies that we group into different categories. We did this evidence review, and then we have a partner who's taking our evidence review and then they're going to create specific policy recommendations for each of the policies. First, there are those we need to protect and enhance—programs that already exist but could use fortification in this moment. Secondly, there are policies that the evidence supports being established, like paid family medical leave and child tax credits. And then there are the exciting emerging strategies, which are currently understudied, such as diaper assistance and predictive scheduling policies.

I think overall for us, a takeaway is that amid dramatic changes in the federal policy landscape, state governments have a critical role to play in helping families thrive. We’ve also been thinking a lot about how, while each of these policies are important on their own, in reality, they only work in combination. And so, we've been thinking a lot about how states can use a more holistic approach and leverage a suite of these interventions of evidence-based economic security policies to promote kids' wellbeing now and into the future.