Ryan budget plan dangerous to kids' health

Budget chairman's proposal would gut programs children rely on

April 11, 2011|By Tina L. Cheng

Earlier this year, in an address to the nation after the horrific shooting spree in Tucson, Ariz., President Barack Obama implored Americans to work together, saying, "All of us — we should do everything we can to make sure this country lives up to our children's expectations." Though there is general agreement that our country must always consider the future and invest in the education and health of our children, many would argue that adults have not lived up to our children's expectations.

The most striking recent example is the budget plan presented this month by Rep. Paul Ryan, the Republican chairman of the House Budget Committee. Mr. Ryan says he wants a more prosperous future for our nation's children, but his proposal — expected to be voted on by the House this week — would deal a devastating blow to child health and well-being.

Despite our nation's wealth, American children are already at a disadvantage compared to children in other industrialized nations. A UNICEF study in 2009 entitled "An Overview of Child Well-Being in Rich Countries" assessed the welfare of children in countries of the Organization for Economic Cooperation and Development, reviewing six dimensions of child well-being. Of 21 nations, the United States was in the bottom third of the rankings for five of the six dimensions. Researchers have predicted that for the first time in two centuries, our current generation of American children may have shorter life expectancies than their parents because of health conditions such as obesity. In addition, children and adolescents have disproportionately high rates of poverty, with 21 percent or 15.3 million children living in poverty and an additional 21 percent living in low-income families.

The poor state of child health is not surprising in light of declining spending on children. According to a recent Urban Institute report, "Kids' Share 2010," between 1960 and 2009 children's share of domestic federal spending (excluding defense, international affairs and adding children's tax expenditures) declined from 20 percent to 14 percent. In comparison, there has been a doubling of expenditures on the nonchild portions of Social Security, Medicare and Medicaid, rising from 22 percent to 44 percent of domestic spending.

Mr. Ryan's budget plan significantly worsens these trends. Big cuts in many children's programs are devastating especially at a time when many families are still hurting from the recession. This includes a $771 billion cut in Medicaid over ten years and a cut in the State Children's Health Insurance Program by $33 billion in just two years.

Converting Medicaid into block grants and rolling back proposed expansion under the Affordable Care Act will only decrease access to a range of health services to low-income children. While more than half of all Medicaid recipients are children, they make up only one-quarter of Medicaid's overall costs. Finally, repealing the Affordable Care Act would reverse the law's investments in prevention and health care coverage expansion that are good for kids.

Health care for children is not the driver of overall health spending. Children under age 18 are 24 percent of the population, but health care services for infants, children, adolescents and young adults consume only 12 percent of total annual health care spending.

Recently, business, finance and policy leaders developed the Telluride Principles for Investing in Young Children. They posit that long-term U.S. economic strength and fiscal sustainability depend on a healthy and successful future workforce and that investing in children is a vital economic growth strategy. Nobel laureate economist James J. Heckman has demonstrated that early investments in the well-being and skill formation of disadvantaged children pay off. Healthy and productive children have much greater odds of being healthy and productive adults. If we don't invest now, we pay much more later.

It is incumbent on adults to do what is right for the sake of the next generation. However, especially in tough economic times, individuals tend to be more focused on their own situation and may not consider the impact of their decisions on future generations. Today's children will face enormous challenges, inheriting a warming planet, growing deficits and increasingly complicated world affairs. They need a fair start.

How will the future remember this period in American history? Will it be remembered as the turning point when American life expectancy declined because child health was neglected? Or will it be remembered as an era that invested in children for the good of our nation?

President Obama closed his memorial speech with a reference to 9-year-old shooting victim Christina Taylor Green, saying, "If there are rain puddles in heaven, Christina is jumping in them today. And here on Earth, we place our hands over our hearts, and commit ourselves as Americans to forging a country that is forever worthy of her gentle, happy spirit."

Our children expect that commitment.

Dr. Tina L. Cheng is a professor of pediatrics and public health and division chief of general pediatrics and adolescent medicine at the Johns Hopkins Children's Center and Bloomberg School of Public Health. Her email is tcheng2@jhmi.edu.

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