Texas KIDS COUNT

Health Equity for Every Child

All children deserve the opportunity for a healthy life. In Texas, not all children have the health insurance, food security, and economic security needed for a healthy childhood, due to disparities rooted in systemic racism. Public policy can improve health equity for all Texas children. Policymakers should make practical changes this Legislative Session to ensure all Texas children have the opportunity to thrive.
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Table of Contents

Food
Insecurity

A child’s potential to thrive is limited if they face hunger. Not having adequate nutrition impacts how children grow, play, and learn. Texas has one of the highest rates of child food insecurity in the nation, at nearly 22 percent, or almost 1.6 million children.
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Health Insurance

Supporting children’s health gives them the best chance of succeeding in school and later in life. Yet, Texas still has the worst child uninsured rate in the U.S. at 12.7%–more than twice the U.S. average of 5.7%. Nearly one in four uninsured children in the U.S. live here in Texas.
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Economic Opportunity

Health starts where we live, learn, work, and play. But 1 in 5 Texas children experience poverty. Making sure parents can get to good paying and supportive jobs can reduce financial distress for working families.
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Data Dashboard

Data Disagregation

White, Black, and Asian are Non-Hispanic throughout the report unless otherwise specified. Breakout for Asian population data is provided when available, otherwise included in Other. Other may include Native Hawaiian and Other Pacific Islander, American Indian and Alaska Native, and two or more races, not broken out due to low numbers. Asian includes Asian Indian, Chinese, Vietnamese, Filipino, Korean, Japanese and other Asian per the U.S. Census Bureau. We’d like to acknowledge that a lack of reliably disaggregated data from all sources obscures the different experiences of each population, and that increasing data disaggregation is an important policy priority.

Food Insecurity

A child’s potential to thrive is limited if they face hunger.

Not having adequate nutrition impacts how children grow, play, and learn.Texas has one of the highest rates of child food insecurity in the nation, at nearly 22 percent, or almost 1.6 million children.[i]

Since the pandemic, the number of food-insecure children has been rising at unprecedented speed, as COVID-related unemployment has put many families in financial stress. In November 2020, 2.6 million adults in Texas (14 percent) reported their household did not have enough food to eat in the past 7 days.[ii]

A family faces food insecurity if they do not have the financial resources to ensure full and consistent access to food.[iii] For a child to face food insecurity is particularly alarming, as parents already tend to eat less or skip meals to ensure that their children have regular access to meals.[iv] Increasing rates of child hunger suggest that families are in significant distress that they cannot shield children from.

Children who face food insecurity in infancy or early childhood risk long-lasting cognitive consequences.

Consequences of Food Insecurity

The cumulative consequences of a child facing food insecurity can linger far beyond the point when that child regains access to regular meals. School-age children that walk into classrooms hungry are less prepared to learn and are more likely to have behavioral problems and emotional problems.[v] The impact of hunger on a child’s educational attainment can translate to poor longer-term outcomes, including lower future earnings.[vi]

Children who face food insecurity in infancy or early childhood risk long-lasting cognitive consequences.[vii] Young children experiencing food insecurity prove more likely to face challenges in kindergarten.[viii] Having adequate food ensures that hunger does not harm early childhood development during a critical period of growth. Even prior to a child’s birth, nutrition impacts children’s potential to flourish without obstacles, as not having adequate nutrition for pregnant mothers impacts the healthy development of the fetus.[ix] Unreliable access to proper nutrition increases the potential for individuals to experience toxic stress—the harmful stress response that can arise living through sustained poverty. Individuals facing the effects of sustained poverty can face stress-related health conditions.[x] When children are consistently exposed to adverse experiences like toxic stress, they are more likely to have developmental delays.[xi]

Programs that combat food insecurity

Federal programs help children gain consistent access to healthy food. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides financial support by funding healthy food for up to a year after childbirth. In 2019, about 681,000 Texas women, infants, and children participated in WIC.[xii] The average benefit for Texan participants in 2019 was about $26 per month in food.[xiii] In the U.S., almost one quarter of children ages 1 to 4 and close to half of all infants benefit from WIC support.[xiv] 1.5 million Texans are eligible for WIC, but only 54 percent participated in 2017.[xv],[xvi]

The Supplemental Nutrition Assistance Program (SNAP) is the leading federal anti-hunger program. Eligibility for SNAP is based on meeting a low-income requirement, and it is designed to be particularly accessible for families in temporary financial crisis.[xvii] The average SNAP benefit in Texas is $1.28 per person per meal, and SNAP reaches about 1 in 9 Texas residents.[xviii] In 2018, 28 percent of Texans children ages 0-17 were enrolled, amounting to 2 million children receiving aid.[xix]

There have been rapid and significant increases in SNAP enrollment due to the COVID-19 pandemic. In Texas, SNAP cases jumped from about 1,427,000 in February 2020 to 1,775,000 in September 2020, an increase of nearly 350,000 cases.[xx] (Cases can include more than one individual, meaning even more individuals receive SNAP benefits than that). COVID relief measures included a boost in SNAP benefits, although the poorest households already receiving the maximum benefit did not see an increase.[xxi]

Federal nutrition programs supporting school-aged children include the National School Lunch Program, the School Breakfast Program, the Afterschool Meals Program, and Summer Nutrition Programs. These programs provide school-based nutrition and also provide support through institutions that work with children, such as churches. In 2018-2019, the National School Lunch Program had on average 2.5 million Texas children participating in free or reduced lunch every day.[xxii] About 75 percent of the eligible Texas population received school lunch and breakfast in 2019, a number which shrunk to an estimated 56 percent in 2020.[xxiii] Due to school closures and subsequent loss of school-based meals, the Pandemic Electronic Benefit Transfer (P-EBT) was created to provide funding for families who were receiving free or reduced-price school lunches.[xxiv] P-EBT served over 2.8 million Texas children in four months, amounting to over $816 million in nutrition aid.[xxv]

The Child and Adult Care Food Program (CACFP) is a federal program that includes young children who are enrolled in participating child care sites, including schools, churches, and community centers.[xxvi] The support that CACFP provides for care centers helps families afford to work and place their children in child care centers. In 2020, CACFP served meals for an estimated 798,000 Texans.[xxvii]

To bridge the gap between nutritional needs and federal programs, private organizations provide support to the public through food banks and food pantries. The largest U.S. hunger-relief organization in Texas, Feeding Texas, reaches over 4 million Texans every year.[xxviii]

Who experiences food insecurity?

Data from the Census Bureau’s weekly Household Pulse Survey indicates a rising hunger crisis for children with the ongoing COVID-19 pandemic. Over June and July 2020, nearly 2 million Texans with children reported their household did not have enough to eat in the past week because they could not afford it.[xxix] Across the country, rates of food insecurity are significantly higher than they were pre-pandemic.[xxx]

Food insecurity impacts communities across the United States, yet financial stressors at the root of food insecurity disproportionately impact Black and Hispanic communities due to the cumulative impact of racial inequity and disparities in opportunities.[xxxi] Rates of food insecurity in November 2020 were still high for Texans across the board, but they were at least twice as high for Black (29 percent) and Hispanic (20 percent) adults as what white adults reported (12 percent) for households with children.[xxxii] Rising unemployment has likely been the driver behind food insecurity, considering Black and Hispanic households are more likely to have workers in low-wage jobs impacted by the pandemic, due to structural inequities in accessing education and employment opportunities.[xxxiii] Historical Black and Hispanic exclusion from wealth-building policies also means that these families have fewer assets to fall back on, compared to wealth accumulated by white families that did not face these exclusions.[xxxiv] Disinvestment in low-income communities has resulted in limited access to stores selling healthy food, contributing to the risk of the only accessible food being poor quality and unhealthy.[xxxv]

Going into the pandemic, 13% of all Texas households had low food security from 2017-2019 – reporting having reduced diet quality and variety. Black households were almost twice as likely at 25%, and Hispanic households at 17% to face this challenge, with white households being less likely at 8%. The same pattern persisted for households experiencing very low food security – eating less or skipping meals multiple times – at 5% for all Texas households but 11% for Black households.[xxxvi]

Many immigrant families are ineligible for federal relief. In general, certain legal immigrants are not eligible for SNAP, and undocumented immigrants are entirely excluded.[xxxvii] Financial support through federal stimulus payments that could have been used for food was also denied to undocumented immigrants, and entire families were denied payments if any adult family member did not have a Social Security number.[xxxviii]

In October 2018, the Department of Homeland Security announced a proposed change that meant applicants seeking green cards or immigration status changes would be penalized for using government benefits. For years, the government has denied entry or denied applications for lawful permanent residency based on the risk that a person becomes a “public charge,” but the new rules are particularly harsh towards low-income people in a way not seen previously.[xxxix] In 2018, early leaked drafts of the proposed regulation showed that the government was considering a wide list of benefits that would be penalized — health insurance programs like Medicaid and CHIP, and nutrition programs like SNAP, WIC, and free and reduced lunch.[xl]

In the confusion, a climate of fear developed within mixed-status families and communities regarding accessing assistance, with trepidation on how the policy changes impacts permanent resident status applications.[xli] At least 18 states reported up to 20 percent declines in WIC enrollment, as immigrants feared accepting assistance that their children are often legally eligible for, since most children of immigrants are U.S. citizens.[xlii] Texas WIC enrollment numbers have been steadily declining in recent years, dropping from about 886,000 Texans participating in FY 2015, to 681,000 participating in 2019.[xliii] The health impacts of reduced program participation will fall on community organizations and state and local government, as families make the difficult choice of surviving without supports due to the threat of immigration consequences.[xliv] One Houston non-profit serving immigrant clients reported a 37 percent decrease in SNAP enrollments between 2016 and 2019, and a 327 percent increase in food pantry demands.[xlv], [xlvi]  In February 2021, President Biden issued an executive order starting a process that will likely result in the 2018 Public Charge rule being reversed, with federal courts also considering whether the rules should be overturned.  Nevertheless , service providers and advocates believe years of new outreach will be needed to overcome the fears created over the last 4 years.

College students and food insecurity.

An often-overlooked population that suffers from food insecurity is college students. Over 70 percent of college students nationwide are “nontraditional,” which includes being financially independent, working full-time while in school, or taking care of dependents.[xlvii] However, most college students are not eligible for SNAP benefits.[xlviii] College students may turn to food pantries, and as of September 2018, over 650 colleges nationwide reported having a food pantry on campus, speaking to a widespread acknowledgement of the food insecurity students face.[xlix]

Recommendations
  • Reduce barriers that deter Texas families from accessing the food they need to stay healthy
  • Increase access to SNAP for low-income college students

Effectiveness of Strategies Reducing Food Insecurity

On average, SNAP kept 742,000 Texans out of poverty each year between 2013 and 2016, including 389,000 children.[l] Nationwide, about 50 percent of households receiving SNAP benefits experience continued food insecurity, suggesting the need to expand benefits further.[li] A 35 percent increase in the maximum allowable benefit would decrease the number of children in deep poverty by over 25 percent nationwide, helping families with a financial buffer to access regular and nutritious meals.[lii]

WIC participation, including having mothers enrolled in WIC, has been shown to play a part in healthier births and in babies being more likely to survive infancy, and also in higher academic achievement for students.[liii] The program has a community-level impact: stores that take WIC benefits provide a broader range of healthier foods, positively impacting low-income communities by allowing all residents to access healthy foods in their area.[liv]

One in four children experiencing food insecurity lives in a household likely excluded from federal nutrition programs, highlighting the importance of food banks and food pantries in providing nutritional support.[lv]

Financial strain due to the pandemic has led to significant increases in food pantry usage as an important source of food for Americans. However, logistical challenges make it impractical to rely on food pantries to address an unprecedented hunger crisis. Hunger-relief organizations report fewer donations from grocery stores and decreases in volunteers due to COVID-19 stay-at-home measures.[lvi] According to Brynne Keith-Jennings at the Center on Budget and Policy Priorities, “While churches and food banks are doing heroic work to address the need created by the COVID-19 pandemic, they are not equipped to address a problem of this scope and scale.”[lvii] Instead, Texas can lessen the barriers to enrollment in federal nutrition programs to make sure that no Texan has to worry about their family’s next meal.

Footnotes: Food Insecurity

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[i] Child Food Insecurity. (2020). https://www.feedingamerica.org/sites/default/files/2020-06/Map%20the%20Meal%20Gap%202020%20Child%20Food%20Insecurity%20Module.pdf.

[ii] U.S. Census Bureau (2020). Household Pulse Survey, Week 19 November 11 – November 23. https://www.census.gov/data-tools/demo/hhp/#/?measures=FIR&s_state=00048&mapPeriodSelector=19&barChartPeriodSelector=19

[iii] Parrott, S., Sherman, A., Llobrera, J., Mazzara, A., Beltrán, J., & Leachman, M. (2020, July 21). More Relief Needed to Alleviate Hardship. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/atoms/files/7-21-20pov.pdf.

[iv] Keith-Jennings, B. (2020, July 8). Boosting SNAP: Needed to Reduce Hardship, Long-Term Effects on Children. Center on Budget and Policy Priorities. https://www.cbpp.org/blog/boosting-snap-needed-to-reduce-hardship-long-term-effects-on-children.

[v] Shankar, P., Chung, R., & Frank, D. A. (2017). Association of Food Insecurity with Childrenʼs Behavioral, Emotional, and Academic Outcomes. Journal of Developmental & Behavioral Pediatrics, 38(2), 135–150. https://doi.org/10.1097/dbp.0000000000000383

[vi] Julian, T., & Kominski, R. (2011). (rep.). Education and Synthetic Work-Life Earnings Estimates, American Community Survey Reports. Retrieved from https://files.eric.ed.gov/fulltext/ED523770.pdf

[vii] Policy Basics: Special Supplemental Nutrition Program for Women, Infants, and Children. Center on Budget and Policy Priorities. (2017, April 26). https://www.cbpp.org/research/food-assistance/policy-basics-special-supplemental-nutrition-program-for-women-infants-and

[viii] Nelson, B. B., Dudovitz, R. N., Coker, T. R., Barnert, E. S., Biely, C., Li, N., . . . Chung, P. J. (2016). Predictors of Poor School Readiness in Children Without Developmental Delay at Age 2. Pediatrics, 138(2). doi:10.1542/peds.2015-4477

[ix] Carlson, S., & Neuberger, Z. (2017, March 29). WIC Works: Addressing the Nutrition and Health Needs of Low-Income Families for 40 Years. Center on Budget and Policy Priorities. https://www.cbpp.org/research/food-assistance/wic-works-addressing-the-nutrition-and-health-needs-of-low-income-families.

[x] Center on the Developing Child (2007). The Impact of Early Adversity on Child Development (InBrief). https://developingchild.harvard.edu/resources/inbrief-the-impact-of-early-adversity-on-childrens-development/. 

[xi] Administration for Children & Families. Early Childhood Adversity. Early Childhood Development. https://www.acf.hhs.gov/ecd/child-health-development/early-adversity.

[xii] U.S. Department of Agriculture. (2020, July 10). Annual State Level Data FY 2014-2019: Total Participation. WIC Data Tables. https://www.fns.usda.gov/pd/wic-program.

[xiii] U.S. Department of Agriculture. (2020, July 10). Annual State Level Data FY 2014-2019: Average Food Monthly Cost Per Person. WIC Data Tables. https://www.fns.usda.gov/pd/wic-program.

[xiv] Gray, K., Trippe, C., Tadler, C., Perry, C., Johnson, P., & Betson, D. (2019, December). National- and State-Level Estimates of WIC Eligibility and WIC Program Reach in 2017. U.S. Department of Agriculture. https://fns-prod.azureedge.net/sites/default/files/resource-files/WICEligibles2017-Volume1.pdf.

[xv] Gray, K., Trippe, C., Tadler, C., Perry, C., Johnson, P., & Betson, D. (2019, December). National- and State-Level Estimates of WIC Eligibility and WIC Program Reach in 2017. U.S. Department of Agriculture. https://fns-prod.azureedge.net/sites/default/files/resource-files/WICEligibles2017-Volume1.pdf.

[xvi] For more information on the physical, mental and economic benefits of WIC, see Carlson, S., & Neuberger, Z. (2017, March 29). WIC Works: Addressing the Nutrition and Health Needs of Low-Income Families for 40 Years. Center on Budget and Policy Priorities. https://www.cbpp.org/research/food-assistance/wic-works-addressing-the-nutrition-and-health-needs-of-low-income-families.

[xvii] Policy Basics: The Supplemental Nutrition Assistance Program (SNAP). (2019, June 25). Retrieved December 16, 2020, from https://www.cbpp.org/research/food-assistance/policy-basics-the-supplemental-nutrition-assistance-program-snap

[xviii] Nchako, C., & Cai, L. (2020, March 16). A Closer Look at Who Benefits from SNAP: State-by-State Fact Sheets: Texas. Center on Budget and Policy Priorities. https://www.cbpp.org/research/food-assistance/a-closer-look-at-who-benefits-from-snap-state-by-state-fact-sheets.

[xix] The Annie E. Casey Foundation. Supplemental Nutrition Assistance (SNAP, formerly Food Stamps) recipients (0-17). KIDS COUNT Data Center . https://datacenter.kidscount.org/data/tables/8984-supplemental-nutrition-assistance-snap-formerly-food-stamps-recipients-0-17?loc=45.

[xx] Supplemental Nutritional Assistance Program (SNAP) Statistics: Monthly SNAP Cases & Eligible Individuals Statewide: September 2005 – current. Texas Health and Human Services. https://hhs.texas.gov/about-hhs/records-statistics/data-statistics/supplemental-nutritional-assistance-program-snap-statistics.

[xxi] Parrott, S., Sherman, A., Llobrera, J., Mazzara, A., Beltrán, J., & Leachman, M. (2020, July 21). More Relief Needed to Alleviate Hardship. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/atoms/files/7-21-20pov.pdf.

[xxii] The Annie E. Casey Foundation. National School Lunch Program participation in Texas. KIDS COUNT Data Center . https://datacenter.kidscount.org/data/tables/8984-supplemental-nutrition-assistance-snap-formerly-food-stamps-recipients-0-17?loc=45.

[xxiii] Legislative Appropriations Request For Fiscal Years 2022 and 2023. Texas Department of Agriculture. (2020, October 2). https://www.texasagriculture.gov/Portals/0/Publications/FIN/2022-2023%20LAR%2087th%20REVISED%20Submission_10.07.20.pdf.

[xxiv] Hake, M., Engelhard, E., Dewey, A., & Gundersen, C. (2020, April 22). The Impact of the Coronavirus on Child Food Insecurity. Feeding America. https://www.feedingamerica.org/sites/default/files/2020-04/Brief_Impact%20of%20Covid%20on%20Child%20Food%20Insecurity%204.22.20.pdf.

[xxv] Koné Consulting. Documenting P-EBT Implementation Texas Case Study. Center on Budget and Policy Priorities . https://www.cbpp.org/sites/default/files/atoms/files/pebt_texas_case_study.pdf.

[xxvi] Cooper, R., & Lee, J. (2014, December). Food & Nutrition in Texas. Every Texan. https://everytexan.org/images/HW_2015_01_NutritionReport_web.pdf.

[xxvii] Legislative Appropriations Request For Fiscal Years 2022 and 2023. Texas Department of Agriculture. (2020, October 2). https://www.texasagriculture.gov/Portals/0/Publications/FIN/2022-2023%20LAR%2087th%20REVISED%20Submission_10.07.20.pdf.

[xxviii] Our Work. Feeding Texas. https://www.feedingtexas.org/about-us/our-work/.

[xxix] U.S. Census Bureau Household Pulse Survey June 25 – July 7, as calculated in Parrott, S., Sherman, A., Llobrera, J., Mazzara, A., Beltrán, J., & Leachman, M. (2020, July 21). More Relief Needed to Alleviate Hardship. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/atoms/files/7-21-20pov.pdf.

[xxx] Parrott, S., Sherman, A., Llobrera, J., Mazzara, A., Beltrán, J., & Leachman, M. (2020, July 21). More Relief Needed to Alleviate Hardship. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/atoms/files/7-21-20pov.pdf.

[xxxi] For more information on Texas county demographics by race and ethnicity, see Interactive Maps. Texas Demographic Center. https://demographics.texas.gov/Geography/Maps/Interactive.

[xxxii] Population Reference Bureau (2020). Analysis of the U.S. Census Bureau, Household Pulse Survey, Oct 28 – Nov 23, 2020. Adults living in households with children who sometimes or often did not have enough food to eat in the past week by race/ethnicity in Texas. https://datacenter.kidscount.org/data/tables/10945-adults-living-in-households-with-children-who-sometimes-or-often-did-not-have-enough-food-to-eat-in-the-past-week-by-race-ethnicity

[xxxiii] Parrott, S., Sherman, A., Llobrera, J., Mazzara, A., Beltrán, J., & Leachman, M. (2020, July 21). More Relief Needed to Alleviate Hardship. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/atoms/files/7-21-20pov.pdf.

[xxxiv] Lee, J., Deviney, F., & Sohn, B. L. (2017, July). State of Texas Children 2016: Race and Equity. Every Texan. https://everytexan.org/images/KC_2016_SOTCReport_web.pdf.

[xxxv] Carlson, S., & Neuberger, Z. (2017, March 29). WIC Works: Addressing the Nutrition and Health Needs of Low-Income Families for 40 Years. Center on Budget and Policy Priorities. https://www.cbpp.org/research/food-assistance/wic-works-addressing-the-nutrition-and-health-needs-of-low-income-families.

[xxxvi] FRAC analysis of 2017-2019 Current Population Survey-Food Security Supplement (CPS-FSS) data.

[xxxvii] Policy Basics: The Supplemental Nutrition Assistance Program (SNAP). (2019, June 25). Retrieved December 16, 2020, from https://www.cbpp.org/research/food-assistance/policy-basics-the-supplemental-nutrition-assistance-program-snap

[xxxviii] Parrott, S., Sherman, A., Llobrera, J., Mazzara, A., Beltrán, J., & Leachman, M. (2020, July 21). More Relief Needed to Alleviate Hardship. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/atoms/files/7-21-20pov.pdf.

[xxxix] Hernandez, N. (2020, June). Summary of Research at the Intersection of Public Charge and Health . Protect Immigrant Families. https://protectingimmigrantfamilies.org/wp-content/uploads/2020/06/Public-Charge-and-Health-Literature-Review-2020-06-16.pdf.

[xl] Fix, M., Batalova, J., & Greenberg, M. (2018, June). Chilling Effects: The Expected Public Charge Rule and Its Impact on Legal Immigrant Families’ Public Benefits Use. Migration Policy Institute. https://www.migrationpolicy.org/research/chilling-effects-expected-public-charge-rule-impact-legal-immigrant-families.

[xli] Parrott, S., Sherman, A., Llobrera, J., Mazzara, A., Beltrán, J., & Leachman, M. (2020, July 21). More Relief Needed to Alleviate Hardship. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/atoms/files/7-21-20pov.pdf.

[xlii] Bottemiller Evich, H. (2018, September 4). Immigrants, fearing Trump crackdown, drop out of nutrition programs. Politico. https://www.politico.com/story/2018/09/03/immigrants-nutrition-food-trump-crackdown-806292.

[xliii] U.S. Department of Agriculture. (2020, July 10). Annual State Level Data FY 2014-2019: Total Participation. WIC Data Tables. https://www.fns.usda.gov/pd/wic-program. 

[xliv] Hernandez, N. (2020, June). Summary of Research at the Intersection of Public Charge and Health . Protect Immigrant Families.

[xlv] Anderson, C. (2020, November). Public Charge and Private Dilemmas: Key Challenges and Best Practices for Fighting the Chilling Effect in Texas, 2017-2019. Children’s Defense Fund – Texas. https://cdftexas.org/wp-content/uploads/sites/8/2020/11/Public-Charge-and-Private-Dilemmas-TX_FINAL-020.pdf.

[xlvi] For more information on the intersection of public charge and health, see Hernandez, N. (2020, June). Summary of Research at the Intersection of Public Charge and Health. Protect Immigrant Families. https://protectingimmigrantfamilies.org/wp-content/uploads/2020/06/Public-Charge-and-Health-Literature-Review-2020-06-16.pdf.

For more information on the impact of public charge in Texas and strategies to combat the effects, see Anderson, C. (2020, November). Public Charge and Private Dilemmas: Key Challenges and Best Practices for Fighting the Chilling Effect in Texas, 2017-2019. Children’s Defense Fund – Texas. https://cdftexas.org/wp-content/uploads/sites/8/2020/11/Public-Charge-and-Private-Dilemmas-TX_FINAL-020.pdf.

[xlvii] Larin, K. (2018, December 21). Food Insecurity: Better Information Could Help Eligible College Students Access Federal Food Assistance Benefits. U.S. Government Accountability Office (U.S. GAO). https://www.gao.gov/products/GAO-19-95.

[xlviii] Policy Basics: The Supplemental Nutrition Assistance Program (SNAP). (2019, June 25). Retrieved December 16, 2020, from https://www.cbpp.org/research/food-assistance/policy-basics-the-supplemental-nutrition-assistance-program-snap

[xlix] Larin, K. (2018, December 21). Food Insecurity: Better Information Could Help Eligible College Students Access Federal Food Assistance Benefits. U.S. Government Accountability Office (U.S. GAO). https://www.gao.gov/products/GAO-19-95.

[l] Nchako, C., & Cai, L. (2020, March 16). A Closer Look at Who Benefits from SNAP: State-by-State Fact Sheets: Texas. Center on Budget and Policy Priorities. https://www.cbpp.org/research/food-assistance/a-closer-look-at-who-benefits-from-snap-state-by-state-fact-sheets.

[li] Coleman-Jensen, Alisha, Matthew P. Rabbitt, Christian A. Gregory, and Anita Singh. 2019. Household Food Security in the United States in 2018, ERR-270, U.S. Department of Agriculture, Economic Research Service, as cited in Trisi, D., & Saenz, M. (2020, February 27). Deep Poverty Among Children Rose in TANF’s First Decade, Then Fell as Other Programs Strengthened. Center on Budget and Policy Priorities. https://www.cbpp.org/research/poverty-and-inequality/deep-poverty-among-children-rose-in-tanfs-first-decade-then-fell-as.

[lii] National Academies of Sciences, Engineering, and Medicine 2019. A Roadmap to Reducing Child Poverty. Washington, DC: The National Academies Press. https://doi.org/10.17226/25246 as cited in Trisi, D., & Saenz, M. (2020, February 27). Deep Poverty Among Children Rose in TANF’s First Decade, Then Fell as Other Programs Strengthened. Center on Budget and Policy Priorities. https://www.cbpp.org/research/poverty-and-inequality/deep-poverty-among-children-rose-in-tanfs-first-decade-then-fell-as. 

[liii] Policy Basics: Special Supplemental Nutrition Program for Women, Infants, and Children. Center on Budget and Policy Priorities. (2017, April 26). https://www.cbpp.org/research/food-assistance/policy-basics-special-supplemental-nutrition-program-for-women-infants-and

Carlson, S., & Neuberger, Z. (2017, March 29). WIC Works: Addressing the Nutrition and Health Needs of Low-Income Families for 40 Years. Center on Budget and Policy Priorities. https://www.cbpp.org/research/food-assistance/wic-works-addressing-the-nutrition-and-health-needs-of-low-income-families.

[liv] Carlson, S., & Neuberger, Z. (2017, March 29). WIC Works: Addressing the Nutrition and Health Needs of Low-Income Families for 40 Years. Center on Budget and Policy Priorities. https://www.cbpp.org/research/food-assistance/wic-works-addressing-the-nutrition-and-health-needs-of-low-income-families.

[lv] Coleman-Jensen, Alisha, Matthew P. Rabbitt, Christian A. Gregory, and Anita Singh. 2019. Household Food Security in the United States in 2018, ERR-270, U.S. Department of Agriculture, Economic Research Service.

[lvi] Fernández , S. (2020, April 8). Food banks rely on donations from grocery stores. But as Texans rush stores, grocers have less to give. The Texas Tribune. https://www.texastribune.org/2020/04/08/texas-food-banks-low-supplies-volunteers-during-coronavirus-pandemic/?utm_source=Editorial%3A+Texas+Tribune+Master.

[lvii] Keith-Jennings, B. (2020, July 31). New Videos: Amid Economic Crisis, Boosting SNAP Will Make Big Difference. Center on Budget and Policy Priorities. https://www.cbpp.org/blog/new-videos-amid-economic-crisis-boosting-snap-will-make-big-difference.

 

Health Insurance

a mom and child at the doctors office

Children's Health

Supporting children’s health gives them the best chance of succeeding in school and later in life. Providing health care coverage is one way of providing wide-ranging and long-lasting impacts on health, educational, and financial outcomes for both children and their families. Yet, after years of improvement, the number of uninsured Texans has worsened for the third year in a row, reaching 5.2 million in 2019, meaning 18 percent of Texans of all ages were uninsured. This is the worst Texas rate since 2014 and is twice the nationwide uninsured rate for 2019. Children (under age 19) are far less likely than adults to be uninsured because they have access to Medicaid and CHIP, yet Texas still has the worst child uninsured rate in the U.S. at 12.7%–more than twice the U.S. average of 5.7%.  Nearly one in four uninsured children in the U.S. live here in Texas.[i] By protecting all children’s right to have affordable and accessible health care coverage, we invest in the success of future generations and set up more equitable conditions to see children thrive.

State and Federal Policies Contributing to Decline in Texas Children’s Coverage

Enrollment options for children not covered by private health insurance plans include Medicaid and the Children’s Health Insurance Program (CHIP), both of which are the largest government-sponsored programs available.[ii] Families at higher incomes can also receive subsidies to purchase health insurance on the Affordable Care Act (ACA) marketplace. Children’s Medicaid provides health care coverage for children in low-income families, while CHIP bridges the gap for children in families who earn more than Medicaid allows, but less than twice the federal poverty income. Medicaid and CHIP provide health insurance coverage for 77 percent of Texas children living in or near poverty.[iii], [iv] After 10 years of enrollment growth, there has been an alarming decrease of 237,000 Texas children enrolled in Medicaid and CHIP, representing a 7 percent decline between the end of 2017 and February 2020.[v] While states may be tempted to cut spending on programs like Medicaid to meet short-term budget needs, the long-term impact of Medicaid has proven to more than justify the return on investment, and is associated with improved health, lower rates of disability, higher educational attainment, and greater long-term financial security for children.[vi]

Recommendation
  • Protect funding for health and human services during the pandemic and recovery

On the federal level, a number of decisions may have contributed to lower public and private enrollment rates in recent years. These include less funding for enrollment outreach, the repeal of the individual penalty for not being insured, and immigration policies that have created reluctance in immigrant communities regarding enrollment (see below).[vii] Also, in 2017, the federal government cut the ACA Marketplace enrollment period from 3 months to just 45 days, forcing Americans to get enrolled in a much quicker time frame if they need to enroll through the HealthCare.gov portal.[viii],[ix]

In recent years, the public charge rule and other immigration policy changes, which proposed tying lawful immigration to immigrants’ use of public benefits, had a chilling effect on families’ decisions seek or keep healthcare coverage. 89 percent of Texas children in immigrant families are U.S. citizens, but families may choose not to participate in programs that would benefit their citizen children, out of fear of deportation or negative immigration consequences for non-citizen family members.[x]

Organizations around Texas report the chilling effect of public charge as the driver for low enrollment among immigrant families in recent years in Children’s Medicaid and CHIP, and even  lower numbers of routine doctor’s visits and vaccinations. One Austin-based organization reported that their clients had no choice but to keep health insurance enrollment for their children with disabilities, but many dropped nutrition benefits like SNAP, mistakenly hoping this reduction in public benefit use would help their immigration status.[xi] 

Recommendations

Strengthen private health insurance by:

  • lowering premiums through a reinsurance option
  • improving subpar plans that have limited benefits and protections, or high costs

On a statewide level, Texas is one of only 12 states that have not accepted federal funds from the ACA to cover uninsured adults. Texas studies estimate the state at least $5 billion dollars a year from not accepting federal funding under Medicaid expansion.[xii] States that chose not to expand Medicaid in recent years saw uninsured rates for young children grow almost three times as fast as states that did expand Medicaid.[xiii] Children in states that have expanded Medicaid are more likely to be insured, because parents often get coverage for their children as they gain health care coverage themselves.[xiv], [xv]  Young adult Texans specifically (ages 19 to 24) could benefit greatly from Medicaid expansion: while more than one third are uninsured today, that could improve to only one in five uninsured post-expansion.[xvi]

Agencies can mitigate the barriers that may prevent Texans from enrolling. These include facilitating enrollment for those enrolling remotely without internet access or smart phones. Additionally, state agencies can ensure information and outreach addresses the concerns of mixed-immigrant status families.[xvii]

Recommendations
  • Accept the federal funding available for Medicaid expansion

  • Fund state-sponsored enrollment assistance and outreach

  • Remove barriers to enrollment, including addressing mixed-status families and enrollment in women’s health programs

Benefits of Health Insurance Coverage are Wide-Ranging

Poor childhood health impacts children’s ability to learn, and children who have health insurance tend to have improved educational and economic outcomes.[xviii] Health insurance is critical in the first years of life, as children experience rapid brain development and growth.[xix] In this period, frequent check-ups help ensure that children get care for any health conditions or developmental issues that may impact their success in school, before those issues become more difficult to address.[xx] With early childhood check-ups, health care providers can also identify parental depression or family stressors that can harm a child’s development.[xxi], For more information on child health outcomes in Texas, check out Texas Child Health Status Report and the National Survey of Children’s Health.[xxii]

health care

To confirm Medicaid eligibility, Texas conducts income checks multiple times a year rather than simply yearly. Under this policy, parents must respond to income checks within 10 days with documentation to confirm a child’s eligibility for Medicaid, or they lose coverage. Thousands of eligible children lose Medicaid coverage every month under this policy, forcing children to miss appointments or pay for appointments out-of-pocket until they can confirm eligibility.[xxiii]

For children who face disruptions to continuous coverage, the lapses in coverage can be particularly detrimental in the first years of life, as health experts recommend 16 visits before age 6 to detect and address problems quickly.[xxiv] Health insurance helps make these frequent and important visits affordable for parents. Uninsured children are overall less likely to get preventive care and are more likely to experience delays in care or receive no care at all.[xxv] One in five Texas children have special health care needs.[xxvi] Facing any lapse in coverage can have significant negative impacts on children with chronic conditions who need regular and frequent visits with providers.[xxvii]

Recommendation 
  • Provide 12 months of continuous eligibility for children on Medicaid to prevent gaps from cycling off coverage due to income changes

Positive health outcomes for children with Medicaid coverage extend beyond just the childhood years. Childhood Medicaid coverage impacts adolescent health outcomes, including reduced reports of mental health problems or eating disorders, lower BMI, lower likelihood of unsafe sexual practices, and reduced drug and alcohol use.[xxviii] There are also positive outcomes in adulthood, including reduced risk of experiencing high blood pressure, heart attacks, adult-onset diabetes, and obesity.[xxix]

Children benefit when parents have expanded access to health care, and health care needs to be available for women before, during, and after pregnancy. Maternal health insurance plays a large role in children’s health, as health insurance for pregnant mothers has positive impacts on children’s wellbeing well into adulthood, such as reduced obesity rates and fewer hospitalizations.[xxx]  However, becoming pregnant does not trigger a special enrollment period for the ACA, so women without coverage who become pregnant risk not benefitting from prenatal care that aids a child’s development.

When uninsured parents are unable to get their own healthcare needs met, it has a harmful impact on the wellbeing of their children, whose development and nurturing bonds with their parents are vulnerable to the effects of untreated parental health issues. Parents burdened with untreated needs may also be unable to get their children the care that they need.[xxxi] One recent study estimated a societal cost of $14.2 billion from the repercussions of untreated mood and anxiety disorders in U.S. mothers before and after childbirth, up to age 5 of the child.[xxxii]

Health insurance also positively impacts financial security for families. Families might face significant burdens budgeting for doctor’s visits, medications, and treatments without support, and may need to take on debt to pay for health needs. Families with the support of Children’s Medicaid are able to spend more on food and housing, and they often see decreases in medical debt.[xxxiii], [xxxiv] Medicaid in general is one of the largest anti-poverty programs nationwide, keeping up to 3.4 million Americans out of poverty in 2010.[xxxv]

Families who avoid poverty with the aid of public benefits also spare their children from potentially years-long health impacts of toxic stress.[xxxvi] On top of the individual benefits, there is a society-wide financial gain from expansions to Medicaid and CHIP, as expansions are associated with children becoming adults with higher earnings that pay more in taxes.[xxxvii]

 

Recommendations

  • Extend comprehensive Medicaid health insurance for new mothers from the current two months of coverage after childbirth to a full year after delivery

Reduce medical debt by:

  • providing additional charity and hospital assistance
  • ending surprise ambulance bills

Disparities in Health Insurance Coverage

Racial discrimination plays a role in health outcomes as it relates to the likelihood of having health care coverage and the impacts of racism itself on the body. Many children of color live in neighborhoods that are more polluted, have fewer resources, and face over-policing, threat of deportation, and outright discrimination.[xxxviii] The negative health impacts of discrimination make it all the more necessary to ensure equitable health insurance coverage rates across groups.[xxxix] Yet Hispanic children continue to experience a high uninsured rate, and Texas holds the largest share of the nation’s uninsured Hispanic children, at 36 percent of the national total.[xl] Hispanic children in Texas are almost twice as likely to be uninsured as non-Hispanic children.[xli]

Causes of low health insurance rates for Hispanic children are linked to socioeconomic and immigration status. Enduring inequities in accessing education and employment opportunities mean that both Texans of color and immigrants are more likely to work in low-wage positions considered “essential.”[xlii] Despite being labeled as essential, these roles largely do not offer employer-sponsored insurance.[xliii] Successfully enrolling Hispanic populations in health insurance requires targeted Medicaid and CHIP outreach, conducted in individuals’ primary languages and by trusted community members, especially for immigrant families.[xliv] Nationally, 17 percent of low- to middle-income Hispanic families reported not being aware that they could apply to public resources like Medicaid, according to one 2015 study, and even immigrants with legal permanent status believed that immigration status disqualified them for public aid.[xlv] Furthermore, fears of deportation may minimize the involvement that undocumented individuals and their families feel comfortable having with the government, limiting program enrollment unless effective outreach is done.[xlvi]

Impact of COVID-19 Pandemic

Pandemic job losses have hit Texans hard. Over 4.2 million Texans filed for unemployment relief from mid-March 2020 through mid-January 2021.[xlvii] The onset of the COVID-19 pandemic only worsened racial and ethnic inequities and brought new challenges to the forefront. [xlviii]  As Schmit et al. (2020) writes, the “second wave” of the pandemic centered around the steep economic costs that heavily impacted Black, Indigenous and people of color communities.[xlix] The sectors most impacted by COVID-related unemployment — restaurant, service, and retail industries — also were the sources of income for many low-income Hispanic families.[l] With job losses also came the risk of losing employer-provided health insurance for those who had it, or losing the means to pay for health care needs. For those who kept their jobs, workers in these sectors also face increased risk of COVID-19 exposure at the workplace. They are often unable to get paid time off to manage illness for themselves or their family and may be less able to pay for health expenses.[li] Estimates from Texas demographer Rogelio Saenz show that of “person-years” lost due to early death from COVID-19 (the difference between a person’s age at death and their life expectancy), 60% of the loss came from Hispanic families, although they make up only 40% of the state’s population.[lii]

COVID-19 has had a significant impact on mental health, with 47 percent of Texans reporting symptoms of anxiety or depressive disorders in November 2020.[liii] 27 percent of Texans reporting these symptoms also report an unmet need for counseling or therapy.[liv] Children may need additional mental health support in the face of changes to their environment.[lv]

For those who lost employer-sponsored health insurance due to COVID-19, they became eligible for a special enrollment period in a Marketplace plan for the 60 days following job loss, or in anticipation of a job loss, helping individuals avoid gaps in coverage. For those who became unemployed in jobs that did not provide health insurance, no such special enrollment period in the federal marketplace was allowed by the Trump administration. In most states, people may have become eligible for Medicaid due to drop in income, but in Texas and 11 other states without adult coverage through ACA Medicaid Expansion, adults with incomes below the poverty line were often left with no Medicaid and no ACA subsidy eligibility.[lvi]

+1.6 Million

The number of Texans and their family members estimated to have lost employer-based health insurance from March to May 2020.

Nationwide, of the 26.8 million people that lost employer-sponsored insurance between March 1- May 2, 2020, over 6 million children became uninsured.[lvii] However, about 89 percent of these children became eligible for Medicaid or CHIP, suggesting that — unlike adults in Texas — the large majority of newly uninsured children could retain coverage.[lviii] However, in a national survey from Kaiser Family Foundation, many people reported that they did not know how marketplace or Medicaid enrollment works, nor did they know the procedures to get enrolled.[lix] To complicate matters, in the past 3 years, the federal government cut funding for federal navigators that aid consumers with outreach and enrollment. In Texas, this was a percentage change cut of 79 percent that left much of the state without in-person help.[lx]

Considering the extent and longevity of the COVID-19 pandemic, ensuring health coverage availability is crucial to protect the health and wellbeing of children, and Texas should make sure enrollment efforts are actively underway to ensure no loss of coverage.[lxi]

Source: Kaiser Family Foundation, 2020

Footnotes: Health Insurance

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[i] Dunkelberg, A. (2020, September 15). New Census Data Show Texas Needs to Expand Health Coverage. Every Texan. https://everytexan.org/2020/09/15/new-census-data-show-texas-needs-to-expand-health-coverage/.

[ii] Murphey, D. (2017, May 12). Health Insurance Coverage Improves Child Well-Being. Child Trends. https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well.

[iii] Snapshot: Covering Texas’ Children. Georgetown University Center for Children and Families . (2018, June 20). https://ccf.georgetown.edu/2018/06/20/state-medicaid-and-chip-snapshots/.

[iv] For more information on Texas children health insurance coverage, see Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health (2016 – present). Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). https://www.childhealthdata.org/browse/survey?s=2&y=32&r=45

[v] Medicaid and CHIP Monthly Enrollment by Risk Group (September 2014 – July 2020), “ Every Texan Analysis of Texas Health and Human Services, email message from Melissa McChesney to Cheasty Anderson, October 7, 2020

[vi] Park, E., Alker, J. & Corcoran, A. (2020), Jeopardizing a Sound Investment: Why Short-Term Cuts to Medicaid Coverage During Pregnancy and Childhood Could Result in Long-Term Harm (Commonwealth Fund, Dec. 2020). https://doi.org/10.26099/qe16-9f97

[vii] Brooks, T., Park, E., & Roygardner, L. (2019). Medicaid and CHIP enrollment decline suggest the child uninsured rate may rise again. Washington, DC: Center for Children and Families, Health Policy Institute, Georgetown University. https://ccf.georgetown.edu/wp-content/uploads/2019/05/Medicaid-and-CHIPEnrollment-Decline_Report.pdf

[viii] Gaba, C., & Gee, E. (2020, April 16). How Trump’s Policies Have Hurt ACA Marketplace Enrollment. Center for American Progress. https://www.americanprogress.org/issues/healthcare/news/2020/04/16/483362/trumps-policies-hurt-aca-marketplace-enrollment/.

[ix] For more information on federal level actions that impacts ACA marketplace enrollment, see https://www.americanprogress.org/issues/healthcare/news/2020/04/16/483362/trumps-policies-hurt-aca-marketplace-enrollment/#:~:text=Nationwide%20marketplace%20enrollment%20has%20fallen,(%2D0.3%20percent)%20for%202020.

[x] The Annie E. Casey Foundation. Children in immigrant families who are U.S. citizens in Texas. KIDS COUNT Data Center . https://datacenter.kidscount.org/data/tables/5921-children-in-immigrant-families-who-are-us-citizens?loc=45&loct=2#detailed/2/45/false/37,871,870,573,869,36,868,867,133,38/any/12547,12548

[xi] Anderson, C. (2020, November). Public Charge and Private Dilemmas: Key Challenges and Best Practices for Fighting the Chilling Effect in Texas, 2017-2019. Children’s Defense Fund – Texas. https://cdftexas.org/wp-content/uploads/sites/8/2020/11/Public-Charge-and-Private-Dilemmas-TX_FINAL-020.pdf.

[xii] The Perryman Group. (2020, December). It Just Makes Sense: Economic and fiscal benefits to Texas of accessing federal funds for health insurance expansion https://www.episcopalhealth.org/research-report/economic-and-fiscal-benefits-to-texas-of-accessing-additional-federal-funds-for-health-insurance-expansion-december-2020/

[xiii] Wright Burak, E., Clark, M., & Roygardner, L. (2019, December). Nation’s Youngest Children Lose Health Coverage at an Alarming Rate. Georgetown University Health Policy Institute Center For Children and Families. https://ccf.georgetown.edu/2019/12/09/nations-youngest-children-lose-health-coverage-at-an-alarming-rate/.

[xiv] Dubay, L., & Kenney, G. (2003). Expanding Public Health Insurance to Parents: Effects on Children’s Coverage under Medicaid. Health Services Research, 38(5), 1283–1302. https://doi.org/10.1111/1475-6773.00177

[xv] For a summary of the economic benefits to Medicaid expansion in Texas, see https://covertexasnow.org/posts/2020/8/10/texas-should-be-the-next-red-state-to-expand-medicaid#:~:text=Here’s%20what%20you%20need%20to,Texas%20adults%20by%20January%202021.&text=Before%20the%20pandemic%20increased%20the,would%20cover%201.5%20million%20Texans.

[xvi] Buettgens, M. (2021). Medicaid expansion would have a larger impact than every during the COVID-19 pandemic. Urban Institute Analysis using the Health Insurance Policy Simulation Model for 2020.  https://www.urban.org/research/publication/medicaid-expansion-would-have-larger-impact-ever-during-covid-19-pandemic

[xvii] For detailed information on how Texas can protect enrollment in women’s health programs, see Pogue, S. (2020, September 8). Testimony: Removing barriers to enrollment in Health Texas Women. Every Texan. https://everytexan.org/2020/09/08/testimony-removing-barriers-to-enrollment-in-health-texas-women/.

For more information on proposed benefits staffing cuts and how Texas can increase efficiencies in benefit applications, see McChesney, M. (2020, December 3). Texas Must Improve Medicaid Renewal to Protect Care for Children and New Mothers. Every Texan. https://everytexan.org/2020/12/03/texas-must-improve-medicaid-renewal-to-protect-care-for-children-and-new-mothers/.

[xviii] For more information on the improved economic, health, and educational outcomes of health insurance, see Murphey, D. (2017, May 12). Health Insurance Coverage Improves Child Well-Being. Child Trends. https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well.

[xix] Wright Burak, E. (2018, October 17). Promoting Young Children’s Healthy Development in Medicaid and CHIP. Georgetown University Health Policy Institute Center For Children and Families. https://ccf.georgetown.edu/2018/10/17/promoting-young-childrens-healthy-development-in-medicaid-and-the-childrens-health-insurance-program-chip/.

[xx] Wright Burak, E. (2018, October 17). Promoting Young Children’s Healthy Development in Medicaid and CHIP. Georgetown University Health Policy Institute Center For Children and Families. https://ccf.georgetown.edu/2018/10/17/promoting-young-childrens-healthy-development-in-medicaid-and-the-childrens-health-insurance-program-chip/.

[xxi] L. Murray and P. Cooper, “Effects of postnatal depression on infant development,” Disease in Childhood 77, no. 2 (1997): 99-101 as cited in Wright Burak, E., Clark, M., & Roygardner, L. (2019, December). Nation’s Youngest Children Lose Health Coverage at an Alarming Rate. Georgetown University Health Policy Institute Center For Children and Families. https://ccf.georgetown.edu/2019/12/09/nations-youngest-children-lose-health-coverage-at-an-alarming-rate/.

[xxii] For more information on Texas children’s health measures, see:

Michael & Susan Dell Center for Healthy Living. Texas Child Health Status Report. https://sph.uth.edu/research/centers/dell/texas-child-health-status-report/index.htm
&

Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health (2016 – present). Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). https://www.childhealthdata.org/browse/survey?s=2&y=32&r=45

[xxiii] Novack, S. (2020, January 22). In Texas, Thousands of Kids Lose Medicaid Coverage Each Month. The Texas Observer. https://www.texasobserver.org/in-texas-thousands-of-kids-lose-medicaid-coverage-each-month/.

[xxiv] American Academy of Pediatrics and Bright Futures, “Recommendations for Preventative Pediatric Health” (Elk Grove, IL: American Academy of Pediatrics, February 2017) as cited in Wright Burak, E. (2018, October 17). Promoting Young Children’s Healthy Development in Medicaid and CHIP. Georgetown University Health Policy Institute Center For Children and Families. https://ccf.georgetown.edu/2018/10/17/promoting-young-childrens-healthy-development-in-medicaid-and-the-childrens-health-insurance-program-chip/.

[xxv] Hadley, J. (2002). Sicker and Poorer: The Consequences of Being Uninsured. Prepared for the Kaiser Commission on Medicaid and the Uninsured. https://www.kff.org/uninsured/report/sicker-and-poorer-the-consequences-of-being/#:~:text=The%20major%20findings%20from%20the,by%2010%2015%20percent%3B%20and

[xxvi] For more information on Texas children’s health needs, see the data dashboard The State of Children’s Health in Texas. Children’s Hospital Association. https://datainsights.childrenshospitals.org/views/PublicPolicyLegislativeInsightDashboard/StateStory?%3Aorigin=card_share_link.

[xxvii] Halterman, J. S., Montes, G., Shone, L. P., & Szilagyi, P. G. (2008). The impact of health insurance gaps on access to care among children with asthma in the United States. Ambulatory Pediatrics, 8(1), 43-49.

[xxviii] Cohodes, S., Grossman, D., Kleiner, S., & Lovenheim, M. F. (2014, October). The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions. Retrieved December 17, 2020, from https://www.nber.org/papers/w20178, as cited in Murphey, D. (2017, May 12). Health Insurance Coverage Improves Child Well-Being. Child Trends. https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well.

[xxix] Murphey, D. (2017, May 12). Health Insurance Coverage Improves Child Well-Being. Child Trends. https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well.

[xxx] Miller, S., & Wherry, L. R. (2019). The long-term effects of early life Medicaid coverage. Journal of Human Resources, 54(3), 785-824.

[xxxi] Murphey, D. (2017, May 12). Health Insurance Coverage Improves Child Well-Being. Child Trends. https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well.

[xxxii] Luca, D. L., Garlow, N., & Staatz, C. (2019, April 29). Societal Costs of Untreated Perinatal Mood and Anxiety Disorders in the United States. Mathematica. https://www.mathematica.org/our-publications-and-findings/publications/societal-costs-of-untreated-perinatal-mood-and-anxiety-disorders-in-the-united-states.

[xxxiii] Boudreaux, M. H., Golberstein, E., & McAlpine, D. D. (2016). The long-term impacts of Medicaid exposure in early childhood: Evidence from the program’s origin. Journal of health economics, 45, 161-17, as cited in Murphey, D. (2017, May 12). Health Insurance Coverage Improves Child Well-Being. Child Trends. https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well.

[xxxiv] For more information on medical debt in households in Texas, see Lewis, J., & Sikes, C. (2019, September). The Mountain of Medical Debt in Texas. Every Texan. https://everytexan.org/wp-content/uploads/2020/03/EO_2019_08_MedicalDebt-1.pdf.

[xxxv] Sommers, B. D. & Oellerich, D. (2013). The poverty-reducing effect of Medicaid. Journal of Health Economics, 32(5), 816-832, as cited in Wagnerman, K., Chester, A., & Alker, J. (2017). Medicaid is a smart investment in children. Georgetown University Health Policy Institute.https://ccf.georgetown.edu/wp-content/uploads/2017/03/MedicaidSmartInvestment.pdf

[xxxvi] Center on the Developing Child (2007). The Impact of Early Adversity on Child Development (InBrief). https://developingchild.harvard.edu/resources/inbrief-the-impact-of-early-adversity-on-childrens-development/. 

[xxxvii] Brown, D. W., Kowalski, A. E., & Lurie, I. Z. (2015). Medicaid as an investment in children: what is the long-term impact on tax receipts? (No. w20835). National Bureau of Economic Research, as cited in Murphey, D. (2017, May 12). Health Insurance Coverage Improves Child Well-Being. Child Trends. https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well.

[xxxviii] For more information on the impact of racial inequities on children, see Schmit, S., Ullrich, R., & Gallagher Robbins, K. (2020, September 3). A Pandemic within a Pandemic: How Coronavirus and Systemic Racism Are Harming Infants and Toddlers of Color. CLASP. https://www.clasp.org/publications/report/brief/pandemic-within-pandemic-how-coronavirus-and-systemic-racism-are-harming.

[xxxix] For more information on Texas health outcomes, needs, and infrastructure by county, particularly around primary care, see Primary Care in Texas. Texas Primary Care Consortium. https://www.txprimarycareconsortium.org/primary-care-in-texas.

[xl] Whitener, K., Lopez, S., Snider, M., & Roygardner, L. (2020, March). Decade of Success for Latino Children’s Health Now in Jeopardy. Georgetown University Health Policy Institute’s Center For Children and Families, Unidos US. https://ccf.georgetown.edu/2020/03/10/decade-of-success-for-latino-childrens-health-now-in-jeopardy/.

[xli] Whitener, K., Lopez, S., Snider, M., & Roygardner, L. (2020, March). Decade of Success for Latino Children’s Health Now in Jeopardy. Georgetown University Health Policy Institute’s Center For Children and Families, Unidos US. https://ccf.georgetown.edu/2020/03/10/decade-of-success-for-latino-childrens-health-now-in-jeopardy/.

[xlii] For more information on the composition of Texas’ essential worker labor force, see Ibarra, M. (2020, April 21). Essential Workers Deserve More Than Praise. Every Texan. https://everytexan.org/2020/04/21/essential-workers-deserve-more-than-praise/.

[xliii] Elise Gould and Jessica Schieder. (2017). Work Sick or Lose Pay? The High Cost of Being Sick When You Don’t Get Paid Sick Days, Economic Policy Institute, https://www.epi.org/publication/work-sick-or-lose-pay-thehigh-cost-of-being-sick-when-you-dont-get-paid-sick-days/;

[xliv] Artiga, S., Rudowitz, R., & Tolbert, J. (2016, March 2). Outreach and Enrollment Strategies for Reaching the Medicaid Eligible but Uninsured Population. KFF. https://www.kff.org/medicaid/issue-brief/outreach-and-enrollment-strategies-for-reaching-the-medicaid-eligible-but-uninsured-population/.

[xlv] Alvira-Hammond, M., & Gennetian, L. A. (2015, December 7). How Hispanic Parents Perceive Their Need and Eligibility for Public Assistance. National Research Center on Hispanic Children & Families. https://www.hispanicresearchcenter.org/research-resources/how-hispanic-parents-perceive-their-need-and-eligibility-for-public-assistance/.

[xlvi] Kennedy, K. (2018, January 21). Deportation fears have legal immigrants avoiding health care. AP News. https://apnews.com/article/9f893855e49143baad9c96816ec8f731.

[xlvii] Texas Workforce Commission. (2021). Unemployment Claims by Numbers. https://www.twc.texas.gov/news/unemployment-claims-numbers#claimsByCounty

[xlviii] Novak, A., & Ferman, M. (2020, December 17). Texas unemployment rate: How coronavirus is hitting the economy. The Texas Tribune. https://apps.texastribune.org/features/2020/texas-unemployment/?_ga=2.195451500.1190019518.1600022011-1386683482.1502712517.

[xlix] Schmit, S., Ullrich, R., & Gallagher Robbins, K. (2020, September 3). A Pandemic within a Pandemic: How Coronavirus and Systemic Racism Are Harming Infants and Toddlers of Color. CLASP. https://www.clasp.org/publications/report/brief/pandemic-within-pandemic-how-coronavirus-and-systemic-racism-are-harming

[l] DeSilver, D. (2020, March 16). No U.S. industry employs mostly immigrant workers. Pew Research Center. https://www.pewresearch.org/fact-tank/2017/03/16/immigrants-dont-make-up-a-majority-of-workers-in-any-u-s-industry/.

[li] Goldman, T. L., Gupta, P., & Hernandez, E. (2018, May 29). The Struggles of Low-Wage Work. CLASP. https://www.clasp.org/publications/fact-sheet/struggles-low-wage-work.

[lii] Kuchment, A. et al. (2020). COVID’s ‘untold story’: Texas Blacks and Latinos are dying in the prime of their lives. The Dallas Morning News, December 19, 2020. https://www.dallasnews.com/news/2020/12/19/covids-untold-story-texas-blacks-and-latinos-are-dying-in-the-prime-of-their-lives/

[liii] U.S. Census Bureau, Household Pulse Survey, Week of 11/11/2020 – 11/23/2020, as cited in Adults Reporting Symptoms of Anxiety or Depressive Disorder During COVID-19 Pandemic. KFF. https://www.kff.org/other/state-indicator/adults-reporting-symptoms-of-anxiety-or-depressive-disorder-during-covid-19-pandemic/?currentTimeframe=0.

[liv] U.S. Census Bureau, Household Pulse Survey, Week of 10/28/2020 – 11/09/2020, as cited in Unmet Need for Counseling or Therapy Among Adults Reporting Symptoms of Anxiety and/or Depressive Disorder During the COVID-19 Pandemic. KFF. https://www.kff.org/other/state-indicator/unmet-need-for-counseling-or-therapy-among-adults-reporting-symptoms-of-anxiety-and-or-depressive-disorder-during-the-covid-19-pandemic/?currentTimeframe=0&selectedRows=%7B%22states%22:%7B%22texas%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

[lv] For more information on the impacts of COVID on child mental health, see Bartlett, J. D., Griffin, J., & Thomson, D. (2020, March 19). Resources for Supporting Children’s Emotional Well-being during the COVID-19 Pandemic. Child Trends, Child Trauma Training Center at the University of Massachusetts. https://www.childtrends.org/publications/resources-for-supporting-childrens-emotional-well-being-during-the-covid-19-pandemic.

[lvi] Marketplace coverage & Coronavirus. (2020). HealthCare.gov. Retrieved December 2020. https://www.healthcare.gov/coronavirus/

[lvii] Claxton, G., Levitt, L., Garfield, R., & Damico, A. (2020, May 13). Eligibility for ACA Health Coverage Following Job Loss. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/.

[lviii] Claxton, G., Levitt, L., Garfield, R., & Damico, A. (2020, May 13). Eligibility for ACA Health Coverage Following Job Loss. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/.

[lix] Pollitz, K., Tolbert, J., Hamel, L., & Kearney, A. (2020, August 7). Consumer Assistance in Health Insurance: Evidence of Impact and Unmet Need – Issue Brief. KFF. https://www.kff.org/report-section/consumer-assistance-in-health-insurance-evidence-of-impact-and-unmet-need-issue-brief/.

[lx] Pollitz, K., & Tolbert, J. (2020, October 13). Data Note: Limited Navigator Funding for Federal Marketplace States. KFF. https://www.kff.org/health-reform/issue-brief/data-note-further-reductions-in-navigator-funding-for-federal-marketplace-states/.

[lxi] Several Texas organizations, including Every Texan, have launched a new #SickOfItTX campaign to ensure that health coverage for all is a top priority issue for state legislators in 2021. For more information, see https://sickofittx.com/.

Economic Opportunity

Economic Opportunity

Health starts where we live, learn, work, and play. The conditions of our schools, workplaces, parks, and even the air and water around us can help or hurt us as we strive to live healthy and fulfilling lives. Every Texan should have the opportunity to enjoy healthy environments, regardless of their income, their education, or their racial or ethnic background, yet not all of us live in an environment that enables us to reach our full potential. By supporting smart policies that improve schools, jobs, and economic opportunity overall, we can ensure that our outcomes are not limited by the condition of the environments we live in.

Improving Access to Work and Child Care

Supporting families’ economic stability reduces the risk that children face the negative and long-lasting consequences of poverty on health. When children experience severe or sustained hardship, the body’s stress response is activated, which is especially harmful for growing children.[i] One in five Texas children experience poverty, but making sure parents can get to good paying and supportive jobs can reduce financial distress for working families.[ii]A

Access to reliable transportation can be a barrier or an aid to maintaining a stable job. Some groups, like Hispanic and immigrant residents, are more likely to live far from their jobs and use transit to commute.[iii] Presently, 15 states and Washington, D.C. allow immigrants without documentation to obtain a driver’s license — but Texas does not.[iv] The benefits of allowing all individuals the chance to get a driver’s license are more than simply helping Texans get to work. Public safety increases for the entire community as individuals gain access to licenses, with safer roads and fewer hit-and-runs.[v]

Recommendation

  • Expand access to driver’s license permits to include immigrants that lack the documentation for a Texas Driver’s License

Having access to transit and a stable job are not the only factors impacting financial stability. COVID-19 has only made it harder for families to get by. School and child care center closures have made it more challenging for parents to stay in the workforce. Parents may need to drop out of the labor force to provide care during the day if there are no other options, or if the options left are unaffordable. When schools and child care centers shut down in response to COVID-19, it was mostly mothers who quit their jobs to take on full-time child care.[vi] We are now seeing a “shecession,” as women are most affected by job losses in the service sector and by a lack of child care options.[vii] Many Texas women live and work in child care deserts, meaning options for child care that would allow parents to work were limited even prior to the pandemic.[viii] Living in a child care desert is associated with lower rates of mothers being in the labor force.[ix] In Texas, nearly sixty percent of children have all available parents in the labor force, so these closures can have a large toll on the families who were counting on having access to child care.[x], [xi]

Providing Livable Wages and Benefits

The employment benefits we offer to parents directly impact their children’s opportunities to stay healthy. Paid family and medical leave gives parents the opportunity to spend time with newborn children, to care for themselves, or to care for sick or aging loved ones. Paid leave allows families the flexibility not to have to choose between earning money and caring for loved ones, but in Texas, 62 percent of workers do not have access to even unpaid family and medical leave under the federal Family and Medical Leave Act.[xii] Without these benefits, Texan workers who need time off to care for children and family members may have no choice but to lose wages, impacting the family’s overall wellbeing. The spread of COVID-19 among Texan communities means many families are experiencing how illness and financial insecurity intersect to devastating consequences when we are made to choose between prioritizing health and going into work.

Recommendation

  • Enact statewide paid family and medical leave and paid sick leave

In Texas, over 4 million workers do not have paid sick days.

In Texas, 40 percent of workers do not have paid sick days, amounting to over 4 million workers.[xiii] If parents have access to paid sick leave, they are more likely to stay home when sick, preventing illnesses from spreading to others in the workplace.[xiv] Parents may have no choice other than to send kids to school sick if they cannot afford losing a day’s wage to stay home with the child. Providing no alternative for parents but to send sick children into school can delay the recovery process for the child, make it difficult for them to learn, and expose schoolmates to illness.

Simply having a job and working full-time is not enough to make ends meet in many parts of Texas. The state minimum wage is $7.25 an hour, and the rising cost of housing makes living in cities impossible for many families who want to access job opportunities in those regions. A minimum wage worker would have to work a staggering 95 hours a week to afford an average one-bedroom rental home in Texas.[xv] Rates are worse in urban centers, and the affordability crisis is even worse for women and people of color. A long history of discrimination and restricted opportunities has limited the wages for women and people of color compared to their peers so that they take home less money for the same hours of work in every job category in Texas.[xvi]

Though evictions have been halted through at least the end of March 2021, the threat of homelessness has become real for families who need to budget too much of their take-home pay for rent, despite their best efforts. Housing instability is linked to worse health outcomes, including poor developmental growth for children.[xvii] 

Recommendations: 
  • Enact increased statewide minimum wage
  • Allow cities and counties to raise local wages

The combination of no paid leave with low wages means parents may not be able to afford taking a day off from work to care for their family’s health. If the jobs that parents hold do not pay a livable wage, we risk keeping families from reaching financial stability, despite their efforts at working and getting ahead.

Extensive job losses due to COVID-19 have hurt families across Texas, and especially those who work in the service sector. Financial uncertainty has made it harder for families to put food on the table, pay for child care expenses, and cover rent each month, on top of dealing with stress that in itself hurts mental and physical health. Raising the state minimum wage and enacting paid family and medical leave and paid sick leave helps ensure working families do not need to sacrifice health to stay afloat. For those who lost their jobs, ensuring unemployment insurance benefits are adequate and removing barriers in the insurance system provides a measure of protection for Texans who lost their jobs through no fault of their own.[xviii]

 

Recommendations:
  • Reform unemployment insurance so that benefits are adequate
  • Enforce strict guidelines on classification of workers so every Texan can get the unemployment benefits they have a right to receive

Support for Immigrant Families

Over 1 in 4 Texas children have a parent who is not a U.S. citizen.[xix] For many immigrants in Texas, the weight of COVID-19 comes on top of years of immigration-related fears and anxieties. Racialized stressors like the threat of deportation have a large impact on family health. One 2017 study found that children born to Latina mothers in Iowa had worse birth outcomes in the period after a large immigration raid, even among U.S.-born Latinas.[xx] Families report that when a parent is deported, children experience negative physical and mental health symptoms, behavioral problems, and trouble in school.[xxi] Families lose stability if housing becomes unaffordable with the loss of a breadwinner, and financial and child care responsibilities become more daunting.

Many immigrant families with children do not participate in programs that children may be eligible for, for fear that their use of government programs would impact eligibility for a green card in the future.[xxii] This “chilling effect” on families under-enrolling in programs was seen even in families composed of naturalized citizens, since the spread of misinformation and fear forces families to be overly cautious.[xxiii]

Statewide enrollment is dropping for health and nutrition programs like Medicaid, the Children’s Health Insurance Program (CHIP), Women, Infants, and Children Program (WIC), and the Supplemental Nutrition Assistance Program (SNAP).[xxiv] Children not enrolled in programs they are eligible for might needlessly suffer from the conditions these programs could have mitigated. Poor access to health care and nutrition hurt child development. Without these services, due to the rising cost of living, providing health care and nutrition for children can simply be unaffordable.

Texas needs to ensure that immigrant families are not blocked from accessing public benefits that increase financial security. For example, Texas is one of only six states that explicitly excludes immigrants with permanent status from enrolling in Medicaid, though the benefits of Medicaid enrollment on children’s health are well-documented and extend beyond childhood.[xxv] As COVID-19 continues to spread quickly across the United States, immigrants have been afraid to access health care despite being some of the populations most affected.[xxvi]

Repealing state policies like Senate Bill 4 (SB 4), which forces local law enforcement to cooperate with federal immigration officers, helps promote financial security for families who depend on the wages of unauthorized family members. The sustained stress of fearing deportation of family members harms child development in families that are already impacted by high rates of job loss and high COVID-19 positivity rates. Texas should not be prioritizing deportations, particularly during a public health crisis, and should instead draw immigrant families out of the shadows and help them access resources to strengthen child wellbeing.

Recommendations
  • Explicitly include immigrants and immigrant mothers who qualify under federal law for Medicaid and Medicaid Maternity Coverage

  • Repeal xenophobic state law SB 4 on immigration enforcement by local law officials

Support for Kinship Families

In Texas, 286,000 children are raised by a grandparent or other relative, a relationship known as kinship care.[xxvii] This kinship relationship is most often informal, as relatives step up to care for children whose parents cannot care for them, without involving state authorities.[xxviii] While kids benefit from staying with family, that family does not receive the same amount of support that they would receive in a formal kinship arrangement through a court order or the foster care system. These families may be eligible for Medicaid and SNAP, but in terms of cash support, the federal program TANF – Temporary Assistance for Needy Families — often falls short.[xxix] In Texas, 46 percent of families providing kinship care are low-income, facing the added financial costs of attending to a child’s needs.[xxx] However, owning a car may disqualify a family from receiving TANF benefits under the asset limits that currently stand. Without funding for a kinship navigator program, Texas will continue to provide limited outreach that could otherwise point families towards the benefits easing the cost of providing a safe and healthy home for children.[xxxi] The TANF program has a limited reach today compared to when the program was created in 1996. Currently, only 4 Texas families of every 100 experiencing poverty receive TANF cash benefits. If TANF currently had the same reach as it did in 1996, then over 210,000 more families would be served.[xxxii]

Recommendations
  • Update restrictions on owning cars and other assets to qualify for TANF
  • Establish statewide kinship navigator program to support relatives

K-12 Education

Adults with more education have better health outcomes. Additional education allows people to earn more and afford what they need to take care of themselves, makes them more effective at navigating health systems, and leads to lower levels of stress.[xxxiii] But educational pathways are not the same for every Texan, and some groups face more obstacles than others as they work towards gaining more skills.

The Commit Partnership’s data dashboard shows how educational outcomes diverge between Black, Hispanic, white and economically disadvantaged students, due to disparate educational opportunities afforded to these groups.[xxxiv]

COVID-19 has highlighted additional obstacles some students need to overcome to get access to the same educational experiences as their peers. Though schools have been moved online due to the pandemic, Texas has one of the worst home internet access rates for children nationwide. Only seven states have worse rates of access to the internet and access to a device at home for children.[xxxv] Rural communities and communities of color in Texas suffer the lowest connectivity rates, meaning that these students are most at risk of lagging behind during the public health crisis.[xxxvi]

Looking beyond the classroom, the majority of Texas schools do not have enough counselors, social workers, or mental health professionals to serve students.[xxxvii] Without staff that support students, schools may default to suspending a student who acts out rather than supporting children experiencing challenges. Nearly 90 percent of punishments in Texas schools are for violating the school code of conduct, not for serious offenses.[xxxviii] Though students of color and students with disabilities are not more likely to misbehave, they are more likely to receive strong punishments than their peers for similar behavior.[xxxix] Students who are frequently disciplined may disengage from school, losing trust in the adults tasked to help them succeed.[xl] On top of lack of trust, any time spent out of the classroom can lead to them falling behind academically compared to peers.

The fact that Texas schools have prioritized police officers in schools rather than counselors takes the state further from building supportive and safe school environments for all children to succeed. Black students who grow up seeing and hearing about police violence in their school and neighborhoods can feel higher stress, anxiety, and hypervigilance, and Hispanic students can experience similar distress associating police authorities with deportations.[xli]

All children in the United States have the right to a public-school education. One priority for Texas is responding to the needs of English language learner (ELL) students, who make up 20 percent of the Texas public school population, and who are as a group overwhelmingly categorized as economically disadvantaged (eligible for free or reduced-price school lunches).[xlii]

Recommendation
  • Address funding gaps for English Learner (EL) students

In 1984, Texas established state-supported pre-Kindergarten (pre-K) to help three- and four-year-old children build learning and social skills. A study of pre-K in Texas showed that attending helps children be more prepared to succeed as they start school, especially for economically disadvantaged students and English language learners.[xliii] As COVID-19 pushes students into online education, low-income students and English-learners that are already impacted by existing equity gaps are now least engaged in classes.[xliv] Disengagement can be because their families are particularly vulnerable to instability during the pandemic or due to a lack of internet access, for example. Prioritizing spending towards engaging English learners can help schools refocus efforts towards providing supports for ELL students that can help keep them on track.

In 2019, the Texas Legislature passed House Bill 3 (HB 3), which provides schools additional funding for early education tied to the number of ELL students and low-income students in grades K-3. Yet the bill does not require that new funding gained from the number of ELL students be spent to support bilingual services. Texas should ensure that funding gained from numbers of ELL students be spent on services directly supporting the children who generated the funding, and that funding for pre-K is provided separately from ELL funds.

Increase School Funding Equity

HB 3 is an $11.6 billion school finance reform law that dedicates over $6 billion toward investments in education and $5 billion toward replacing school property taxes with state aid. The property tax cut portion of HB 3 is set to expand each year, costing the state more money annually without sending any additional funding into classrooms.

While HB 3 makes an ongoing financial commitment to property tax cuts, no similar promises are made to the children of Texas to keep pace with rising future education costs, reform special education funding, or improve funding for the English learners left behind in HB 3.

Most concerning is the elimination of the fundamental tax equity principle that school districts must receive similar revenue for similar tax effort, which is measured in tax rates. The largest portion of the total school district tax rate is now based on the amount of property value growth within the district, rather than taxing everyone at the same unified rate. School districts with high property value growth will see rates plummet while those with slower growth will see their rates remain stagnant. Because all districts will still be entitled to similar levels of revenue for that portion of the property tax, regardless of tax rate, the state is now requiring school districts with less robust economic growth to subsidize lower tax rates for school districts seeing the fastest economic growth.

Recommendation
  • Invest more state funds in public education by eliminating the inequitable school district tax compression that favors some districts over others

Because of the costly property tax cuts in HB 3, the law will put a strain on the state’s 2022-2023 budget and limit resources available for keeping school funding whole as our districts work through the COVID-19 crisis and accompanying instability in enrollment and attendance. The first priority of the 2021 Legislature should be to ensure our schools have stable funding throughout this school year and the coming biennium, and add any additional resources needed to combat losses of learning and pivots in service delivery. To accomplish this, the Legislature should freeze the harmful property tax cuts for the biennium and put our students first.

Another way to support equity in school funding is to reject the continuation of Chapter 313, the program of school property tax abatements that reduces companies’ property tax payments if they locate in Texas. The state budget makes up for any foregone school tax revenue, locking up state revenue, rather than allowing companies to contribute to a sustainable source of revenue for schools. One study showed that 85 percent of companies would have located in Texas without the tax abatements, suggesting that the program is unneeded and should not be renewed after its program end in 2022.[xlv]

Under its current funding formula, Texas funds schools by student attendance, and not by student enrollment. What this means is that 262,000 students are unfunded, a figure that is about the same as West Virginia’s entire student body population. This system disproportionately impacts schools that serve more low-income students, who may face family instability that impacts their ability to attend school reliably. Making the switch to fund by student enrollment helps schools pay for the salaries, infrastructure, and resources needed every day, regardless of if a student misses class.[xlvi]

Recommendation
  • Ensure a more accurate accounting of student needs by using average daily enrollment to calculate school funding instead of average daily attendance

Support Affordability of Higher Education

Whether or not Texans can afford higher education impacts their future employment prospects and their ability to provide financial security for their households. Taking on debt is the only way that many Texans can access higher education, which is becoming the standard for well-paying jobs. If Texans do not get the skills needed for well-paying jobs, they may end up unable to keep up with the rising cost of living and essentials like food, rent, and medical costs. But for Texans that had to take on too much debt to unlock the opportunities that college affords, the pressure to make high loan payments can be one more barrier preventing them from reaching financial security.

The portrait of the typical college student is changing. It’s becoming less common for college students to be financially supported by parents, and more common instead for college students to have their own dependents to care for.[xlvii] In Texas, an estimated 26 percent of undergraduates are student parents, and one study showed significant returns to supporting single mother students, who make up about 43 percent of the Texas student parent population.[xlviii]

Recommendations
  • Eliminate higher education tuition & fees for low-income families
  • Reduce student loan debt and pass legislation that protects student borrowers from predatory lending

As the state invests less in Texas higher education institutions, tuition has only gone up. The annual tuition to attend a public university in Texas doubled over 15 years.[xlix] The average debt for Texas students was over $25,000 in 2019, with 43 percent of graduates facing student loan debt.[l] Protecting student borrowers and reducing predatory loan practices needs to be a priority for Texas to support a healthy and highly skilled future workforce. Current Texas policy of revoking professional licenses for graduates who default on loans puts Texans in an impossible situation, forcing them to lose the means through which they can earn funds to pay back loans.[li]

Helping college students before they graduate prevents students from dropping out early and accumulating debt without having gotten a degree. For low- and moderate-income Texans, paying for housing, food, books, and other supplies can be a significant source of hardship. Without additional support, housing instability and food insecurity is a very real possibility for students. Many students need to work to cover expenses, but at Texas’ minimum wage of $7.25 an hour, moderate income students would have to work 21 hours a week to cover average unmet expenses.[lii]  This is 11 hours more than what is recommended for student success, but the alternative is to risk getting pushed out of college due to unaffordability.[liii] Making sure it is financially in-reach for students to attend school means eliminating tuition and fees for low-income families, investing in sustained emergency aid programs for all students, and increasing access to needed benefits. Tuition is just one aspect of college affordability.

Overall, supporting child wellbeing requires simultaneously supporting parents. Two-generation approaches that provide services for both children and parents address the conditions where parents need child care and out of school-time programming so that they can pursue workforce training or post-secondary education.[liv] Removing the barriers to opportunities where families live, learn, work, and play allow families to make choices that support their health and the health of their children.

Recommendations
  • Expand affordable access to college by protecting and increasing investment in need-based financial aid programs
  • Invest in sustained emergency aid programs for all higher education students
  • Increase access to benefits for students, including SNAP

Footnotes: Economic Opportunity

Back to top of page

[i] Center on the Developing Child (2007). The Impact of Early Adversity on Child Development (InBrief). https://developingchild.harvard.edu/resources/inbrief-the-impact-of-early-adversity-on-childrens-development/. 

[ii] The State of Children’s Health in Texas. Children’s Hospital Association. https://datainsights.childrenshospitals.org/views/PublicPolicyLegislativeInsightDashboard/StateStory?%3Aorigin=card_share_link.

[iii] Anderson, M. (2016). Who relies on public transit in the U.S. in Numbers, Facts, and Trends Shaping Your World Pew Research Center, as cited in Ramirez, A. (2019, May 10). Research: Latinos Face Big Public Transportation Challenges. Salud America. https://salud-america.org/research-latinos-face-big-public-transportation-challenges/.

[iv] Morse, A. (2020, February 26). States Offering Driver’s Licenses to Immigrants. National Conference of State Legislatures. https://www.ncsl.org/research/immigration/states-offering-driver-s-licenses-to-immigrants.aspx.

[v] Carratala, S. (2019, October 10). States Are Making Progress on Expanding Access to Driver’s Licenses. Center for American Progress. https://www.americanprogress.org/issues/immigration/news/2019/10/10/475627/states-making-progress-expanding-access-drivers-licenses/.

[vi] Miller, C. C. (2020, November 17). When Schools Closed, Americans Turned to Their Usual Backup Plan: Mothers. The New York Times. https://www.nytimes.com/2020/11/17/upshot/schools-closing-mothers-leaving-jobs.html?campaign_id=29.

[vii] DeFrancesco Soto, V. M. (2020). America’s Recovery from the 2020″ Shecession”: Building a Female Future of Childcare and Work. LBJ School of Public Affairs Research & YWCA. https://repositories.lib.utexas.edu/handle/2152/83388

[viii] Hamm, K., Malik, R., Schochet, L., Novoa, C., Workman, S., & Jessen-Howard, S. (2018, December 6). America’s Child Care Deserts in 2018. Center for American Progress. https://www.americanprogress.org/issues/early-childhood/reports/2018/12/06/461643/americas-child-care-deserts-2018/. 

[ix] Children at Risk. Child Care Desert Map. (February 2020) https://childrenatrisk.org/childcaredesertmap/, as cited in Davis, C., & Knop-Narbutis, A. (2020). Economic Issues for Women in Texas 2020. Every Texan & Texas Women’s Foundation. https://txwfecoissues.org/report/.

[x] The Annie E. Casey Foundation. Children under age 6 with all available parents in the labor force. KIDS COUNT Data Center . https://datacenter.kidscount.org/data/tables/5057-children-under-age-6-with-all-available-parents-in-the-labor-force?loc=37&loct=2#detailed/2/45/false/870,573,869,36,868/any/11472

[xi] For more information on issues impacting economic security for women in Texas, see Phadke, S., Pedreiro, S., Boesch, D., & Ahmed, O. (2018, September 26). Fast Facts: Economic Security for Women and Families in Texas. Center for American Progress. https://www.americanprogress.org/issues/women/reports/2018/09/26/458722/fast-facts-economic-security-women-families-texas/.

[xii] diversitydatakids.org. (2015). Working Adults Who Are Eligible For and Can Afford FMLA Unpaid Leave (Share) as cited in Paid Leave Means a Stronger Texas. The National Partnership for Women & Families . (2020, January). https://www.nationalpartnership.org/our-work/resources/economic-justice/paid-leave/paid-leave-means-a-stronger-texas.pdf.

[xiii] Milli, J., Huang, Y. (2017, March 10). Access to Paid Sick Time in Texas. The Institute for Women’s Policy Research. https://iwpr.org/iwpr-publications/briefing-paper/access-to-paid-sick-time-in-texas/.

[xiv] Ranji, U., Long, M., & Salganicoff, A. (2020, December 14). Coronavirus Puts a Spotlight on Paid Leave Policies. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/coronavirus-puts-a-spotlight-on-paid-leave-policies/.

[xv] Out of Reach: Texas. National Low Income Housing Coalition. (2020). https://reports.nlihc.org/oor/texas.

[xvi]  Davis, C., & Knop-Narbutis, A. (2020). Economic Issues for Women in Texas 2020. Every Texan & Texas Women’s Foundation. https://txwfecoissues.org/report/.

[xvii] Cutts, D. B., Meyers, A. F., Black, M. M., Casey, P. H., Chilton, M., Cook, J. T., … Frank, D. A. (2011). US Housing Insecurity and the Health of Very Young Children. American Journal of Public Health, 101(8), 1508–1514. https://doi.org/10.2105/ajph.2011.300139

[xviii] For more information on steps to reform unemployment insurance in Texas, see Lewis, J. (2020, July 8). 10-Point Plan for Texas Unemployment Insurance Reform. Every Texan. https://everytexan.org/2020/07/08/10-point-plan-for-texas-unemployment-insurance-reform/.

[xix] Dunkelberg, A., & Anderson, C. (2019, November 11). UPDATE: The Administration’s proposed changes to “PUBLIC CHARGE” Rule, Impact on Texans, and Best Practices for Providers, Assisters, and Agencies…. Every Texan & Children’s Defense Fund Texas. https://everytexan.org/images/2019_HW_11_11_Public_Charge_Impact_in_TX.pdf.

[xx] Novak, N. L., Geronimus, A. T., & Martinez-Cardoso, A. M. (2017). Change in birth outcomes among infants born to Latina mothers after a major immigration raid. International Journal of Epidemiology, 46(3), 839–849. https://doi.org/10.1093/ije/dyw346 

[xxi] Koball, H. (2015, September 20). The costs for children when parents are deported. Urban Institute. https://www.urban.org/urban-wire/costs-children-when-parents-are-deported.

[xxii] Bernstein, H., Gonzalez, D., Karpman, M., & Zuckerman, S. (2019, May 22). One in Seven Adults in Immigrant Families Reported Avoiding Public Benefit Programs in 2018. Urban Institute. https://www.urban.org/research/publication/one-seven-adults-immigrant-families-reported-avoiding-public-benefit-programs-2018. 

[xxiii] Bernstein, H., Gonzalez, D., Karpman, M., & Zuckerman, S. (2019, May 22). One in Seven Adults in Immigrant Families Reported Avoiding Public Benefit Programs in 2018. Urban Institute. https://www.urban.org/research/publication/one-seven-adults-immigrant-families-reported-avoiding-public-benefit-programs-2018.

[xxiv] Dunkelberg, A., & Anderson, C. (2019, November 11). UPDATE: The Administration’s proposed changes to “PUBLIC CHARGE” Rule, Impact on Texans, and Best Practices for Providers, Assisters, and Agencies…. Every Texan & Children’s Defense Fund Texas. https://everytexan.org/images/2019_HW_11_11_Public_Charge_Impact_in_TX.pdf.

[xxv] For more information on the improved economic, health, and educational outcomes of health insurance, see Murphey, D. (2017, May 12). Health Insurance Coverage Improves Child Well-Being. Child Trends. https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well.

[xxvi] For more information on the vulnerability of immigrants to COVID and fear of accessing medical treatment and economic supports, see Hernandez, N. (2020, June). Summary of Research at the Intersection of Public Charge and Health. Protect Immigrant Families. https://protectingimmigrantfamilies.org/wp-content/uploads/2020/06/Public-Charge-and-Health-Literature-Review-2020-06-16.pdf.

[xxvii] The Annie E. Casey Foundation. Children in Kinship Care in Texas. KIDS COUNT Data Center . https://datacenter.kidscount.org/data/tables/10455-children-in-kinship-care?loc=45&loct=2#detailed/2/45/false/1985,1757/any/20160,20161

[xxviii] Kids Living with Relatives (Kinship Care). Every Texan. https://everytexan.org/our-work/policy-areas/jobs-financial-security/kids-living-with-relatives/.

[xxix] Kids Living with Relatives (Kinship Care). Every Texan. https://everytexan.org/our-work/policy-areas/jobs-financial-security/kids-living-with-relatives/.

[xxx] Cooper, R. (2016, July). Keeping Kids with Family: How Texas Can Financially Support Kinship Caregivers. Every Texan. https://everytexan.org/wp-content/uploads/2020/04/HW_2016_Kinship_InterimHearing.pdf.

[xxxi] For more information on a Kinship Navigator program for Texas, see Cooper, R. 2020-2021 Legislative Budget Request Recommendation: Kinship Navigator Program Funding. Every Texan. https://everytexan.org/images/Kinship_Navigator_Program_LAR_4-18.pdf.

[xxxii] State Fact Sheets: Trends in State TANF-to-Poverty Ratios (Texas). Center on Budget and Policy Priorities. (2020, November 30). https://www.cbpp.org/research/family-income-support/state-fact-sheets-trends-in-state-tanf-to-poverty-ratios.

[xxxiii] McMorrow, S., Skopec, L., & Thomas, T. (2019, May 16). Education and Health: Long-Term Trends by Race, Ethnicity, and Geography, 1997-2017. Urban Institute. https://www.urban.org/research/publication/education-and-health-long-term-trends-race-ethnicity-and-geography-1997-2017.

[xxxiv] The Commit Partnership Data Dashboard.  (2020). https://commitpartnership.org/dashboard

[xxxv] Blagg, T. (2020, October 14). 3 Ways to Address Texas’ Digital Divide and the Widening Educational Achievement Gap. Every Texan. https://everytexan.org/2020/10/14/3-ways-to-address-texas-digital-divide-and-the-widening-educational-achievement-gap/.

[xxxvi] Blagg, T. (2020, October 14). 3 Ways to Address Texas’ Digital Divide and the Widening Educational Achievement Gap. Every Texan. https://everytexan.org/2020/10/14/3-ways-to-address-texas-digital-divide-and-the-widening-educational-achievement-gap/.

[xxxvii] Craven, M., Stone, E., & Fowler, D. GUARDING OUR MOST PRECIOUS RESOURCES: Comparing the Staffing of Counselors and Mental Health Professionals to Police in Texas Schools. Texas Appleseed. https://www.texasappleseed.org/sites/default/files/Guarding%20our%20most%20precious%20resources.pdf.

[xxxviii] Texas: The State of School Discipline 2017-2018. Texas Appleseed. https://texasappleseed.org/sites/default/files/SchoolDisciplineinTexas-new.pdf.

[xxxix] Texas: The State of School Discipline 2017-2018. Texas Appleseed. https://texasappleseed.org/sites/default/files/SchoolDisciplineinTexas-new.pdf.

[xl] Texas: The State of School Discipline 2017-2018. Texas Appleseed. https://texasappleseed.org/sites/default/files/SchoolDisciplineinTexas-new.pdf

[xli] For more information on how police violence and threat of deportations affect children of color, see Schmit, S., Ullrich, R., & Gallagher Robbins, K. (2020, September 3). A Pandemic within a Pandemic: How Coronavirus and Systemic Racism Are Harming Infants and Toddlers of Color. CLASP.  https://www.clasp.org/publications/report/brief/pandemic-within-pandemic-how-coronavirus-and-systemic-racism-are-harming

[xlii] Enrollment in Texas Public Schools 2019-20. Texas Education Agency. (2020, August). https://tea.texas.gov/sites/default/files/enroll_2019-20.pdf.

[xliii] Huston, A., Gupta, A., &; Schexnayder, D. (2012, March). Study of Early Education in Texas: The Relationship of Pre-K Attendance to 3rd Grade Test Results. Ray Marshall Center. https://raymarshallcenter.org/2013/10/04/early-childhood-2/.

[xliv] Lazarín, M. (2020, June). COVID-19 Spotlights the Inequities Facing English Learner Students, as Nonprofit Organizations Seek to Mitigate Challenges. Migration Policy Institute. https://www.migrationpolicy.org/news/covid-19-inequities-english-learner-students.

[xlv] Jensen, N. M. Economic Development Incentive Evaluation Project. Nathan M. Jensen. https://www.natemjensen.com/economic-development-incentive-evaluation-project/ as cited in Lavine, D. (2020, August 13). End the Inefficient Corporate School Tax Break Program that Wastes Valuable State Revenue. Every Texan. https://everytexan.org/2020/08/13/end-the-inefficient-corporate-school-tax-break-program-that-wastes-valuable-state-revenue/.

[xlvi] Kring Villanueva, C. (2020, May 12). COVID-19 & Education: We Should Tie School Funding to Enrollment. Every Texan. https://everytexan.org/2020/05/12/covid-19-education-we-should-tie-school-funding-to-enrollment/.

[xlvii] Larin, K. (2018, December 21). Food Insecurity: Better Information Could Help Eligible College Students Access Federal Food Assistance Benefits. U.S. Government Accountability Office (U.S. GAO). https://www.gao.gov/products/GAO-19-95.

[xlviii] Reichlin Cruse, L., Milli, J., Contreras-Mendez, S., Holtzman, T., & Gault, B. (2019, December 18). Investing in Single Mothers’ Higher Education by State. Institute for Women’s Policy Research. https://iwpr.org/iwpr-issues/student-parent-success-initiative/investing-in-single-mothers-higher-education-state/.

[xlix] Williams, A. (2019, February 12). Why Is Texas Investing Less and Expecting Better College Graduation Rates? Every Texan. https://everytexan.org/2019/02/12/why-is-texas-investing-less-and-expecting-better-college-graduation-rates/.

[l] 2020 Texas Public Higher Education Almanac. Texas Higher Education Coordinating Board. (2020). https://www.highered.texas.gov/data-reports/texas-public-higher-education-almanac/.

[li] Williams, A. (2019, February 22). Texans Who Can’t Pay Student Loans Shouldn’t Lose Professional Licenses. Every Texan. https://everytexan.org/2019/02/22/texans-who-cant-pay-student-loans-shouldnt-lose-professional-licenses/.

[lii] Williams, A. (2019, February 12). College Students Left to Fend for Themselves as State Support Declines. Every Texan. https://everytexan.org/2019/02/12/college-students-left-to-fend-for-themselves-as-state-support-declines/.

[liii] A Benchmark for Making College Affordable. Lumina Foundation. (2015, August). https://www.luminafoundation.org/files/resources/affordability-benchmark-1.pdf, as cited in Williams, A. (2019, February 12). College Students Left to Fend for Themselves as State Support Declines. Every Texan. https://everytexan.org/2019/02/12/college-students-left-to-fend-for-themselves-as-state-support-declines/.

[liv] For more information on 2-generation strategies, see Austin/Travis County 2-Generation Strategic Plan 2019-2023. United Way For Greater Austin. https://www.unitedwayaustin.org/2gen2018/.

Acknowledgements

Every Texan gratefully acknowledges Methodist Healthcare Ministries of South Texas, Inc., for their financial support of this publication. The opinions expressed in this document are those of Every Texan and do not necessarily reflect the views of Methodist Healthcare Ministries.

This report was authored by Every Texan’s Research and Data team—Tara Blagg, Tania Uruchima, and Amy Knop-Narbutis—as part of the Texas KIDS COUNT project. KIDS COUNT is a national and state-by-state effort to track the status of children in the U.S. funded by the Annie E. Casey Foundation. Check out the Kids Count Data Center for extensive child well-being data on kids across the U.S. and for each of Texas’ 254 counties. This research was funded in part by The Annie E. Casey Foundation; Inc., and we thank them for their support; however, findings and conclusions presented in this report are those of the authors alone and do not necessarily reflect the opinions of the Foundation.

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Thanks to everyone who contributed ideas to the early stages of report development, which were used to hone the focus of this report: Justin Yoo and Jenny Mathai for Community Health Choice; Emily Timm, Stephanie Gharakhanian and Ana Gonzalez for Workers Defense Project; Irene del Toro for Driscoll Health Plan’s Public Affairs; Meaghan Read for Mental Health America of Greater Dallas; Cheasty Anderson and Patrick Bresette for Children’s Defense Fund-Texas; Celia Kaye for League of Women Voters of Texas; Adriana Kohler and Katie Mitten for Texans Care for Children; Vanessa Alvarado with La Union del Pueblo Entero (LUPE); JC Dwyer for Feeding Texas; Morgan Craven for IDRA; Denise Gomez for Children’s Health.
Special thanks to Randy Rosso and the Food Research and Action Center (FRAC) for contributing updated food security data by race and ethnicity and to Aunt Bertha, The Social Care Network, for providing social services search data.

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