The Republican strategy of delaying reauthorization of the Children's Health Insurance Program serves their broader agenda.
By forcing advocates to defend kids' human right to see a doctor, they deflect attention from how their tax plan and social service cuts will harm the health of America's young.
Eleven states will run out of CHIP money by the end of this month. Another 20 will collapse in January. Some are already sending out notices to low-income families to look for private alternatives.
It's hard to imagine that Republicans in Congress will actually move to reverse their bipartisan support for the state-run program and withhold approval of the $15 billion needed to fund CHIP next year. They must know that people who depend on CHIP, and their tens of millions of supporters, will never forgive legislators who eliminate health insurance that covers 10 million American children and pregnant women.
Yet the benefits gained under CHIP are yesterday's news. Those improvements have been overwhelmed by the new threats to poor kids' well-being: social conditions that are overwhelming families and providers, and are being totally ignored in the current debate.
The new threats are existential, mental and physical. They are the outgrowth of poverty, violence, and deprivation. Healthcare providers are poorly positioned to tackle these problems.
Where providers can make a difference, CHIP's record is encouraging. Since its passage in 1997, infant mortality before age 1 fell to 5.8 per 1,000 live births in 2014 from 7.2. That translates into more than 5,000 additional children reaching their first birthdays every year.
Vaccination rates continued their upward march under CHIP despite the rise of an anti-vaccination movement. By 2015, 83% of children had received the four major vaccines, a nice uptick from the 76% of kids who got those vaccines in 1997.
Access to dental care, which must be covered for children on Medicaid or CHIP, also improved since the late 1990s. In 2015, 90% of kids saw a dentist at least once, compared with just 79% in 1997.
But the social conditions that ultimately determine childhood well-being are moving in the opposite direction.
The homes of American children are getting poorer. Today, 40% of children are born to single women, twice the level of the early 1980s. More than 1 in 5 children are being raised by single mothers.
Women are paid on average 79% of what men are paid. About 1 in 5 children are growing up in poverty and another 20% live in households between 100% and 200% of the federal poverty level. Those economic circumstances are directly correlated with health status, educational attainment and a child's long-term prospects.
Despite headline-grabbing gun violence, kids are physically safer today. Violent inner-city neighborhoods and mass shootings are shocking, yet data indicate overall deaths from gun violence and accidents are in sharp decline. Teen alcohol use and sexual activity also are sloping downward.
But the social and economic environments for many American teens are toxic. The share of youths age 12 to 17 reporting a major episode of depression rose to 13% in 2015 from 9% in 2004. More than 40% of teens in 2015 reported having been treated for depression at least once.
Most disturbing from the perspective of long-term health, the childhood obesity epidemic shows no sign of abating. About 20% of kids were obese in 2014, up from 16% in 2002 and 6% in 1980. Obesity-related health consequences like high blood pressure, diabetes, early puberty and asthma are climbing, too.
Going forward, improving the health status of our nation's children and teens will require better support for families; reducing the stress in kids' daily lives; and improved nutrition and exercise. All of those issues get pushed onto the back burner when we have to re-litigate whether kids even have the right to see a doctor.