Let’s Not Forget Affordable Dental Care

January 23, 2017

A comment posted some time ago raised an issue about Medicaid that seems even more timely now because it opens to the door to larger current and prospective issues.

Seems the commenter had to have some teeth pulled. Her dentist told she would have to wait for dentures until her mouth heals instead of getting a temporary set. She felt that she and others covered by Medicaid were “treated differently from other people,” who aren’t doomed to toothlessness. Would I look into this?

And I did, learning more in the process about not only the source of her problem, bur dental care in our health insurance system — today and prospectively. Results, as follows.

The commenter is actually quite fortunate. States don’t have to include dental services in their Medicaid programs, except when they administer the Children’s Health Insurance Program by expanding them.

For adults, dental care is an optional benefit, both for those whom states covered before the Affordable Care Act and those who became newly eligible when states opted for expansion. Those states must provide “essential health benefits” for the latter, but dental care isn’t one of them.

Virtually all states and the District of Columbia do cover some dental services, but only fifteen cover a comprehensive mix, the Kaiser Family Foundation reports.

Many cap per person spending or the number of services covered. And thirteen cover only emergency treatment. Even coverage doesn’t ensure affordability because beneficiaries may face high out-of-pocket costs.

Not all states that cover dental services cover dentures. And even fewer cover dentures for all beneficiaries as often as they might need them. They’re responding here to limits the federal government sets on reimbursements.

But low-income adults aren’t treated all that differently from their better-off peers. Traditional Medicare provides no coverage for dental services, except in certain limited cases when the beneficiary is in a hospital.

We who’ve had employer-sponsored health insurance also know that incomplete—or no—coverage for dental services is more common than the commenter apparently assumed.

But better-off people can shell out for dental care or supplementary insurance. Not so for low-income working age adults. Only 19% of those who were officially poor went to a dentist in 2013. And 44% had had untreated cavities in the prior two-year period.

Nearly a third of those with incomes low enough to qualify for an expanded Medicaid program reported an unmet need for dental care last year.

Without it, they may not only lose teeth and have to live with gaps in their mouths. Untreated oral diseases, including cavities can cause or worsen a range of other health problems.

Lack of sufficient coverage is obviously a major barrier, but it’s not the only one. In some places, e.g. rural areas, inner cities, there simply aren’t enough dentists. That’s partly due to an unwillingness on their part to treat low-income patients, especially those covered by Medicaid.

Dentists object to the paperwork and lost income because Medicaid patients—at least, by reputation—often don’t show up for appointments. But dentists also cite low reimbursement rates—sometimes so low as to not even cover costs.

Now, we know that states often cut provider reimbursement rates when economic downturns drive up their Medicaid costs because that’s more politically palatable than tightening up on eligibility or coverage.

And we know they’d face budget crunches—and not only during recessions—if Republicans in Congress convert Medicaid to a block grant and the President agrees.

Not much of an “if” here. The Trump’s campaign’s policy positions included a block grant. And Congressman Tom Price, his choice for Secretary of Health and Human Services, folded a block grant into the House budget plan when he chaired the responsible committee.

Looking at how states now use their flexibility to limit dental care coverage, we could reasonably expect them to make further cuts there.

They might instead (or also) cut dentists’ reimbursement rates. More than half the states did that in the aftermath of the Great Recession. So Medicaid beneficiaries who still had dental coverage may have had more problems finding someone to treat them, as certainly seems the case in Washington and in Florida.

Some states might instead join those that provide no coverage whatever.

The block grant is only one of the clear and present dangers to the health of poor and near-poor people, including the health of their teeth, gums and everything else in and around their mouths.

The impending repeal of the Affordable Care Act would immediately deny higher federal reimbursement rates to the 31 states and the District of Columbia that have expanded their Medicaid programs.

The repeal, in and of itself, would free them to shrink or eliminate dental health benefits for the newly-eligible children they enrolled because they’d no longer have to provide the essential health benefits the ACA specified.

This would also be true for most other insurance plans, unless state regulations required them because the same EHB requirements apply. And if, as predicted, premiums soar, one could expect plans to drop dental care or, at least, radically cut back coverage.

Some of you may recall the boy who died from a brain infection because his mother couldn’t find a dentist to treat him in time—this for wont of Medicaid. We might have more such cases, with or without it.

We’d almost surely have more low-income adults toothless (and not only temporarily) and more dead too because they couldn’t afford dental care—or related medications.

I know this seems a worst case scenario and perhaps an unwarranted leap from a singular problem to a vast array. But when we think about what will happen in the aftermath of health care “reforms,” we need get beyond the numbers, as important as they are.

Price objects to our government programs because they get between doctors and their patients. But, in fact, people who should be patients won’t be.

And when we think of them, we shouldn’t forgot those who need dental care because, as one dentist said, “the mouth and the head are connected to the rest of the body.”


Another Stab at Defunding Planned Parenthood, Another Threat to Low-Income People’s Health

January 9, 2017

Last week, House Speaker Paul Ryan assured reporters that the forthcoming bill to repeal the Affordable Care Act would include a provision denying federal funds to Planned Parenthood. This is supposedly pro-life, but it’s a major threat to the lives and well-being of thousands of low-income women.

Republicans (and some Democrats) have put Planned Parenthood in the bull’s eye because it’s one of the country’s largest providers of abortion services — and in some areas, the only provider.

Yet abortions represent a small fraction of the services Planned Parenthood provides—about 3% in 2014-15.

And those abortions are rarely, if ever, funded by the federal sources Republicans would shut off — Medicaid and Title X of the Public Health Services Act. An amendment routinely attached to spending bills has seen to that.

So the loss of federal funds would deny both women and men other health services — notably, tests and treatment for sexually transmitted diseases, pap smears, breast exams and affordable, reliable contraception.

Shrinking Planned Parenthood’s resources would thus increase health risks — and the risks of unwanted pregnancies. The latter, among other things, would keep more women mired in poverty and increase the number of children born and likely to remain poor.

Defunding Planned Parenthood is hardly a novel notion. So we have some evidence of consequences. Texas shifted its family planning funds out of Planned Parenthood in 2013—this after cutting its family planning budget.

Researchers found a 35% drop in the number of women using long-acting, reversible contraceptives supplied by clinics the state funded. The pregnancy rate among women who’d previously used injectable contraceptives—an alternative long-acting form of birth control—rose 27%.

Another study looked at what happened in Texas and Wisconsin when clinics closed because they’d lost public funding. Researchers found that fewer women got Pap smears and breast exams — in both cases because they’d have had to drive much further to get to a clinic.

About 40% of Planned Parenthood’s funds come from Medicaid, through reimbursements, and Title X, through grants. These sources cover care for approximately 60% of its patients—roughly 1.5 million people.

Republicans have said that the funds they’ll deny Planned Parenthood will go to other organizations and thus sustain the services its clinics can no longer provide.

This might be true in the long-run. But it surely wouldn’t before many thousands of women suffered irreparable harms. Professor Sara Rosenbaum, who’s worked with community health services for years, cites three major reasons.

Rosenbaum was responding to a defunding bill introduced in the Senate about a year and a half ago. The House actually passed a one-year defunding bill shortly thereafter.

The Congressional Budget Office assessed that bill and concluded that it would have caused an estimated 400,000 Planned Parent clients to lose access to care while also increasing federal Medicaid costs due to more unintended births.

The fate of these vulnerable people—and thousands who’ll come after—hinges on the Republican leadership’s getting a simple majority of votes in favor of the vehicle chosen to repeal the ACA. Some have suggested they might not get there. A very iffy prediction.

Our incoming President has talked on both sides of his mouth on this, as on other issues. But he’s said he’ll sign a defunding bill so long as Planned Parenthood is involved in abortions.

What this means, of course, is that we’re looking at even worse prospects for comprehensive, affordable health care than what we glean from the ACA dismantling in the works.

NOTE: I’m indebted to posts by Judith Solomon at the Center on Budget and Policy Priorities for data and links to original sources on the impacts of the prospective defunding. You can find her latest here.


Devastating Effects of Affordable Care Act Repeal

January 5, 2017

The Urban Institute puts some hard numbers on what will happen if the Republicans in Congress dismantle the Affordable Care Act. They’re shocking.

An estimated 53.5 million people would have no health insurance in 2021. That’s more than double the number who’d have no coverage if the ACA were intact.

Coverage would shrink most for low-income people enrolled in Medicaid, presumably because states would no longer receive funds to cover most of the costs of people who became eligible when they expanded their programs.

They’d be hard put to make up the loss and so would probably set lower limits on income eligibility, cut back on services covered and/or further reduce their reimbursements to healthcare providers.

Looking only at the first of these cost-savers, the Institute estimates that 14.5 million fewer children and working-age adults would have coverage under Medicaid.

The Institute’s estimates do not include the results of converting Medicaid to a block grant, as lead Congressional Republicans—and our incoming President—favor.

His choice for Secretary of Health of Human Services included one in the budget plan he produced while Chairman of the House Budget Committee. It would have cut federal Medicaid spending by a whopping $1 trillion over the next 10 years.

No way that state and local governments could compensate for losses so great. The crunch, however, could well be larger.

An economic downturn (likely) would cause job losses and so make more people income-eligible, even with lower thresholds. The federal government would no longer pick up its share, as it does under the current system.

The Center on Budget and Policy Priorities used the Institute’s data to estimate state-level losses. Here’s what we learn about the District of Columbia.

In 2019, 32,000 fewer residents would have health insurance if Congress repeals the ACA. This, like the nationwide total, is more than double the number who’d otherwise no coverage.

Nearly 23,500 more residents have gained affordable health insurance through Medicaid since 2013. Many would lose this coverage unless the District used its own funds to make up for the federal funds that would no longer pay most of the costs for the newly eligible. That would require a total of $1.7 billion between 2019 and 2028.

The District would also lose $85 million in funding for its health insurance marketplace. And residents who now have insurance through the marketplace would immediately lose the tax credits that subsidize their costs.

The Center doesn’t estimate how much more they’d have to pay to retain the coverage they have now. It does, however, say that the credits cover 73% of monthly premiums nationwide. Faced with that much more out of pocket, many lower-income residents would presumably forgo insurance.

In short, repeal of the ACA will have devastating effects on low and moderate-income District residents, as it will on virtually everyone but the very well-off nationwide.

Millionaires would, in fact, get tax cuts bigger than the total average income of families in the bottom two-fifths of the income scale. The very wealthiest would get cuts averaging $260,630.

We’re given to understand that the Republican leadership has put repeal at the top of its agenda. It probably won’t, however, impose an immediate death sentence on every provision, what with not having the promised replace.

It does, however, have a bill that Republican majorities have already passed. It would eliminate the two provisions I’ve focused on here—the additional funding for states that have expanded Medicaid and the tax credits that low and moderate-income people get to subsidize the costs of plans they buy on exchanges.

Republicans also, as I’ve mentioned, have the basis for converting Medicaid into a block grant. So they could make a costly down payment on a major campaign promise.

Hard to find a hopeful note to end on. So I’ll borrow from Ron Pollack, the long-time Executive Director of Families USA, a leading advocacy organization for Americans’ healthcare needs.

“One should never underestimate the extraordinary backlash that occurs when people have something they value that’s taken away,” he says.

What remains to be seen is whether they’ll lash back forcefully enough before the affordable healthcare protections the ACA provides are taken away.


Broken Bone, But Not Broke, Thanks to Medicare

December 1, 2016

A week before Thanksgiving, I got up on the right side of bed, but from closer to the edge than I realized. Landed flat on my back and lay there in excruciating pain. But I managed to get dressed, make sure essentials were in my purse, call 911 and hobble downstairs to open the door.

Folks in the ER took X rays and a CAT scan. Determined I’d fractured a pelvic bone, but probably wouldn’t need surgery. So they sent me to a hospital, where the tests were repeated and the same diagnosis made.

Then on to a rehabilitation center, where I got both physical and occupational therapy to ready me for living at home alone and as much painkiller they’d allow. I’m still in pain, but otherwise in pretty good shape—and home again neither permanently disabled nor bankrupt..

I’m told that the transport, medical and therapy services and the rooms, food and the like in the hospital and rehab center will cost me nothing. The painkillers require copay, but it’s small. And my Medicare Advantage plan sets a low cap on all my out-of-pockets for the year.

I shudder to think of the bills I’d face if not enrolled in Medicare — or more precisely, the Advantage plan I chose. And I says to myself, what if I were twenty or so years younger now and I’d had the same accident when I was sixty-five?

You know, I’m sure, that this isn’t a hypothetical question. House Speaker Paul Ryan apparently plans to link his pet Medicare “reforms” to whatever the Republican majority does to dismantle the Affordable Care Act,

“Medicare has got some serious problems because of Obamacare,” he recently told Fox News, claiming, as he has in the past, that the program “is going broke.” This is wrong on both counts, as the Washington Post’s fact checker explains. And Ryan probably knows it.

But he also knows he’s got an opportunity he didn’t before. He’s produced multiple versions of his so-called Medicare reform plan. The latest, in his Better Way healthcare policy paper, is a dense, blame-heavy thing. This much, however, I think, we can gather in answer to my what-if question.

I wouldn’t have health insurance through any form of Medicare. Ryan would link the minimum eligibility age to the age former workers become eligible for full Social Security retirement benefits. That would be sixty-seven under current law. But Ryan, among others, has wanted to raise it further.

The rationale for withholding both sorts of benefits from people who’ve reached what we ordinarily think of as retirement age is that Americans are living longer. This, Ryan says, is because we’re healthier—thus, inferentially, not in need of Medicare until we’re significantly older.

Set aside the over-simple reading of the rising longevity figure, we’re not living longer because we’re healthier. It’s rather because medical science has gotten better at keeping sick people alive and because we’re spending more on healthcare—this according to the National Bureau of Economic Research.

The constantly evolving treatments of various sorts will mean nothing, of course, if people who need them don’t have insurance to cover most, if not all of the costs.

And what about a case like mine? My life expectancy had nothing whatever to do with my falling, though my age may have had something to do with the fact that a bone cracked.

Say, however, I’d reached the ripe old age for Medicare. It wouldn’t come close to covering my healthcare costs. I’d get a subsidy of some sort to help me pay premiums for either a non-government insurance plan, misleadingly termed an Advantage Plan, or traditional Medicare, also misleadingly termed.

Ryan misleads because neither of the choices we’d have would offer as much care for as relatively little. Our premium support would do more for the poor than the well-off. But it wouldn’t rise to keep pace with rising healthcare costs.

This is a main feature, not a bug. Ryan’s fundamental aim isn’t to save Medicare, as he claims, but to cut federal spending. So the subsidy—not, he protests, a voucher—would cover less and less over time.

But we’d get more bang for the buck, he says, because insurers would reduce costs and improve quality of care so we’d choose their program over competitors’. Medicare would then have a built-in cost containment mechanism, as it doesn’t now.

It already has various price controls, however, though Republicans would blow some away in repealing the ACA.

The bigger deal, however, is that private insurers can’t keep premium costs and out-of-pockets low enough for most of us to afford them. Nor can what’s now traditional Medicare, which would be in even worse shape than its alternatives.

And the bigger deal yet is that the soon-to-be Secretary of Health and Human Services has long objected to Medicare and enthusiastically supported Ryan’s privatization plan.

Shortly before his nomination, he said he expected Congress to move forward with a Medicare replacement plan in six to eight months—as soon as it’s dispatched with the ACA.

Republicans can tackle both without any Senate Democrats voting in favor, through a somewhat arcane process known as budget reconciliation. So unless more than two Republicans heed the vast majority of Americans, who oppose any spending cuts to Medicare, future seniors won’t have affordable health care.

This tally assumes that Trump will ignore his promise to leave Medicare alone. We still don’t have a clear read on that. But I’m even less confident now than I was a couple of weeks ago. One need only look at the healthcare reform page on his new website—and, of course, his choice for HHS.

The fact that I personally got—and will continue to get—the healthcare services I need at a price I can afford doesn’t make what seems to be coming down the pike irrelevant to me, though that’s clearly what the Medicare reform crew intends.

Nor do I rest easy, knowing that ending Medicare as we know it is only one piece of the attack on our affordable healthcare system.

We know, for example, that block granting Medicaid appeals to Trump—and that he’ll almost surely have a chance to sign a bill that denies low-income people, seniors among them, the affordable healthcare services they can count on now.

This wouldn’t directly affect me. But if I had less money, it would because Medicaid would help pay for my Medicare out-of-pockets—and, in at least some states, the costs of a home health aide. Anyone hobbling around the way I am needs someone to help with basic tasks.

But how many states would still provide it as healthcare costs rise and federal funding doesn’t?


HUD Acts to Limit Lead Hazards in Low-Income Housing, But Could Do More

October 6, 2016

I’ve said my piece, at least for now, on the leaded water crisis that recently had another 15 minutes of fame. Now to the recent policy development I left hanging.

We know that lead from sources other than water poses risks to far more children. The most common is lead in the paint used on houses before the federal government banned it in 1998.

Lead in the soil around houses — from flecking paint, the exhaust formerly emitted by cars and trucks or some combination — is a major hazard too. In at least one case, nearby factory operations left an extraordinarily high level of lead (and arsenic) in the soil a public housing complex sat on.

The U.S. Department of Housing and Urban Development has rules to address lead hazards is housing it owns and housing subsidized by programs it administers, e.g., public housing, housing with units covered by vouchers.

But it requires “environmental intervention” only when the blood lead level in children tested in three or four times greater than the trigger the Centers for Disease Control has recommended.

HUD has (belatedly) heeded the CDC — and undoubtedly the widespread media coverage of lead poisoning found in children who live in poor neighborhoods.

It’s proposed a rule change that would align its trigger with the CDC’s — and potentially with any the CDC subsequently adopts.

The rule would also establish more comprehensive testing procedures for federally-owned and assisted housing when a young child living there has had a blood test showing lead above the new intervention level.

Swift interim controls and subsequent longer-term measures would apply wherever the inspections found lead paint hazards. So children who hadn’t been tested might be protected from further exposure, as would adults.

But the proposed rule still leaves them at high risk for lead poisoning. For example, it doesn’t change the types of inspections required before a family with children moves into a federally-subsidized unit — or a unit that will be subsidized by the family’s housing voucher.

For the latter and some of the former, that’s just a look around the place, not an actual test of the paint, dust, etc. When inspectors do find lead hazards, landlords don’t have to eliminate them before children suffer damage. They’ve got up to 90 days to finish the job.

They do have to do some things to limit exposure sooner, e.g., clean off surfaces. But note that a child’s high blood lead level often remains the trigger for thorough inspections.

So children will remain the canaries in the coal mine. And families will still have to choose between staying where their children incurred lead poisoning and leaving, perhaps for a shelter or a home in their car — this because the proposal, like the current rule, fails to ensure they can move to another affordable place.

The proposal also preserves a big exemption — no inspection of any sort for an efficiency unit, though the prospective tenant may plan to have a child living with her.

Or she may have one on the way. The CDC warns that lead poisoning can cause pregnant women to miscarry or lasting damages to babies that survive.

The lead hazard standards HUD uses for paint and dust are themselves flawed. The agency relies on the Environmental Protection Agency’s — one established more than 20 years ago, the other dating back to 2001.

Both permissible lead levels are far higher than what scientific research would now support. (A lawsuit seeks to change them, but HUD could de-link in favor of its own.)

In short, the proposed rule is a step in the right direction, but it wouldn’t protect low-income children as well as it could. Not the end of the story, however.

Interested parties have until the end of this month to comment on the proposal. One can hope the end result is a stronger final rule — and as soon as possible.

Because the health of young children in some 128,000 homes is at risk now — or already damaged. Countless more in the future, of course.

But even a stronger rule won’t protect them. Everything we read suggests that neither HUD nor EPA has the resources to ensure that their lead-poisoning protections don’t leave seemingly protected people in danger.

The endangered, if not already damaged, aren’t only children, as I’ve briefly noted before. Some will remain exceedingly vulnerable, unless Congress acts — and not only on the resources issue.

HUD, for example, requires no lead hazard inspections of subsidized units exclusively for low-income people with HIV/AIDS, unless they’re pregnant or will have a child under six living with them.

So here are people with compromised immune systems who may unknowingly live in a place that heightens their risks of diseases they’re already prone to.

Nothing HUD alone can do about this. Congress largely exempted the units when it created the Housing Opportunities for People With AIDS program in 1990, when we knew far less about the disease and what lead in the body can do.

More work then for advocates, even if HUD beefs up its proposal to afford children more protection.

NOTE: I’m indebted to a rulemaking petition filed by 30 organizations and academic experts and to Professor Emily Benfer at Loyola University Chicago School of Law for insights into he current HUD rule and what the proposal would and would not do. Opinions and any errors are my own.


Some People’s Water Crises Are More Urgent Than Others

October 3, 2016

A public epidemic has become public knowledge, thanks, in a manner of speaking, to egregious negligence by Michigan state and local Flint officials.

We’ve learned that millions of children are at risk of lead poisoning — or already have it. Undoubtedly adults too. And they can suffer a wide range of harms. But such research as we have focuses on young children because they’re at highest risk for lifelong damages.

So what then have our federal policymakers done since all this became common knowledge?

The U.S. Department of Housing and Urban Development has taken a first step toward strengthening protections against the most common sources of lead poisoning — old house paint and the soil around housing.

But I’ll defer that and focus here on water because it’s been made newly newsworthy by a cliffhanger we may see again.

The administration sent water, filters, funds and folks to Flint shortly after Michigan’s governor declared a state of emergency. But there are still reportedly problems with the water there. And they’ll cost many millions of dollars to fix.

Flint is hardly the only community with lead in the water that comes out of faucets in homes and schools. And, as with Flint, dumping some chemicals into the water supply won’t solve the problem. Lead pipes corrode and have to be replaced.

USA Today reports nearly 2,000 other water systems with higher lead levels than the maximum the Environmental Protection Agency has set as a trigger for action. They’re in all 50 states, it says.

In the District of Columbia too, it seems, though our big lead-in-the-water crisis supposedly ended in 2005 — not, however, because the District no longer has lead pipes. And not apparently because the chemicals added to the water protect us.

The agency responsible for public buildings recently found that over half the public school water systems it tested had lead levels higher than the EPA trigger.

That’s three times higher than what the Centers for Disease Control now says should trigger public health actions. So we’ve had a child health emergency for some time.

The Senate recently approved $220 million to address leaded water problems — this by an overwhelming majority. About $100 million would go to states with drinking water emergencies.

They’d get an additional $70 million to subsidize (not by much) loans for related infrastructure projects. Another $50 million would be divvied up among small, economically disadvantaged communities to help them comply with existing drinking water standards.

This much is fully offset in the much larger water resources development bill. The substantial investments needed to remedy water infrastructure problems would hinge on the outcomes of the annual budget process.

Leading Senate Democrats wanted the paid-for piece included in the continuing resolution needed to prevent a government shutdown. The Republican leadership would have none of it, though it included more than twice as much to aid recently-flooded communities, mainly in Louisiana.

A stalemate then because not enough Democrats would agree to vote on the CR unless it did something about both water crises. And the House couldn’t pass a CR without Democrats because too many Republicans there object to such a short-term stopgap.

A compromise forged by the House Speaker and Democratic Minority Leader averted this different sort of crisis. Seems that impending government shutdowns, like hangings, concentrate the mind wonderfully.

Basically, they agreed to amend the House version of the water resources bill. It had no funds for Flint or any other community whose residents, the youngest especially, are at risk of lead poisoning.

The amended bill, also passed by a large majority, would add $170 million. So there may be some money in the pipeline for some communities with lead in their water pipelines in the upcoming year.

But the $50 million difference in emergency spending is only one of many differences between the House and Senate bills. So negotiators will have a lot of work to do. And whatever they come up with will, of course, have to pass in both the House and Senate.

No such delay or doubts for the flooded communities, however, because their half million is in the CR. Some people’s water crises are more urgent than others.

Now, if lead-laden water had been flowing into members’ own homes — or out of the drinking fountains in their children’s schools ….


Progress Perhaps, But a Long Way to Go Before Every Kid Healthy

April 18, 2016

This is Every Kid Healthy Week, invented to celebrate what schools are doing to turn out healthy kids. Would that every kid were healthy — or even that schools could make them all so.

Not saying schools can’t do a lot, mind you. They can, for example, schedule daily physical activities and offer after-school and summer sports programs.

They can include nutrition in their curricula and get kids interested in healthful foods, e.g., by having gardens where they can plant and tend vegetables. And they can, of course, serve nutritious meals, even if Congress lets them off the hook somewhat.

They can also, in many cases, help ensure that kids who need those meals most actually get them by taking advantage of a new option called community eligibility. And a growing number of schools are.

That’s the good news. The bad news, also delivered shortly before this celebratory week, is that many children with dangerously high levels of lead in their blood are more likely to suffer toxic effects because they don’t get enough of the right kinds of things to eat. And no real news, alas, from Congress.

Free School Meals for More Poor Kids

Schools ordinarily require parents to apply for free or reduced-price meals for their children — and to reapply every year. This, needless to say, is a barrier, especially for parents who don’t read well and/or fear scrutiny by bureaucrats.

Schools must bypass this process for children whose families receive SNAP (food stamp) benefits. They may also directly certify children who receive certain other federal benefits, e.g., Temporary Assistance for Needy Families.

They can do this, however, only if their computer system links to systems in other agencies and can perform data matches. For this and perhaps other reasons, they missed well over one in five eligible children in 2013-14, the latest year we have figures for.

The newest version of the Child Nutrition Act gives some schools another option that eliminates not only the application and technology barriers, but another — the stigma low-income children feel if they go to the cafeteria.

Schools with at least 40% of children who automatically qualify for free school meals may opt for community eligibility. In other words, they can expand eligibility for free school meals to the entire student community.

Last year was only the second that all high-poverty schools could seize this opportunity. More did, the Center on Budget and Policy Priorities and the Food Research and Action Center report.

Just over half of all schools that could had adopted community eligibility by the end of the school year. A lot of variation, as one might guess.

The District of Columbia reached 87%, second only to North Dakota. Less than a quarter of high-poverty schools in 10 states were adopters. But almost all states had more schools participating than during the first year when what had been a pilot program became an option nationwide.

Higher Lead Poisoning Risks Due to Poor Nutrition

We’re all familiar now with exposure to lead poisoning — from water, as in Flint, Michigan, which put the problem on the public radar screen, and from other sources, e.g., paint, contaminated soil.

And we’re familiar with the lifelong damages that lead in the body can cause, especially in young children, and with the fact that alarming numbers of those tested have dangerously high levels of lead in their blood.

These children are only the tip of the iceberg because states don’t test all children for lead poisoning — even apparently all children at high risk. But what we do know indicates that it’s far more common among children in high-poverty communities — presumably then among poor and near-poor children.

Certain vitamins and minerals can reduce lead absorption and/or the toxic effects of lead absorbed. So a well-balanced diet does even more for children’s health than what’s commonly said.

Looked at the other way, children at high risk of lead exposure are also at higher risk for harmful health effects because the foods they’re served at home are less likely to deliver enough of the protective nutrients.

The Urban Institute tries to show an actual link by focusing on a subset of high-poverty counties — those that tested at least 1,000 children and found at least 5% with blood lead levels over the Center for Disease Control’s high-risk threshold.

The five with the highest test results also had child food insecurity rates above the very high national average, it reports. Most of the rest of the counties it sampled had higher than average rates too.

So, wrapping back around, high-poverty schools have an extra incentive, were one needed, to opt for community eligibility.

What Only Congress Can Do, But Isn’t

Community eligibility can do only so much. Many low-income children are too young for even kindergarten, of course. They’ll need well-balanced meals and snacks in daycare programs.

School-age children will need the same during summer months, when their families now often have to stretch their too-low SNAP benefits to feed them as many as 10 extra meals a week.

The Urban Institute draws the connection. Only Congress can expand and strengthen the programs that are supposed to prevent hunger and malnutrition among low-income children.

It’s again let the umbrella for these programs — the Child Nutrition Act — expire, though it’s given the current law a brief extension.

The Senate has had a pretty good bill to reauthorize the CNA pending since late January. But the Majority Leader seems more preoccupied with the Supreme Court vacancy — and with proving that he and his Republican colleagues can get something done.

Don’t even look to the House, which is apparently looking to the Senate to pass its version of the CNA. It will, of course, have to vote on a bill sooner or later.

Seems that action there could, among other things, roll back progress on community eligibility, since the draft committee bill would raise the opt-in threshold to 60% of poor and near-poor students.

Action to help Flint get the lead out of its water — and to prevent more such crises — seems stalled too, by one lone Senator, who asserts that Michigan has plenty of money.

No concern about lead poisoning elsewhere, but rather that his colleagues would just “funnel taxpayer money to their own home states,” as if they don’t have corroding lead water pipes too.

More concern on the part of the Majority Leader to protect a dubious Senate custom than endangered children, it seems  — or perhaps more to prevent another intra-party rift.

Too soon to say how any of this will ultimately pan out. But it’s clear that Every Kid Healthy Week is a bittersweet occasion.