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America has made progress against child neglect with a program that barely mentioned that as one of its goals – the expansion of Medicaid.
Most of us want governments to do more to stop child abuse and neglect, but targeted efforts have seldom met expectations. However, since some states expanded Medicaid under the Affordable Care Act (ACA) medical researchers have found a range of effects, some unexpected, by comparing trends in the states that did and did not expand the program. Dr Emily Brown of the Seattle Children's Research Institute decided to see if there had been any impact on child neglect and non-sexual child abuse.
A key part of the ACA's efforts to make medical cover available to all Americans involved the federal government offering money to states to expand Medicaid to people previously ineligible to receive it, but considered too poor to afford private health insurance. Twenty-four states (and Washington DC) agreed to the program immediately. However, 26 states where the governors or legislature objected to the program initially refused to participate. The decision put a major hole in the objective of achieving near-universal coverage, but it proved an exceptionally valuable opportunity for scientists, creating a massive experiment in how government-sponsored medicine affects public health, made even stronger when seven states joined at later dates.
The baseline figures for abuse and neglect prior to the Medicaid expansion make horrifying reading. More than a million children met official classifications for neglect, and those are only the ones reported to authorities.
Both abuse and neglect dropped after 2014, Brown reports in JAMA Network Open, but the reduction was small in the states that refused expansion. There was a larger drop in physical abuse in expansion states, but the difference was not statistically significant. However, states that expanded Medicaid experienced a major, and very significant, fall in neglect. For every 100,000 children, 422 fewer suffered neglect; one in nine of those who would otherwise have suffered neglect were spared that pain.
Child abuse and neglect are primarily tragedies for the children involved. Years before launching the ACA President Obama summarized the justification for programs like it saying: “If there's a child on the south side of Chicago who can't read, that matters to me even if it is not my child.” Even those who disagree with that basic principle might consider the economic consequences of child abuse and neglect. A single year's worth of child maltreatment is estimated to cost America $124-$428 billion dollars in increased medical care and lower productivity.
Among the hundreds of positive results from similar studies are that Medicaid expansion led to improved mental health for low-income parents, reduced infant mortality, and earlier diagnosis of cancer, leading to better treatment.
