SALT LAKE CITY — Utah is one of the best states for a child to live in, according to new findings in an extensive report from the Annie E. Casey Foundation, a national children's advocacy organization.
The report, titled Kids Count, last week ranked Utah seventh in overall child well-being in 2015, the latest year for which data has been finalized.
Based on statistics compiled using numerous factors, Utah finished fifth in children's economic well-being, 15th in education, third in family and community influences and 19th in children's health.
But leaders of Voices for Utah's Children, another children's advocacy group, believe the data now represent a snapshot in time more so than an ongoing positive trend, thanks to potentially sweeping changes to health care in the United States.
"We see trouble ahead," said Voices for Utah's Children CEO Micah Nehring.
"(It is) frightening considering the uncertainty around the Medicaid and CHIP programs," Nehring said, referring to the Children's Health Insurance Program.
Utah's "continual improvement in our health ranking" in the landmark report, according to Nehring, are "largely due to our reduced number of children without health insurance."
Between 2010 and 2015, the number of children without health insurance declined from 11 percent to 7 percent in Utah, the Kids Count report found.
If the American Health Care Act were to pass the U.S. Senate in its current form, predictions from the Congressional Budget Office say 23 million more Americans will be without health insurance by 2026, compared to current law, and $834 billion in Medicaid funding will be slashed.
"The AHCA cuts will likely lead to children losing health care coverage and Utah kid of moving back," along with the rest of the country, Nehring said.
Utah ranks close to the national average in teenager alcohol and drug abuse as well as child and teenager mortality rate. However, the percentage of eligible children who are enrolled in the Children's Health Insurance Program in Utah rate dead last in the country among Hispanic children and close to last generally.
Jessie Mandle, senior health policy analyst for Voices for Utah's Children and a member of the state's Medical Care Advisory Committee, said children frequently don't enroll because of a lack of awareness by the family.
"They just don't know about these programs," Mandle said.
Funds provided at the state level to fund information campaigns about the Children's Health Insurance Program have greatly dried up since 2007, she said.
"We have great community partners in outreach and enrollment, but without state funding, we're still going to have a hard time," Mandle said.
Dr. William Cosgrove, a pediatrician who sits on the Salt Lake County Board of Health and is vice chairman of the Utah Medical Care Advisory Committee, said immigrant communities often shy away from signing up for government programs because of fears about themselves or loved ones being deported.
"The kids are often eligible, but the parents just either aren't aware of it or they think that if they sign up for it, somebody's going to put them on a list for deportation," said Cosgrove, who also previously served as president of the Utah chapter of the American Academy of Pediatrics.
The resulting lack of insurance can have a legitimate impact on children's health, Cosgrove said. He cited a 2009 John Hopkins study, which analyzed 23 million child hospitalizations, and found that children without insurance were 60 percent more likely to die during their hospital stay — from 5 in 1,000 to 8 in 1,000.
Despite receiving the same care while in hospitals, families without insurance may not seek medical care as quickly as those who do, Cosgrove said.
"If you don't have insurance, then parents tend to delay a little bit," he said, adding that, emotionally, "(Insurance represents) permission for the family to seek help as soon as they think they need it rather than thinking of themselves as outside the fence or disenfranchised."
Metrics besides health
Under the family and community category, Utah's highest ranking metric in the Kids Count report, the number of children who live in single parent families in Utah in 2015 was just a little more than half of the national rate: 19 percent compared to 35 percent. And only 8 percent of children lived in homes without a high school diploma in 2015, compared to 14 percent nationally.
There were also fewer children living in high-poverty areas and fewer teenagers giving birth in Utah compared to nationwide averages.
Economic well-being measures also showed Utah children are doing comparatively well. Children whose parents "lack secure employment" was just 20 percent, compared to 29 percent in the United States generally, the Kids Count report found.
About 26 percent of Utah children in 2015 were estimated to be living in a home with a high housing cost burden — where at least 30 percent of the household's income goes toward rent or a mortgage. That's compared to a 33 percent average nationwide.
Despite promising economic trends in Utah, economic instability and poverty deeply affect every aspect of the well-being of children who aren't seeing the fruits of the state's overall economic success, Nehrig said.
"If you're a child in poverty, that suggests that you're (also) going to have challenges accessing health care and succeeding in school," he said.
Under the education metric, Utah slightly beat the nationwide average in number of high school students who don't graduate on time, and did well in significant reading and mathematics benchmarks. In all, about 60 percent of Utah fourth-graders were not considered proficient in reading in 2015, compared to 65 percent nationwide.
About 62 percent of Utah eighth-graders were considered not proficient in math, compared to the larger 68 percent average in the United States.
However, advocates also have plenty of concerns over how cuts to Medicaid funding could affect special needs education in schools. Medicaid dollars are dispersed by school districts, who staff and coordinate those programs.
"That makes a huge difference for our schools, with the ability of kids with special health care needs to learn and thrive," Mandle said. "(Medicaid cuts) would have a significant impact on our schools. I think people don't realize the impact Medicaid has on our schools and special needs children."
Emily Ybarra, of Lehi, believes that dried up Medicaid spending under the American Health Care Act would be devastating to her 9-year-old son, who is autistic and relies on robust funding directly and through the help provided in his customized special needs class at school.
"He didn't talk until he was 4 (years old). Now he's 9 and he talks nonstop, he's very bright," Ybarra told the Deseret News recently. "He's doing phenomenal and my worry is that if there's cuts, it will make it so that he or other children do not get those services. Because those are vital resources. if those kids don't get those resources it's really tough on the kids and the families and the school system."
Ybarra said her school can currently afford to put "three of four aides," plus a teacher, in a specifically tailored class of only 14 students. That environment, combined with speech therapy since Ybarra's son turned 3, has paid off for her family in the long run, improving his test scores and communication skills, she said.
"It really hits home because my son has been able to get services from the get-go, and he's made so much progress because he's been able to get those services," she said. "If you reduce the money that goes into those service, the quality's not going to be very good."
Ybarra believes special education saves the government money in the long run because it helps children with learning and physical disabilities live well-adjusted lives well beyond their time in school. If special education quality is subpar, she said, the government could eventually find itself paying in otherways "for all these adults who can't live on their own."