Jillian McKoy, firstname.lastname@example.org
Michael Saunders, email@example.com
Michelle Falinski, Michelle.Falinski@bmc.org
In the months after the advance federal Child Tax Credit cash payments ended in December 2021, low-income families with children struggled the most to afford enough food. Black, Latino, Indigenous, and immigrant families were also disproportionately impacted by the loss of the cash relief benefit.
When Congress failed to renew advance Child Tax Credit (CTC) payments last year, public health experts feared that the loss of this monthly federal pandemic relief benefit would push millions of families and children in America back into poverty and hunger.
Now, a new study led by researchers at Boston University School of Public Health (BUSPH) and Boston Medical Center (BMC) reveals that in the months after this policy ended, there was a substantial increase in the percentage of US households with children that could not afford enough food to eat in a seven-day period—a situation known as food insufficiency.
Published in the journal JAMA Network Open, the study found that food insufficiency increased by approximately 25 percent among families with children from January 2022 to July 2022, after they stopped receiving monthly CTC payments on January 15, 2022. The monthly cash benefits were a cornerstone of the Biden administration’s American Rescue Plan, providing an estimated 92 percent of US households up to $3,000 per child ages 6 to 17 and up to $3,600 per child under age 6 from July 2021 to December 2021, with half of the credit amount distributed as advance monthly payments.
The study is the first to measure the impact of the expired benefits on food insufficiency among households, and it follows the researchers’ previous study in JAMA Network Open, which showed that the CTC expansion reduced food insufficiency by 26 percent in 2021, findings that President Biden cited during the White House Conference on Hunger, Nutrition, and Health in late September.
This increase in food insufficiency is an urgent problem, particularly among households with children, as poor nutrition uniquely affects the health and well-being of growing children, the researchers say.
“This significant increase in food insufficiency among families with children is particularly concerning for child health equity, as child health, development, and educational outcomes are strongly linked to their family’s ability to afford enough food,” says study lead and corresponding author Allison Bovell-Ammon, director of policy and communications at Children’s HealthWatch, headquartered at BMC. “Even brief periods of deprivation during childhood can have lasting impacts on a child.”
As Congress negotiates a year-end tax relief package, the researchers urge lawmakers to pass a fully refundable and inclusive advance CTC that ensures that all families with children across the US are able to afford enough food to keep their children healthy.
“The six short months of these Child Tax Credit advanced payments clearly made a big difference for American families, a permanent expansion would be a game-changer for reducing child poverty for good,” says study senior author Paul Shafer, assistant professor of health law, policy & management at BUSPH. “There is more to do to make sure that very low-income families actually get the monthly payments, prompting efforts like GetCTC.org, but a permanent expansion allows resources and awareness to build around the policy in a way that short-term fixes don’t.”
For the study, the researchers examined nationally representative census data on demographic characteristics, employment, social supports, and food insufficiency among nearly 600,000 household families, from July 2021 to July 2022 (the period before and after expiration of the CTC monthly payments).
The findings also indicate that the expiration of the CTC exacerbates racial and economic inequities in consistent access to adequate and healthy food. The study showed that low-income households experienced the greatest increases in food insufficiency after the advance payments ended in January—particularly in the spring, after many families likely depleted the second half of their CTC credits issued in a lump sum payment after tax filings. The analysis showed that single-adult, non-Hispanic Black, and Hispanic households—groups that historically have faced greater hardships around food access—also experienced greater food insufficiency after losing their advance CTC payments.
“Black, Latino, Indigenous, and immigrant families in the US consistently experience food insecurity—a broader measure that assesses quantity, quality, and variety of food —at higher rates than White families as a result of current and historical marginalization and systemic racism,” Bovell-Ammon says.
The expanded CTC in 2021 reduced racial inequities by ensuring access to the credit for predominantly Black, Latino, and Indigenous children who were previously excluded from the full benefits of the CTC, she says.
Immigrant families also experienced significant barriers to CTC access, says study coauthor Stephanie Ettinger de Cuba, research associate professor of health law, policy & management at BUSPH and executive director of Children’s HealthWatch. “These barriers were due in part to specific eligibility exclusions, but they also occurred even when immigrant families were eligible. Following the expiration of the payments at the end of 2021, the gains in racial equity were eroded, potentially further exacerbating racial and health inequities and increasing distrust.”
This study was also coauthored by Nicole C. McCann and Martha Mulugeta, PhD students in Health Services Research at BUSPH; and Julia Raifman, assistant professor of health law, policy & management at BUSPH.
About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
About Boston Medical Center
Boston Medical Center (BMC) is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. BMC offers specialized care for complex health problems and is a leading research institution, receiving more than $110 million in sponsored research funding in fiscal year 2021. It is the 13th largest funding recipient in the U.S. from the National Institutes of Health among independent hospitals. WellSense Health Plan was founded in 1997 as Boston Medical Center HealthNet Plan, now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in Boston HealthNet – 12 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.
JAMA Network Open
Method of Research
Association of the Expiration of Child Tax Credit Advance Payments With Food Insufficiency in US Households
Article Publication Date
Ms McCann reported receiving grants from the National Institute on Drug Abuse outside the submitted work. Ms Raifman reported receiving grants from the National Institutes of Health and the Robert Wood Johnson Foundation during the conduct of the study. Dr Shafer reported receiving grants from the Commonwealth Fund during the conduct of the study. No other disclosures were reported.