RALEIGH, N.C. -- The number of uninsured children is swelling in North Carolina and a dozen other states that have not opted to expand their Medicaid programs, according to new data from the Georgetown University Center for Children and Families.

An estimated 142,000 North Carolina children were uninsured in 2019, and experts say the number has likely grown during the pandemic.

Kaylan Szafranski, health program director for NC Child, said a generation of young children will miss out on critical health needs, potentially with lifelong consequences.

"And so, in practical terms, what this really means is that 142,000 children are missing out on important developmental screenings, immunizations, checkups that keep them on track for school," Szafranski contended.

North Carolina lawmakers have refused to raise the income threshold for Medicaid eligibility, which would open healthcare access to more low-income, working parents.

The American Rescue Plan signed into law last week offers states major financial incentives to expand the program, but it remains unclear whether lawmakers will be swayed.

Among the holdout states, almost three-quarters of adults who would gain coverage live in the "big four" states; Texas, Florida, Georgia and North Carolina.

Szafranski explained getting parents health coverage creates a "welcome mat effect."

"When parents have access to care themselves, it improves the child's access to coverage and care and services that they need as well, because the whole family is engaged in the health system and is utilizing care," Szafranski argued.

Democratic Gov. Roy Cooper has repeatedly attempted Medicaid expansion, but faced obstacles in the Republican-led Legislature.

Adam Searing, health-policy research professor at the Georgetown University Center for Children and Families and the report's lead author, said among voters, the issue crosses party lines.

He noted residents of other "red" states, like Missouri and Oklahoma, have chosen to expand Medicaid.

"Once you get outside the legislatures and the governorships, even in very conservative states, expansion is very popular with Republican voters and with Democratic voters," Searing observed. "It really is a bipartisan policy that appeals to a wide range of people."

According to the report, 92% of people in the Medicaid coverage gap live in the South.

Despite a recent policy victory, Wisconsin labor leaders still express concern about the current environment for shielding young teens from unsafe work environments.

Gov. Tony Evers this month vetoed a bill which would have expanded the elimination of required work permits for those younger than 18. The bill's language applied to 14- and 15-year-olds, several years after the state did away with parental permission for 16- and 17-year-olds.

Stephanie Bloomingdale, president of the Wisconsin State AFL-CIO, said the recent debates are policy fights advocates thought they won decades ago when minors often worked in dangerous conditions. She cautioned there is a strong push to chip away at protections.

"We are seeing a growing movement from different, unscrupulous employers that want to put kids back in the workplace, and not have the kind of oversight that is needed," Bloomingdale contended.

The Economic Policy Institute said rollbacks have been approved in a dozen states in the past few years. While current efforts are thwarted in Wisconsin, Bloomingdale worries about similar debates in future sessions.

Meanwhile, violations are trending upward, with the U.S. Labor Department reporting an 83% increase in financial penalties. Backers of the Wisconsin bill said the goal was to reduce red tape for families.

Bloomingdale countered taking away another layer of protection does more to trample on the rights of parents and guardians. And with higher consumer prices placing more pressure on household budgets, she added some kids might feel the need to bring in additional income.

She emphasized the current law helps the whole family make an informed decision.

"It's important for kids to get a good work ethic," Bloomingdale acknowledged. "But at the same time, these kids need to make sure that they are getting enough sleep, that they are able to participate in their school, and really making sure that balance is there."

The Economic Policy Institute report showed amid the push in many states to weaken laws, several other states have advanced bills to strengthen protections. There have been bipartisan bills in Congress which, among other things, would crack down on violators.


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As communities across Georgia come together to raise awareness during Child Abuse Prevention Month, local groups are taking steps to equip parents with the resources and support to prevent adverse childhood experiences year-round.

The Gwinnett Coalition, in partnership with the Georgia Center for Child Advocacy, is launching a series of parenting courses as a part of Resilient Gwinnett.

Sandy Chavarria, Hispanic outreach prevention coordinator at the Georgia Center for Child Advocacy, said the goal is to give parents more resources and tools to foster resilience and safeguard children's well-being.

"Our offerings are centered around learning how we can better protect our children from child abuse, child maltreatment -- well, more specifically, child sexual abuse," Chavarria explained. "We've also been focusing on providing education on childhood adversity."

Chavarria pointed out they are hosting two classes to address these topics. The first class, called the Positive Parenting Program, will be held May 16. She said it covers key points for creating an encouraging environment through expectations, discipline and self-care for parents.

The second class, titled "Becoming a More Resilient Parent," takes a deeper dive into addressing trauma. It will be held Sept. 17.

Kamesha Walker, community health program manager for the Gwinnett Coalition, believes resilient parenting classes are essential for helping parents cope with the challenges of parenthood and teaching them to recover their strength, ultimately enabling them to support their children's adaptability. Walker emphasized the importance of self-care, mindfulness and self-compassion in fortifying parents and children alike.

"Being a parent, there's no book," Walker emphasized. "These parents in classes would provide just some kind of structure, some kinds of guidelines to help those who may want assistance. So when they're able to be more resilient, then they are able to have their children be resilient."

Walker and Chavarria said they hope the classes help foster safe and stable environments leading to fewer adverse childhood experiences and building on the positive ones. In 2023, nearly 55,000 caseworkers investigated reports of abuse and neglect involving more than 106,000 children.

The shrinking supply of child-care workers continues to impact Kentucky, and advocates say helping more people receive a Child Development Associate degree could fill critical gaps in child care and early learning - especially in rural regions.

Jennifer Roe is an early-childhood coordinator with Save the Children's Early Steps Program who's currently enrolled in a CDA program at Eastern Kentucky University.

She said it hasn't been easy working full time while in school, but says Save the Children's Career Pathways Program has helped with tuition and other resources, putting her on track on track to graduate next spring.

"When I walk across that stage with that diploma in my hand, it's going to be one of the most rewarding things I've ever done," said Roe. "And not only for myself, but for the families that I serve and for my community."

According to the Bureau of Labor Statistics, on average, more than 153,000 openings for child-care workers are projected over the next decade - largely driven by the need to replace workers who have left the field or retired.

Save the Children's Career in Education Workforce Development Managing Director Karen Harrison said the program aims to reduce barriers to obtaining a credential or higher-education degree.

"We either pay all or partial of their tuition," said Harrison. "We pay stipends for books, supplies and materials. And we also give barrier-reduction stipends; we know that child care for participants themselves can be an issue."

Roe added that a CDA degree opens the door to immediate job opportunities working in day-care centers, opening a child-care business, or teaching preschool.

"We can't wait 'til they get to kindergarten and expect them to know their ABCs and such," said Roe. "They've got to know when they get there because, if they don't, they're already behind."

Meanwhile, Kentucky child-care providers say the state's industry is on the verge of collapse when federal pandemic funds expire this fall.

In a recent letter, hundreds of providers across the state asked lawmakers to pass a supplemental funding bill to help centers stay afloat.