Iowa is the “First in the Nation” caucus state during presidential elections, so Iowans have a special opportunity—and responsibility—to insist that presidential candidates address the issues facing children and families. According to a recent poll, 80% of Iowa voters believe that children’s issues are a top priority for the next president to address.1

Since 1990, the Children’s Policy Coalition has worked to make child policy issues in five key areas—children’s health, early education, children’s safety and wellbeing, family economic security, and equal opportunity—part of the first-in-the-nation electoral dialogue. 

This guide presents key information about these five policy issues and the questions presidential candidates need to address and incorporate into their policy platforms. 

The Children’s Policy Coalition is a group of more than 20 nonprofit, nonpartisan organizations committed to electoral advocacy around children’s issues. The coalition does not endorse any candidates or parties.

The State of America’s Kids

Every child deserves to grow up healthy, safe, and free from poverty. As the cost of everything from rent to child care to college tuition goes up, families are having a harder and harder time meeting their children’s basic needs and providing opportunity for their futures. 

One in five infants lives in a poor household.2 The United States has a higher rate of infant mortality than other wealthy nations, but spends less money per capita on preventive care and welfare for infants and young children.3

  • More than half of Americans live in child care deserts, areas where there are either no licensed child care providers for children under the age of five or there is less than one slot in a licensed child care center for every three children under the age of five.4 
  • More than half of 3- and 4-year-olds are not in preschool. High-quality early education sets children up for success in school and career, and helps to narrow the opportunity gap for low-income children. Too many young children lack access to affordable, high-quality preschool programs.5 
  • Nearly two-thirds of fourth graders in American public schools are reading below proficiency. Children not proficient in reading by fourth grade are at greater risk of struggling academically and dropping out of school.6 
  • After years of steady decline, the number of children without health insurance rose by 276,000 in 2017. The uninsured rate is highest for American Indian children (12% uninsured) and Latinx children (7% uninsured).7 
  • Despite making up 25% of the population, children only receive 8% of federal budget funds, a decline from five years ago.8

Presidential candidates must present bold platforms on how they will ensure that every child in America has the opportunity to succeed and the safety and support to do so.

Candidates should describe specific policy solutions and plans across the following five areas of concern: 

  1. children’s health,
  2. early education,
  3. safety and wellbeing,
  4. family economic security, and
  5. equal opportunity.


Question for the Candidates
As president, what will you do to ensure all children have health coverage and get the health services they need? 

Insurance is the key that opens the door to the health-care system. When a child is covered, their parents can take them to the doctor when they are sick, go to the hospital without fear of catastrophic bills and get them the comprehensive preventive care that lays the foundation for lifelong health. 

Nationwide, we reduced the share of uninsured kids from 10 percent in 2008 to 5 percent in 2017, primarily due to bipartisan expansions of Medicaid and the Children’s Health Insurance Program (CHIP).9 In Iowa, the share of uninsured kids in 2017 was even lower, 3 percent.10

But signs of concern are emerging. Fewer U.S. children were enrolled in Medicaid and CHIP at the end of 2018 than the previous year. Data is preliminary, but does not appear to be fully explained by a good economy nor by kids moving to employer-sponsored insurance.11

Beyond coverage 

Health insurance coverage is the first step. Making sure kids get holistic care that includes — and goes beyond — treating illness and injury is equally important. Children need care that: 

  • Is delivered by providers who understand children’s unique developmental needs 
  • Focuses on preventive and well-child care to catch concerns early and head off chronic health conditions 
  • Incorporates mental and behavioral health 
  • Treats children in the context of their families and communities — the places they live, play and grow. 
Medicaid and CHIP play a critical role in getting kids the care they need 

U.S. children by type of insurance, 2017 

Source: Kaiser Family Foundation, “Health Insurance Coverage of Children 0-18,” 2017, accessed at 

Early Education

Question for the Candidates
As president, what will you do to ensure all families can find and afford child care and early education so children are prepared for school and parents can work? 

A child’s earliest experiences play crucial roles in the development of their brain and lay the foundation for future learning, behavior and health. Families with young children are especially financially stretched and need support so they can go to work or school. 

Quality, affordable early education provides children with a strong start and strengthens today’s workforce, giving parents the basic support that they need to perform well at work or school and contribute to their local economies. 

Recent boosts in federal child care investments have allowed states to better support providers, and in turn offer higher-quality care for more children. 

But widespread ‘deserts’ of unavailability exist, and a huge gap remains between what parents can afford and the actual cost of quality child care. This leaves parents — particularly those with low- and moderate-incomes — with limited options for care. 

Beyond child care 

A robust early childhood agenda also includes: 

  • Preschool experiences that help close the gap in school readiness 
  • Family leave policies that allow new parents to develop strong bonds with their infants 
  • Home visiting and family support initiatives that help parents grow in their important roles as their child’s first teacher, nurse and nurturer 
  • Early intervention services that respond to children’s developmental needs 
Working families are the norm
Child care is a major family expense 

The average cost of center-based infant care exceeds tuition and fees at a four-year public university in 28 states and DC, Iowa among them.13

Children’s Safety and Well-Being

Question for the Candidates
As president, what will you do to ensure the safety and well-being of all U.S. children? 

Being part of a family is a basic human need. Ample research has shown that removing children from their parents, even when necessary for their safety, is in itself a source of trauma. 

Recent federal legislation is pushing state child welfare systems to prevent out-of-home placements when possible — for example, by helping parents get mental health or substance abuse treatment or improve parenting skills — and place children who must be removed in family settings, with relatives when possible. 

Progress is real but uneven, with fewer gains for older teens and children of color.15 Better meeting their needs, and those of older teens who “age out” of the system without permanent connections to family, require continued effort. 

Strengthening families 

The Strengthening Families framework identifies five family “protective factors” that reduce the likelihood of child abuse and neglect: 

  • Parental resilience, the ability to bounce back from challenges that emerge in every family’s life 
  • Social connections that offer emotional support, parenting advice and opportunities to give back 
  • Concrete support in times of need, including food, shelter, clothing and help in times of crisis 
  • Knowledge of parenting and child development so parents have appropriate expectation 
  • Social and emotional competence of children, including ability to self-regulate behavior and communicate feelings16 
Young children are most likely to experience abuse or neglect 

Child Maltreatment rate* by age, 2017 (per 1,000)17;

Older foster youth face special needs 

Half of teens in care “age out” of the system without permanent connections to family who can ease the transition to adulthood. 

Family Economic Security

Question for the Candidates
As president, what will you do to ensure all families have the resources to meet their children’s basic needs and invest in their futures? 

Growing up in poverty is one of the greatest risks to child well-being, often bringing stress and adversity that hinders all aspects of development: social, emotional, physical and cognitive. 

Even after modest gains during the recent economic recovery, many parents still struggle to meet the needs of their family. Today, nearly 1 in 5 U.S. children — more than 13 million kids — live in poverty.19

Helping families make ends meet is a key way to improve child outcomes. Research has shown that even a modest boost in parental income or work support programs in the early years is connected to future school and employment success. 

Roadmap to reduce child poverty 

The National Academies of Sciences, Engineering and Medicine this year released “A Roadmap to Reducing Child Poverty,” which came to the “overwhelming conclusion” it is feasible to cut the U.S. child poverty rate in half within a decade.20

It outlined possible “packages” of policies and programs to achieve the goal, including mixes of: 

  • Tax codes changes, including expansions of the the Earned Income Tax Credit, Child Tax Credit and Child and Dependent Care Tax Eredit 
  • Improved SNAP benefits for children 
  • Better access to housing and child care assistance programs 
  • Expanded benefit eligibility for immigrant families 
  • Higher federal minimum wage21 
Young children most likely to be in poverty 

Share of population below 200 percent of poverty by age22

Children are more likely to live in poverty than working-age adults or seniors. The federal poverty level in 2017 was $20,420 for a family of three. Twice that amount —200% of poverty — is considered a more accurate measure of what it actually takes for a family to make ends meet. 

Equal Opportunity

Question for the Candidates
As president, what will you do to end discrimination and ensure that all children have equal opportunities? 

Obstacles that perpetuate racial disparities often derail children of color, undercutting their incredible potential. For our nation to move forward, we need all of our children to have access to resources and opportunities to succeed. 

Today, nearly half of U.S. children are children of color (from 31 percent non-white in 1990 to 47 percent in 2017) and one-quarter have at least one immigrant parent (from 13 percent in 1990 to 26 percent in 2017).23

For children in immigrant families, especially the 5 million living with an undocumented parent, the threat of separation from family is greater than at any time in recent history.24

Many hard-fought gains — from anti-discrimination in education, employment and housing to expanded rights to public accommodation — are under threat, and much work remains to fully acknowledge and dismantle the systemic barriers faced by children of color and their families. 

Action steps 

A serious equity agenda must: 

  • Close gaps in access to and quality of health and education services to help children of color grow up healthy and ready for life 
  • Increase economic opportunity for families of color 
  • Enforce and expand anti-discrimination policies 
  • Keep families together and in their communities 
Children of color face obstacles

A recent KIDS COUNT report by the Annie E. Casey Foundation, measured children’s progress on 12 key education, health and economic milestones by race. 

It developed a composite score of these milestones on a scale of one (lowest) to 1,000 (highest) to make comparisons. No group has all its children meeting milestones, but black, American Indian and Latino children face the biggest barriers to stability and opportunity to reach their fullest potential.25


1 Children’s Policy Coalition. “Poll Reveals that Children’s Issues are Most Important to Iowa Voters for 2020.” 5/29/2019. 

2 Zero To Three. “High baby and toddler poverty rate a wake-up call for America, leading early childhood development expert says.” 9/12/2018. 

3 Time. “American babies are less likely to survive their first year than babies in other rich countries.” 1/9/2018. 

4 Center for American Progress. “America’s Child Care Deserts in 2018.” 12/6/18. 

5 The Annie E. Casey Foundation. 2018 Kids Count Data Book: State Trends in Child Wellbeing. 

6 The Annie E. Casey Foundation. 2018 Kids Count Data Book: State Trends in Child Wellbeing.  

7 NPR. “Number of U.S. kids who don’t have health insurance is on the rise.” 11/29/18.

8 First Focus. Children’s Budget 2018. 

9 Joan Alker and Olivia Pham, “Nation’s Progress on Children’s Health Coverage Reverses Course,” Georgetown Center for Children and Families, November 2018. 

10 “Medicaid: Putting Iowa Children on a Path to Success,” Georgetown Center for Children and Families and American Academy of Pediatrics, 2019. Accessed at 

11 Tricia Brooks, Edwin Park and Lauren Roygardner, “Medicaid and CHIP Enrollment Decline Suggests the Child Uninsured Rate May Rise Again,” Georgetown Center for Children and Families, May 2019. 

12 Population Reference Bureau analysis of data from the U.S. Census Bureau American Community Survey, via Kids Count Data Center, 2017. 

13 Child Care Aware, “The US and the High Cost of Child Care 2018 Report,” accessed at costofcare/ 

14 University of Iowa 2017-18 tuition, accessed at undergraduate/2017-2018 

15 Annie E. Casey Foundation, “Keeping Kids in Families: Trends in U.S. Foster Care Placement,” April 2, 2019. Accessed at 

16 Center for the Study of Social Policy, “About Strengthening Families™ and the Protective Factors Framework,” Accessed at 

17 U.S. Department of Health & Human Services, Administration on Children, Youth, and Families, Children’s Bureau. (2002-2019). Child Maltreatment 2000-2017. Via Child Trends, “Key facts about child maltreatment,” Accessed at https://www. 

18 Annie E. Casey Foundation, “Fostering Youth Transitions: Using Data to Drive Policy and Practice Decisions,” November 13, 2018. Accessed at https://www. 2 Annie E. Casey Foundation, “Fostering Youth Transitions: Using Data to Drive Policy and Practice Decisions,” November 13, 2018. Accessed at https://www. 

19 Annie E. Casey Foundation, “2019 Kids Count Data Book: State Trends in Child Well-Being.” Accessed at 

20 The National Academies of Sciences, Engineering and Medicine, “A Roadmap to Reducing Child Poverty, 2019. Accessed at DBASSE/BCYF/Reducing_Child_Poverty/index.htm 

21 First Focus Campaign for Children, “Implementing A Roadmap to Reducing Child Poverty,” 2019. Accessed at sites/2/2019/06/Implementing-A-Roadmap-to-Reducing-Child-Poverty.pdf 

22 U.S. Census Bureau American Community Survey, 2017. 

23 Annie E. Casey Foundation, “2019 Kids Count Data Book: State Trends in Child Well-Being.” Accessed at 

24 Annie E. Casey Foundation, “2017 Race for Results: Building a Path to Opportunity for All Children.” Accessed at 

25 ibid.