Health equity devolves to cities and states as the federal government cuts taxes for the wealthy
I have a bunch of pieces on equity planning and social urbanism, touched off by my experience on a DC Grand Jury. As one of the court reporters said "breaking the cycle--man, we're just cutting the grass." I figured that the city spends a couple billion dollars a year on the impoverished in DC, just to keep them in place.
-- "An outline for integrated equity planning: concepts and programs" (2017)
-- "Equity planning: an update" (2020)
-- "Social urbanism and equity planning as a way to address crime, violence, and persistent poverty: (not in) DC" (2022)
-- "Experiments in Social Urbanism"
-- "'Social urbanism' experiment breathes new life into Colombia's Medellin Toronto Globe & Mail
-- "Medellín's 'social urbanism' a model for city transformation," Mail & Guardian
-- "Medellín slum gets giant outdoor escalator," Telegraph
-- "Medellín, Colombia offers an unlikely model for urban renaissance," Toronto Star
United Way Greater Toronto for more than a decade has focused its program funding on languishing impoverished neighborhoods ("Guiding the United Way through the next decade," Toronto Star). From the article:
United Way Greater Toronto just launched an incredibly ambitious 10-year strategic plan. We’re going to sustain the 10 community hubs we have and create 10 more. Hubs are like a one-stop shop for social and healthcare services in neighbourhoods that need it most. So, it improves access to services. It improves quality. It pulls together organizations under one roof, so it increases collaboration across organizations.
Our second goal is a community real estate vision. Seventy per cent of the community organizations we support are at risk of losing their space, and they’re also at risk of then being, in essence, priced out of communities that need them the most. We have a real focus on supporting those organizations to ensure the stability of those physical sites being owned by community organizations and stewarded for generations to come.
At least with the cities, the programs tend to wax and wane as new administrations succeed previous ones more committed to poverty.
If we think that cities (and counties, see "Pontiac Michigan: a lagging African American city in one of the nation's wealthiest counties" and "East County, Montgomery County, Maryland: Council redistricting spurs ideas for revitalization | Part 1 -- Overview") should focus on addressing poverty with place-based solutions, I'm thinking it's the same with health equity. Programs like Medicaid expansion--run at the state level in most places--provide health care to people who are medically needy.
This op-ed in City & State by NYC's health commissioner, "I am New York City’s doctor. This is how we treat chronic disease" makes the point that as the federal government cuts health programs (and medical research) cities and states should step up and fill the gap.
[RFK Jr.] has fired at least 20,000 employees from the Department of Health and Human Services. Billions of dollars in lifesaving medical research have been cut. Tens of millions of Americans, including millions of New Yorkers, will lose their Medicaid, Medicare, and Supplemental Nutrition Assistance Program (SNAP) benefits because of Republicans’ “One Big Beautiful Bill.” The record-breaking government shutdown multiplied the confusion and loss.
... My job is to support all New Yorkers in leading their healthiest lives, no matter their income or neighborhood. We have the experience and expertise to improve outcomes and even prevent chronic disease entirely. We know what approaches are proven to make a lasting impact.
That’s why, at the New York City Health Department, we recently released a city-wide chronic disease prevention strategy, which outlines how local government can address the root causes of chronic disease.
The strategy recommends promoting healthy living through nutritious foods and physical activity. But we must also meet people’s material needs. Improving access to basic resources – with direct cash payments, grocery credits and more – has a proven impact on health. And informed conversations around marketing, product design and creative media approaches can increase consumer awareness of the health impacts of the products they buy.When people can afford the things they need – housing, health care, the ability to put healthy food on the table – they aren’t waiting to be treated in the ER once they’re in crisis.
This also comes up in Chicago, with multi-decade differences in life expectancy based on race, income, and neighborhood ("As they live Chicago's 'death gap,' a 3-generation family fights to end it," Chicago Sun-Times).
I have a series of articles about developing a comprehensive program at the bigger city scale on health equity, but I never termed it that way. City and county poverty amelioration programs need to focus on health equity as an element of equity planning, and these entries lay out a way forward.
-- "Revisiting East of the River medical care: United Medical Center" (2018)
-- "Update on DC's plans to build a new United Medical Center" (2018)
-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital" (2018)
Labels: change-innovation-transformation, civic assets, crime, criminal justice system, equity planning, health and wellness planning, health equity, policing, public safety, social urbanism, urban design/placemaking
posted by Richard Layman @ 3:30 AM&Permanent Link
23 Comments:
https://unbiasthenews.org/dollar-stores-food-deserts-in-chicagos-frontline-communities-redlining/
Dollar stores, diesel fumes and food sovereignty in Chicago’s frontline communities
Understanding and Addressing Racial Disparities in Health Care
Health Care Financing Review, 2000
https://pmc.ncbi.nlm.nih.gov/articles/PMC4194634/
Racial disparities in medical care should be understood within the context of racial inequities in societal institutions. Systematic discrimination is not the aberrant behavior of a few but is often supported by institutional policies and unconscious bias based on negative stereotypes. Effectively addressing disparities in the quality of care requires improved data systems, increased regulatory vigilance, and new initiatives to appropriately train medical professionals and recruit more providers from disadvantaged minority backgrounds. Identifying and implementing effective strategies to eliminate racial inequities in health status and medical care should be made a national priority.
On the hook for uninsured residents, counties wonder now how they’ll pay
https://www.ocregister.com/2026/01/06/on-the-hook-for-uninsured-residents-counties-wonder-now-how-theyll-pay/
This is about Ontario, but still relevant to the US.
https://www.thestar.com/opinion/contributors/reducing-ontario-health-care-waits-six-solutions-avoiding-privatization-pitfalls/article_9db9be78-d44b-4bfe-8809-637452c5d0b9.html
Reducing Ontario health care waits: Six solutions avoiding privatization pitfalls
- need more beds, need more beds in nursing homes, rehab, and long term care
- Why do operating rooms close by 4 p.m. while patients are stuck on wait-lists? If Ontario can find billions to build private clinics, it can afford to run its own ORs past 4 p.m.
- more family doctors and a better system of preventative care
- wait times for certain specialties are worse than others. Single‑entry models put referrals into a single queue so patients get assigned to the first available specialist. This reduces wait times and prioritizes patients.
- lack of access to health records.
Actually in the US, with the use of Electronic Health Records this isn't an issue. It can be a problem if you are a patient in multiple systems, although most systems do provide a way to share, at least in Utah.
- better records for vaccines
Again, with good EHR systems, this isn't a problem in the US.
St. Francis Hospital, Wilmington, DE, Healthy Village concept
Healthy Villages are located in economically challenged neighborhoods and are designed to enhance the traditional safety net hospital model. The partners are typically organized and engaged according to investments in the Social Influencers of Health:
Economic stability (e.g., meaningful jobs and careers)
Safe neighborhoods (e.g., housing, transportation, parks, retail services)
Education (from literacy to higher education and everything in-between)
Food security (including good nutrition)
Social support (e.g., childcare, adult daycare)
Health care (e.g., emergency services, short-term stays including observation beds, post-acute care such as behavioral health and skilled nursing, primary care, care management and access to quality specialty care when needed)
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https://delawarelive.com/saint-francis-hospital-sees-healthy-village-as-national-social-services-model-for-healthcare/
https://delawarelive.com/saint-francis-hospital-sees-healthy-village-as-national-social-services-model-for-healthcare/
Located in economically challenged neighborhoods, Healthy Villages are designed to enhance the traditional safety net hospital model.
“The goal is to create the ultimate one-stop care setting that promotes synergy, diversity, and equity,” said Lillian Schonewolf, executive director of the Healthy Village at Saint Francis, in a YouTube video.
According to Marlow Levy, who became president of Saint Francis Hospital and Mercy Fitzgerald Hospital in Darby, PA, in August, Saint Francis is the only hospital in the country with a Healthy Village.
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Why St. Francis is making housing and community services priorities at the hospital
https://www.delawareonline.com/story/news/health/2022/09/02/st-francis-community-health-with-partners-within-hospital-healthy-village/65418073007/
To address these needs, Delaware's only Catholic hospital has announced plans to treat much more than medical conditions with the inception of its Healthy Village, an endeavor that intends to locate organizations offering community services inside the 98-year-old hospital.
"Taking care of someone's medical needs is really only 20% of their care," said Lillian Schonewolf, Trinity Health Mid-Atlantic's Vice President for Community Health and Well Being and Healthy Village's Executive Director. The other 80% includes addressing a person's behavioral, social and environmental well-being.
Based on research the hospital conducted that focused on Wilmington's west side, Schonewolf said they found the area's top concerns include trauma from gun violence, lack of healthy food options, housing issues, and behavioral and mental health treatment. Additional interviews with residents in the hospital's surrounding neighborhood also identified education, job training and senior care as desired services.
Through partnerships with community organizations, service providers will occupy whole floors or just an office inside the hospital to allow St. Francis' patients — many of whom do not own vehicles — a convenient one-stop shop of sorts for vital resources. Healthy Village partners will pay for their space inside the hospital, along with electricity and water. Administrators said they also anticipate increased usage of the hospital's cafeteria and environmental services.
Safety Net Barriers Add to Child Poverty in Immigrant Families
https://www.nytimes.com/2023/04/06/us/politics/child-poverty-immigrants.html
New research shows we pay doctors less to care for Black and Latino patients than white ones
We get what we pay for. In the U.S., doctors are paid very different sums for different patients, even when providing the same service.
https://www.inquirer.com/opinion/commentary/healthcare-doctor-pay-less-black-hispanic-patients-20260111.html
Our new research shows that practices receive 8.8% less for visits with Black patients and nearly 10% less for Hispanic patients than for their white peers. For children, the gaps are even wider. Physicians got 13.9% less for visits with Black children and 15% less for Hispanic children.
https://ldi.upenn.edu/our-work/research-updates/new-national-study-finds-doctors-paid-less-for-treating-black-and-hispanic-patients/
We get what we pay for. In the U.S., doctors are paid very different sums for different patients, even when providing the same service. Commercial insurance tends to pay the most. Medicare, which primarily serves older Americans, pays less. And in most states, Medicaid, which serves low-income Americans, pays the least.
What does this mean for a child on Medicaid? Many physicians refuse to treat anyone with Medicaid. When researchers posed as parents and called pediatrician offices seeking an asthma appointment, over half of callers with Medicaid were denied appointments.
Yet, when these same clinics received a call about a child with private insurance, every single one offered an appointment. Financial incentives matter.
This disparate pay will only worsen after the largest funding cut in Medicaid’s history. The recently passed “One Big Beautiful Bill Act” reduced federal Medicaid support by roughly $1 trillion over the next 10 years.
States now face three options: remove people from Medicaid, cut optional services, or further reduce what they pay providers. States like North Carolina have already moved to cut doctor pay, and others will likely follow suit.
Even among patients with similar coverage, like commercial insurance, Black and Hispanic patients still found themselves in plans that paid doctors less. These differences amount to a “tax” physicians face for treating patients whose health insurance pays less. This tax not only penalizes physicians in safety net roles but also shapes which patients ultimately get treated.
Physicians provide more care when they are paid higher prices. One frequently cited study showed that raising physician payment by 2% resulted in 3% more care provision. Based on this figure, we project that eliminating pay disparities would cut the gap in general checkup visits by more than half between white children and Black or Hispanic children.
As long as we provide less incentive to treat some patients, we will get what we pay for: a system that falls short for people with less, especially children. Reversing this trend will require strengthening Medicaid rather than gutting it. Raising Medicaid payments to doctors to be equal to Medicare rates would improve access, evidence suggests. But reforms like this require investment.
https://www.nejm.org/doi/full/10.1056/NEJMsa1413299
In Philly, Medicaid and SNAP cuts will be big — but not beautiful
Roughly a third of city residents rely on Medicaid and SNAP benefits. They are not abstract budget numbers. They are policy decisions that will impact the health and dignity of our neighbors.
https://www.inquirer.com/opinion/commentary/big-beautiful-bill-snap-medicaid-cuts-impact-philadelphia-20260526.html
According to the Pennsylvania Partnerships for Children, Philadelphia County is projected to lose $11.4 billion in Medicaid and SNAP funding between 2027 and 2034.
In our city, 34% of residents — including 68% of children — rely on Medicaid for healthcare coverage. In 2023, nearly 30% of Philadelphians received SNAP benefits to help put food on the table. As these cuts take effect, thousands of residents are expected to lose Medicaid coverage entirely, while many more households could lose some or all of their food assistance.
Behind every number is a family struggling to afford groceries, a child in need of medical care, or a senior depending on long-term support services. These are not abstract budget numbers. They are policy decisions that will directly impact the health, dignity, and well-being of our neighbors.
The impact will ripple throughout the city’s healthcare and social service systems. Hospitals, community health centers, nursing homes, behavioral health providers, and food assistance programs all will face increasing strain. Cuts of this magnitude threaten not only healthcare access, but also the stability of families already under economic pressure, seniors, and the disabled.
Thousands drop health insurance in Mass., and picture is expected to get worse, experts say
https://www.bostonglobe.com/2026/05/27/business/massachusetts-aca-health-connector-subsidies-expired-uninsured
Also left struggling were many noncitizen immigrants with legal status and incomes below the federal poverty level. About 66 percent of that group surveyed, who are not eligible for full Medicaid coverage, reported being uninsured.
Double-digit premium hikes push Michigan small businesses to reconsider health coverage
https://www.crainsdetroit.com/health-care/cgr-sbam-survey-20260526
More than 40% of Michigan small business owners say they may have to decide within three years whether to drop employee health coverage altogether, as years of double-digit premium increases push them to a breaking point.
Another 16% said they may have to consider dropping health benefits within four to six years because they cannot continue to absorb the rising costs, according to a Small Business Association of Michigan May member survey.
The survey results are “shocking numbers in terms of their scale and implications, but not surprising,” Small Business Association of Michigan CEO Brian Calley told Crain’s.
Employers for a decade have steadily adjusted health benefits to manage rising costs, and now “more and more are questioning their ability to continue, and the ramifications for that are enormous,” Calley said.
“We have reached a breaking point,” he said. “What they’re telling us is they can’t do it anymore.”
The high cost of employee health benefits “is like a built-in incentive to explore AI,” Calley said.
https://www.detroitnews.com/story/opinion/2026/05/27/investing-in-healthy-babies-can-grow-michigans-economy-hanna-opinion/90275046007/
At the Mackinac Policy Conference, Michigan leaders are gathering to discuss economic growth, workforce development and the future of our state. This year, that conversation also includes recognition that investing in healthy babies is investing in Michigan’s future.
The state has already begun to make that investment. Last year, Gov. Gretchen Whitmer signed a bipartisan budget that included a $250 million investment in Rx Kids, a first-in-the-nation maternal and infant health program that provides direct support to pregnant moms and babies.
This is one of the smartest investments Michigan has made in decades.
Rx Kids was built around a simple idea: if we want healthier babies and stronger communities, we must invest early. The program provides pregnant moms with $1,500 during pregnancy and $500 monthly during infancy. Launched in Flint in 2024, Rx Kids has now expanded to more than 40 communities across Michigan, from Detroit to the entire Upper Peninsula, because the results are hard to ignore ― families are more stable and moms and babies are healthier.
This week, new peer-reviewed findings published in The Lancet Public Health provide some of the strongest evidence yet that reducing financial stress during pregnancy improves birth outcomes at a population level — including lower rates of preterm birth and costly neonatal intensive care admissions. This adds to recently published research in JAMA Pediatrics showing a 32% reduction in child welfare investigations among infants.
These findings are a big deal. They show that when we address the social drivers of health early and at scale, we can improve outcomes not only for individual families, but for entire communities.
The returns extend far beyond health. Healthy babies help build healthy economies.
Rx Kids is not only reducing downstream medical and social costs, it is also strengthening local economies. The costs of infancy add up fast, and families spend this support quickly and locally at grocery stores, childcare centers and neighborhood businesses. An independent analysis by the W.E. Upjohn Institute for Employment Research found that this spending circulates and multiplies through communities, creating hundreds of jobs and generating broader economic activity.
When Profit-Driven Clinics Kick “Noncompliant” Patients off Dialysis, Is Anybody Watching?
https://www.motherjones.com/politics/2024/05/dialysis-davita-fresenius-involuntary-discharge/
More Than 770,000 Children Are No Longer Receiving SNAP Benefits After Trump Changes Federal Food Program
https://www.propublica.org/article/snap-benefits-children-food-stamps
Deeply affordable, Section 8, with a Federally Qualified Health Center on site in Queens, NY.
https://www.breakingground.org/our-housing/sutphin-senior-residence
https://washingtoncitypaper.com/article/788918/oh-snap-how-program-cuts-are-impacting-food-access-in-the-dmv
I hadn't thought of reduction of SNAP benefits having impact on inner city stores.
https://www.supermarketnews.com/store-closings/yellow-banana-ready-to-close-6-chicago-stores-loses-tie-with-save-a-lot
The Trump administration wants you to believe SNAP is broken. Tell that to 62,000 kids in Mass. who lost it
https://www.bostonglobe.com/2026/07/25/metro/snap-cuts-children-losing-benefits/ About a year ago, Republicans in Congress passed what they still insist on heralding as the One Big Beautiful Bill that further slashed the safety net and gave massive tax breaks to the rich. That included huge cuts to Medicare, and to SNAP — the assistance that helps struggling Americans pay for food.
In addition to the funding cuts (which will kick in after the midterms, natch), the law introduced even more red tape into an already incredibly complicated SNAP application process, claiming the new requirements clean up a program that is riddled with fraud and abuse. It also put more of the financial burden for administering that labyrinth of red tape onto states that were already struggling with it, locking out even more applicants.
The results have been predictable. A report last week found that, in the 19 states where data are available, 2.4 million people have already lost SNAP. The Center on Budget and Policy Priorities estimates that nationally, 1.5 million children have lost nutritional assistance.
Like with homelessness policy under Trump, 180 turns in policy are debilitating in other areas.
Government Overhauls Teen Pregnancy Program to Focus on Marriage and Starting Families
The administration canceled federal grants to organizations across the country, accusing them of encouraging premarital sex. New criteria say programs should stress abstinence.
https://www.nytimes.com/2026/07/22/us/politics/teen-pregnancy-prevention-trump.html
A few weeks ago, Rena Dixon, the head of Fact Forward, a South Carolina nonprofit that offers adolescent health and sex education classes, got a letter from the Trump administration with crushing news. The government was terminating the organization’s $1.6 million grant from a federal program to reduce teen pregnancies, effective immediately.
The administration’s priorities, it said, do not align with “content that encourages, normalizes or promotes sexual activity for minors.”
The move is the latest in a campaign that began in the first Trump administration to defund or overhaul the 16-year-old, $100 million initiative. Courts blocked the effort in 2018, but this time the administration, which abruptly canceled 53 of the program’s 67 grants last month, has been taking steps to be on firmer legal ground.
The new criteria say that grant recipients must teach abstinence as the only means to prevent teen pregnancy. Courses must stress the importance of marriage and procreation and instruct young people how to safeguard their fertility. They make scant reference to preventing sexually transmitted infections and virtually none to lesbian, gay and transgender sexuality.
The five-year projects funded by the Teen Pregnancy Prevention grants had supported topics in sex education, including consent, decision-making and healthy relationships, adjusted for age as well as a local community’s values and culture. Locations ranged from schools to juvenile detention centers to foster care settings. The programs also hold communication workshops with teens and trusted adults.
The teenage birthrate has been plummeting steadily for over two decades. Researchers say explanations are varied, but include increased teen access to forms of long-acting birth control, abortion pills and even smartphones.
Public health scholars and bipartisan congressional committees have also attested to the influence of the federal prevention programs on teen behavior, including delayed sexual initiation.
The birthrate among girls 15 to 19 has dropped by more than 65 percent during the time the program has been in effect, to 11.7 births per 1,000 in 2025 from 34.3 births per 1,000 in 2010, according to the latest provisional data from the Centers for Disease Control and Prevention.
Yet at a time when the overall American birthrate is declining, a trend decried by many conservatives and others, the new, 89-page grant application requires programs to draw from a curriculum known as “sexual risk avoidance,” which connects abstinence during the teenage years to maturity and readiness for marriage and parenthood.
It often lifts language almost wholesale from The Body Literacy Project, a curriculum praised by some conservative thinkers and religious leaders as an alternative to public school sex education. The project’s website says its courses were developed to align closely with the administration’s priorities for the teen pregnancy prevention program.
Since the federal grants began in 2010, teen birthrates in South Carolina have dropped 59 percent. Yet as of 2024, when the latest federal data was completed, the state still ranked at No. 11 nationwide in teen births. Dr. Dixon, like some other program directors, has decided to adjust to the new criteria; the funding is too crucial. Fact Forward will turn in its application this week.
“It’s a real disservice to what we know works best in our state,” Dr. Dixon said. “But if I can keep some of our programs from closing so that young people are still hearing about healthy relationships, something is better than nothing. I don’t know if we’ll be successful, but at least I’m going to try.”
https://www.minnpost.com/cityscape/2026/07/whenever-you-hear-about-an-encampment-sweep-first-ask-where-will-the-people-go
For core cities, encampments generate hundreds of emergency calls per year, not to mention secondary issues around disinvestment or quality of life. These broad social costs are borne specifically by central cities, in their exploding budgets, vacant properties, nuisance crimes and the like. The people of Minneapolis and St. Paul, and their respective counties, should not be singled out to pay for a regional plague of poverty.
Unfortunately, squaring this circle is impossible. The correct solution to ongoing poverty, addiction and a crisis of affordable housing should be a national program of some kind. COVID-era federal funding, somewhat unintentionally, proved that widespread federal programs can actually solve problems in the United States.
Drawing on that support, Ramsey County offered a particularly laudable example of moving unsheltered people into housing. Federal financing through programs like the expanded child tax credit proved that reducing poverty is a relatively straightforward equation of resources and distribution.
Yet these programs were one-time flashes in the pan, disappearing almost as soon as they made an impact. (It sadly reminds me of the plot of the 1990 Robert DiNero/Robin Williams tearjerker, “Awakenings,” only for government.)
Instead, today’s federal government actively exacerbates these same social problems. For example, the unconstitutional rescinding of healthcare funding and the removal of food aid subsidies both shift costs onto local governments, widening budget crises. Policy decisions amount to the weaponization of poverty against blue cities, in particular. Of course, during the recent occupation of Minnesota cities by federal agents, this latent conflict became far more literal, direct and damaging.
Local governments can’t solve this problem, and the federal government won’t, which means the only meaningful solution to encampments has to come at the state level. The next Minnesota governor and Legislature should make housing a priority, and that doesn’t just mean programs to build more market-rate housing, though this is also important. Proposals must include statewide funding to alleviate the desperate needs of our unhoused population.
https://www.nytimes.com/2026/07/30/business/aca-obamacare-health-insurance.html
Uninsured Patients Rise Sharply, Hospitals Report, Citing Obamacare Cuts
Executives running some of the biggest hospital systems, including large for-profit chains spanning many states, expressed concern over the unexpectedly sharp rise in uninsured patients and the costs associated with treating them.
And many executives said that the hospitals were also reporting more unpaid medical bills and providing more in the way of charity care. Some hospital systems also found that patients were forgoing or postponing lucrative elective surgeries like knee replacements in recent months.
The significant increase in uninsured patients, about 20 percent in some cases, was disclosed in earnings reports in the past week and interviews with nonprofit hospital groups. Major hospital officials expressed growing unease over lost revenues amounting to hundreds of millions of dollars across the country’s vast health systems.
In an earnings call with analysts last Friday, executives at HCA Healthcare, the nation’s largest for-profit hospital chain, said patients who were previously enrolled under the Affordable Care Act appeared unable to find other sources of coverage but still needed emergency care from a hospital.
They had “migrated almost one for one to uninsured,” Sam Hazen, the chief executive of HCA, said. The American company, which operates 190 hospitals in 19 states and Britain, said the impact was greatest at its hospitals in Florida and Texas as well as South Carolina and Georgia.
Company officials warned investors that the most likely result would be about roughly $1 billion less in operating profits this year.
The hospitals most vulnerable to the falloff in enrollment in government programs like the Affordable Care Act and Medicaid are smaller rural hospitals and safety net hospitals that treat a large share of people without insurance. Because these types of hospitals make so little profit, “every little weight on the scale brings additional challenges,” said Duane Fitch, who advises hospitals for Plante Moran, a consulting firm.
Few industry experts predicted a surge in the number of closed hospitals, but many said hospitals were starting to shutter individual clinics and cut services like maternal care and behavioral health services. Some hospitals will cut back on big projects and defer maintenance on their facilities.
“We have seen systems quietly closing services,” said Dan Steingart, who oversees Moody’s Ratings coverage of nonprofit hospitals. The facilities are not making announcements, he said, but cutting services to reduce costs.
HS proposes cutting many federal education and health guidelines for Head Start
https://www.washingtonpost.com/education/2026/08/06/hhs-proposes-overhaul-health-education-guidelines-head-start/
Trump Administration Plans to Upend Head Start by Deregulating It
The White House tried but failed to block funding for preschool for poor children. Instead, it will seek to strip away standards on health, literacy — and brushing teeth.
https://www.nytimes.com/2026/07/31/us/politics/head-start-deregulation.html
Administration officials say the changes will streamline a heavily regulated program while giving states and cities more control over how it is run.
But Head Start advocates say that erasing regulations serves as a backdoor way to dismantle a program the administration does not like. The White House last year called Head Start “radical” and tried but failed to freeze spending on it.
While Head Start facilities will still be required to comply with state rules, there are almost no comparable state-level programs with similar requirements. And even though the federal rules would not prohibit centers from providing traditional antipoverty services, some fear that the lack of any requirements means that many are likely to stop doing so.
“Eliminating Head Start’s performance standards guts the science-backed standards that ensure our youngest learners get what they need to arrive at kindergarten ready to succeed,” she said.
The program, which today serves about 700,000 children under 6, has for decades attracted bipartisan support. President Ronald Reagan expanded Head Start’s budget to over $1 billion, and President George W. Bush signed a bipartisan law to update and modernize the program. Even President Trump in his first term increased the program’s budget by $900 million.
That has now changed dramatically.
Project 2025, the policy blueprint by the conservative Heritage Foundation, called for the elimination of Head Start. “The program should function to protect and educate minors,” the document says. “Sadly, it has done exactly the opposite.”
So proponents of upending the program tried a new approach. In June, the Heritage Foundation issued a report calling on the administration to “sunset Head Start and deregulate the program until officials end it.”
Among the most significant of the proposed new changes expected to be released next week is the removal of federal limits on Head Start class sizes. Instead, they will now align with a patchwork of state standards.
For example, under current Head Start rules, one teacher is required to supervise four 2-year-olds. But in Idaho, one teacher can supervise nine 2-year-olds. In Ohio, the rule is one teacher per eight 2-year-olds.
Mr. Adams and other conservatives have promoted the change as a way to give more children access to the program, although many early education policy experts say that the larger class sizes will relax standards of care.
The changes would also delete requirements that Head Start employees perform vision and hearing screenings on children, and ensure that children receive medical and dental checkups. That could mean helping parents schedule appointments, fill out Medicaid forms and arrange transportation.
The proposed changes would also remove requirements that staff members visit families at home to help navigate problems like shut-off utilities.
They would eliminate teaching standards for math, literacy, and social and emotional development — such as self-regulating and responding to emotions, making friends and interacting appropriately with adults.
Some requirements providing access for children with disabilities would go away, as well.
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