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entitled 'Highlights of a Forum: Ensuring Opportunities For 
Disadvantaged Children and Families' which was released on November 13, 

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GAO Highlights: 

Highlights of GAO-09-18SP, a GAO forum. 

Why GAO Convened This Forum: 

Investments in the education and health of children are critical to the 
nation’s future, as the nation’s security and well-being depend on a 
productive citizenry. While families play the essential role in 
nurturing their children, the federal government has traditionally 
provided aid to disadvantaged children and families. However, federal 
spending on current health care and retirement programs—Medicaid, 
Medicare, and Social Security—is projected to grow dramatically and 
absorb an increasing share of the federal budget and economic output. 
Absent meaningful changes, little room will be left in the federal 
budget to address other priorities, including programs designed to 
assist and ensure opportunities for disadvantaged children and 

GAO convened this forum on June 25, 2008, to identify key areas of 
concern related to disadvantaged children and their families and to 
discuss ideas to address these concerns within this fiscal environment. 

Participants included budget experts; representatives from federal, 
state, and local governments; research and policy institutes; and 
philanthropic and nonprofit organizations. Comments expressed during 
the proceedings do not necessarily represent the views of all 
participants, the organizations they represent, or GAO. Participants 
reviewed a draft of this summary, and their comments were incorporated, 
as appropriate. 

What Participants Said: 

The following themes were highlighted by participants: Improve income 
supports to families: Participants noted a range of issues facing some 
families and their children, including intermittent work, low-wage 
jobs, and deep poverty. This raised concerns that many children face 
significant instability in their lives, such as frequent moves, 
changing child care arrangements, and unstable family incomes. Some 
participants asserted that work and income supports to families help 
reduce the negative effects of poverty on children. However, it was 
noted that existing work and income supports don’t help everyone, and 
that policymakers need to find ways to better assist the most 
vulnerable groups in order to stabilize their lives and reduce the 
harmful effects of these circumstances on children. 

Focus on health care services and prevention: Participants noted the 
important role that health care services play in ensuring opportunities 
for all children. They raised concerns about the lack of health care 
coverage for a significant portion of people, citing health insurance 
costs as a growing burden for workers, businesses, and government. They 
also suggested the need to revamp the health care system, including 
payment policies, to ensure that health care professionals help prevent 
illness and disease. 

Expand educational opportunities: Participants pointed to the need for 
increased opportunities for early, secondary, and postsecondary 
education to support the long-term success of disadvantaged children. 
Concerns were raised that low-income children are less likely to get 
quality early care and education services, stay in school, or acquire 
postsecondary education. This is due, in part, to challenges faced in 
affording quality child care, being English language learners, and 
navigating college application and financial assistance processes. 
Restore fiscal health to the federal budget: A presentation by one 
participant suggested that slowly changing the allocation of federal 
resources from retirement programs to programs focused earlier in the 
life cycle of individuals, such as education, could yield brighter 
futures for individuals and less reliance on federal support in later 
years over the long run. This increased focus on prevention would help 
address projected deficits and improve well-being among some children 
and families, noting that child well-being in the United States ranks 
below that of several other rich countries. Use the federal budget 
process, research, and data to make federal investment decisions: Some 
participants suggested that policymakers examine how to enable federal 
budget deliberations to discuss funding in terms of long-term 
investments versus current consumption so that policymakers can make 
explicit choices about the right mix of each. Others discussed the need 
for research and national indicators—and using the results of these––to 
direct federal investments to programs and interventions that work. 
Overall, the discussion highlighted that doing more to ensure all 
children have opportunities to become productive citizens—through 
income support, health care, and education policies––will require new 
thinking about federal investments with an increased focus on 
prevention and longer term investments. 

To view the full product, click on 
[hyperlink,]. For more 
information, contact Cynthia Fagnoni at (202) 512-7215 or 

[End of section] 

United States Government Accountability Office: 







Participants Discussed Ways to Address Concerns About Income Supports, 
Health Care, and Education for Disadvantaged Children and Families: 

Forum Participants Discussed the Need to Address Long-term Budget 
Issues And Information Gaps in Finding Ways to Assist Disadvantaged 
Children and Families: 

Appendix I: Agenda: 

Appendix II: Forum Participants: 

Appendix III: Presentation by Cynthia M. Fagnoni, Managing Director, 
Education, Workforce and Income Security Issues, GAO: 

Appendix IV: Presentation by Dr. Isabel Sawhill, Brookings Institution: 

Appendix V: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 


Figure 1: Growth in Spending for Social Security, Medicare, and 
Medicaid Is Expected to Outpace Economic Growth (2008-2032): 


CCDF: Child Care Development Fund: 

EITC: Earned Income Tax Credit: 

FAFSA: Free Application for Federal Student Aid: 

NCLBA: No Child Left Behind Act: 

SCHIP: State Children's Health Insurance Program: 

SNAP: Supplemental Nutrition Assistance Program: 

TANF: Temporary Assistance for Needy Families: 

VAT: value-added tax: 

United States Government Accountability Office: 

Washington, DC 20548: 


Investments in the education and health of children are critical to the 
nation's future, as the nation's security and well-being depend on a 
productive citizenry. While families play the essential role in 
nurturing their children, the federal government has traditionally 
provided aid to disadvantaged children and families and helped to 
ensure they have opportunities to succeed. The federal government is on 
an unsustainable fiscal path, however, that could make it more 
difficult to aid the disadvantaged, as well as more broadly ensure a 
prosperous future for all children. Budget experts now agree that the 
growing gap between spending--driven largely by rising health care 
costs and an aging population--and revenues could result in an 
escalating cycle of deficits and debt. The growth in Social Security, 
Medicare, Medicaid, and interest on debt held by the public dwarfs the 
growth in all other types of spending. Without meaningful action, this 
fiscal course will lead to increasingly little room for other federal 
priorities. Yet, the nation faces a range of current and emerging 
problems that require attention: instability in financial markets, 
energy, environmental protection, and homeland security, to name a few. 
These long-term challenges have profound implications for our future 
economic growth, standard of living, and national security, and raise 
issues about the future prospects of all of the nation's children, 
including the disadvantaged. 

GAO convened a forum on June 25, 2008, to examine future prospects for 
the nation's children. Participants were asked to identify any concerns 
about the current and future prospects for children, particularly the 
disadvantaged, as well as any actions that might address these concerns 
and to discuss the implications of current federal spending priorities 
for investments in children and families. (See app. I for the forum 

Policymakers will need to consider these and other issues facing the 
country in the context of the nation's long-term fiscal challenges. In 
view of the tough choices and trade-offs that are involved, GAO 
convened this forum, bringing together a diverse group, including 
budget and fiscal experts, and participants from federal, state, and 
local governments; research and policy institutes; and philanthropic 
and nonprofit organizations representing children, families, and 
communities; economic development; and social insurance. (See app. II 
for a list of participants.) The forum was structured so that 
participants could comment on issues openly, although not all 
participants commented on all topics. 

This summary attempts to capture the ideas and themes that emerged at 
the forum, the collective discussion of participants at the sessions, 
and participants' comments on a draft of this summary. This summary 
does not necessarily represent the views of the organizations whose 
representatives participated in the forum, including GAO. Participants 
reviewed a draft of this summary, and their comments were incorporated 
where appropriate. 

I would like to thank the forum participants for taking time to share 
their knowledge, insights, and perspectives on this important topic. 
Others will benefit from these contributions. GAO looks forward to 
working with the participants on these and other issues of mutual 
interest and concern in the future. 

Signed by: 

Gene L. Dodaro: 

Acting Comptroller General of the United States: 

November 13, 2008: 


Data show that, on some measures, some children and families are not 
faring well. In a 2007 report, GAO noted that the poverty rate was 
higher among children than for the total population, and higher than 
among the elderly. The poverty rates in 2006 for African-American and 
Hispanic children were 33 percent and 26.6 percent, 
respectively.[Footnote 1] While most youth successfully transition to 
adulthood, a significant number of youth are disconnected from school 
and employment. These youth are more likely than others to engage in 
crime, become incarcerated, and rely on public systems of 
support.[Footnote 2] Research shows that individuals living in poverty 
face an increased risk of adverse effects, such as poor educational 
outcomes, poor health, and criminal activity. Recent research reported 
by the Brookings Institution has also shed new light on the extent to 
which low-income children can escape this economic status. While most 
children improve their economic position compared with their parents, 
42 percent of children born to parents in the bottom one-fifth of the 
income distribution will stay there. This research also found that 45 
percent of African-American children whose parents were in the middle 
of the income distribution in the 1960s fell to the bottom of the 
income distribution, compared to 16 percent with white 
children.[Footnote 3] 

The Role of Government in Assisting Low-Income Families: 

The federal government has had a long history of efforts to improve the 
conditions of those living with limited income and resources. Federal 
and state governments are involved in the provision of supports for low-
income families through an array of programs targeted at child care, 
medical, housing, food, and utility and other social services 
assistance.[Footnote 4] On the federal side, these programs and 
benefits, many of which help support recipients' efforts in achieving 
self-sufficiency, assist tens of millions of low-income families 
nationwide at a cost of over $100 billion annually.[Footnote 5] 
Eligibility to participate in federal programs and benefits is 
typically predicated on whether a recipient's income is equal to, or at 
some percentage below or above a poverty threshold established by the 
U.S. Census Bureau (Census). Over the years, experts have debated 
whether or not the way in which the poverty threshold is calculated 
should be changed and the National Academy of Sciences has recommended 
alternatives.[Footnote 6] In response, Census published experimental 
poverty measures in addition to its traditional one. However, Census 
has not yet changed the factors included in the official 
measure.[Footnote 7] 

The roles and responsibilities of the federal and state governments 
vary for the broad array of low-income programs. For example, supports 
for low-income families vary in terms of whether they are funded with 
federal funds, state funds, or a combination; whether funding is fixed; 
and the extent to which the federal government, state government, or a 
combination is responsible for determining eligibility rules, 
availability, and benefit structures. In addition, some supports, such 
as the Food Stamp Program (now the Supplemental Nutrition Assistance 
Program) and Medicaid, are entitlements, for which eligible applicants 
are guaranteed receipt.[Footnote 8] For other supports, such as 
subsidized child care and transportation assistance, provision of the 
supports is not mandatory and receipt is not guaranteed.[Footnote 9] 

A key feature of the nation's set of low-income programs is its 
decentralized, patchwork nature. While this offers some flexibility to 
address various state and local needs, it has also raised some 
concerns. Numerous federal departments and agencies, state and local 
offices, community-based organizations, and other entities are 
responsible for administering these programs. Authorized by different 
congressional committees at different points in time, these programs 
were created to meet the various needs of different groups of low- 
income people. However, when viewed as a whole, they have given rise to 
long-standing concerns that the nation's assistance programs for low- 
income families are too difficult and costly to administer and too 
complicated for families to navigate. 

Income Supports and Low-Income Families: 

Supplementing the income of those who are economically disadvantaged is 
one approach used by some federal programs to help alleviate economic 
hardship and to support efforts toward self-sufficiency. Two key 
programs through which the federal government provides income supports 
to eligible low-income individuals and families are the Earned Income 
Tax Credit (EITC) and the Temporary Assistance for Needy Families 
(TANF) block grant. 

The EITC provides a refundable tax credit to workers with and without 
children. The EITC is a percentage of the person's earnings, based on 
the number of children, up to a maximum earned income amount. Beginning 
at a certain income level (i.e., the phase-out income level), the EITC 
is reduced. Unlike most tax credits, the EITC is a "refundable" credit 
meaning that a person need not owe or pay any income tax to receive the 
EITC.[Footnote 10] 

The TANF block grant, created by the 1996 welfare reform law (Pub. L. 
No. 104-193), places a greater emphasis on moving parents into work and 
on personal responsibility than its predecessor program. TANF provides 
money to states to fund a wide range of benefits and services for 
economically disadvantaged families, including child care and job 
search activities, as well as cash welfare for low-income families with 
children. The monthly TANF cash welfare benefit, which is time-limited, 
is determined by the states and benefit amounts vary widely among the 
states. TANF also funds activities to help achieve the goals of 
reducing out-of-wedlock pregnancies and raising children in two-parent 
families.[Footnote 11] 

Early Care and Education for Low-Income Children: 

Early care and education has long been recognized as a critical support 
to families' self-sufficiency in that it provides care to children so 
that parents can work. Emerging research in recent years has also shown 
that quality care can have a positive impact on children's development 
and on their chances for success in school and beyond. Early care and 
education in the United States is provided by a variety of individuals 
and organizations, including part-day or full-day centers and schools; 
nonrelated providers in the provider's home; neighbors or friends; or 
by au pairs, nannies, or sitters in the children's own homes. These 
services are known by different names, such as child care, 
prekindergarten or family child care, but they share the essential 
element of providing care for children. 

The bulk of expenditures on early care and education are paid by 
parents although government also contributes significant amounts of 
funding. The public financing structure for early care and education in 
the United States involves multiple funding streams at various levels 
of government--federal, state, and local. A significant portion of 
federal support for early care education is provided through the Child 
Care and Development Fund (CCDF), Head Start, TANF, and the Dependent 
Care Tax Credit. CCDF and TANF are funding streams to states that help 
provide subsidies to low-income families so that they are able to pay 
for child care.[Footnote 12] Within the parameters of federal guidance 
and regulations, states determine their own specific policies 
concerning the administration of these monies, which include who is 
eligible to receive subsidies and the amount of the subsidy. Head Start 
is the federal government's early care and education program for 
children ages birth through 5.[Footnote 13] It also provides 
comprehensive health, nutritional, social, and other services to 
children and their families. Grants are directly awarded to various 
types of organizations to develop and run Head Start programs. The tax 
credit is a funding mechanism provided through the tax code. It allows 
taxpayers to claim a credit on their income tax form for some of the 
expenses of work-related child care. The credit may be claimed for any 
legal form of child care used so that parents can work, including: 
child care centers, nursery schools, family child care homes, in-home 
child care (such as nannies), paid care provided by relatives, and day 
camps. Low-income families who do not earn enough to pay taxes are not 

Education for Disadvantaged Children: 

The nation's economic prosperity and global competitiveness depend in 
large part on the effective education of the 48 million students who 
attend public schools. While the mainstay of funding for K-12 education 
in the United States is from state and local sources, the federal 
government also contributes monetary support. The primary vehicle for 
federal aid for K-12 education is the Elementary and Secondary 
Education Act, particularly its Title I, Part A--Education for the 
Disadvantaged, known as the No Child Left Behind Act of 2001 (NCLBA). 

NCLBA increased the federal government's role in K-12 education by 
setting two key goals: to reach universal proficiency on state academic 
assessments whereby all students score at the proficient level of 
achievement--as defined by the states--by 2014, and to close 
achievement gaps between high-and low-performing students, especially 
those in designated groups: students who are economically 
disadvantaged, are members of major racial or ethnic groups, have 
learning disabilities, or have limited English proficiency.[Footnote 
14] To accomplish the goals set out under NCLB, states are required to 
(1) set academic standards for all students, (2) establish increasing 
annual targets for student performance, (3) provide suitable assistance 
to schools to enable improvement, and (4) offer educational 
alternatives for families with children in schools that have not shown 
adequate improvement despite assistance. 

Health Care and Low-Income Children and Families: 

Some economic research points to health as a key variable in the 
productivity not only of individuals but the economy as a whole. Good 
health can enhance workers' productivity by increasing their physical 
and mental capacities and help them improve educational attainment 
through scholastic performance.[Footnote 15] However, some data show 
that health outcomes are worse for individuals with low incomes than 
for their more affluent counterparts. This is due, in part, to limited 
access to health insurance and thus less access to health care, 
particularly preventive care.[Footnote 16] Many low-income families and 
their children are covered through Medicaid and the State Children's 
Health Insurance Program (SCHIP), which are jointly financed by the 
federal and state governments.[Footnote 17] While these programs are 
targeted to those who are low-income, eligibility varies among the 
states, and not everyone who is poor is covered. 

The Federal Government Faces Long-term Fiscal Challenges: 

The United States is facing large and growing structural deficits 
driven largely by health care costs, demographics, and revenues. An 
increasing portion of the federal budget is on "autopilot." As the baby 
boom generation ages and retires, federal spending on current health 
care and retirement programs--Medicaid, Medicare, and Social Security-
-is projected to grow dramatically and absorb an increasing share of 
economic output (see fig.1). In 1967, these programs accounted for 
about 16 percent of federal spending, but by 2007 they already 
accounted for more than 40 percent.[Footnote 18] State and local 
governments will also face similar fiscal challenges over the next 
decade. As is the case for the federal government, rising health care 
costs will be the primary driver at the state and local level--both for 
Medicaid and for employee and retiree health coverage.[Footnote 19] 
Absent change, this fiscal path will affect the federal and state 
governments' roles in many areas, including providing assistance to 
disadvantaged families and children. 

Figure 1: Growth in Spending for Social Security, Medicare, and 
Medicaid Is Expected to Outpace Economic Growth (2008-2032): 

This figure is a line graph with shading showing growth in spending for 
social security, medicare, and Medicaid is expected to outpace economic 
growth (2008-2032). The X axis represents the year, and the Y axis 
represents the percentage of GOP. The shading represents Medicare, 
Medicaid, and Social Security. 

[See PDF for image] 

Note: Social Security and Medicare projections are based on the 
intermediate assumptions of the 2008 Trustees' Reports. Medicaid 
projections are based on CBO's January 2008 short-term Medicaid 
estimates and CBO's December 2007 long-term Medicaid projections 
adjusted to reflect excess cost growth consistent with the 2008 
Trustees' intermediate assumptions. 

[End of figure] 

Participants Discussed Ways to Address Concerns About Income Supports, 
Health Care, and Education for Disadvantaged Children and Families: 

During the forum, participants were asked to discuss their key concerns 
about opportunities for disadvantaged children and families, as well as 
possible approaches to address these concerns. From this discussion, 
income supports, health care, and education emerged as areas the 
government needs to focus on to ensure that disadvantaged children and 
families have sufficient opportunities for healthy development and a 
prosperous future. 

Income Supports: Participants Discussed the Importance of Income 
Supports to Alleviate the Adverse Effects of Poverty While Also 
Providing Incentives for Work: 

Some participants noted the growth in income inequality and stagnant 
wages for younger individuals and families and suggested the importance 
of finding ways to broaden income supports and other means to help 
families alleviate the adverse effects of poverty and build self- 

During a discussion recapping some of the poverty research and 
evaluations of intervention programs, one participant stated that 
earlier research illuminated the adverse effects of poverty on 
children's outcomes, but that less was known about how to address those 
effects. Several years of additional studies have helped the United 
States learn about how work and income supports assist in reducing the 
effects of poverty on families and lead to better cognitive and 
behavioral outcomes for children in these families. This work has led 
to support for an expanded EITC, for example. 

Another participant commented on the expansion in recent years of 
important supports to low-income families that help promote and support 
parents' work efforts. However, this participant pointed out that none 
of these federal supports directly encourage family formation, 
specifically marriage, or help keep the family unit intact, in part 
because these supports often do not include low-income males. He 
suggested policymakers consider ways to include these men. Such 
policies would encourage more low-income males to work, which in turn 
could also encourage marriage and result in family stability. The 
participant noted that some proposals have been developed to expand 
EITC to help achieve these goals. Along the lines of policies that 
encourage work, another participant emphasized that policies should 
strive to maximize parents' own responsibility for their children. 

One participant noted several concerns about vulnerable populations and 
the critical importance of addressing their needs. These concerns are 
as follows: 

* While the increased emphasis on work and work supports has helped 
some families, the safety net has been weakened for others. Research 
shows that TANF provides cash assistance to about 40 percent of 
eligible families compared with 70 percent to 80 percent of eligible 
families under its predecessor program, Aid to Families with Dependent 

* An estimated 2-3 million children are in families who are in deep 
poverty, defined as having an annual income at or below 50 percent of 
the poverty line. This is related, to some extent, to fewer poor 
families receiving cash assistance. 

* These and other families, including some who are working at low-wage 
jobs and/or not working full-time or year-around, face significant 
instability in their lives, such as frequent moves, changing child care 
arrangements, and unstable incomes. 

* While it is important to have policies that encourage parents to work 
and to promote parental responsibility, greater focus is needed on 
reducing the instability in these families and its harmful effects on 
their children. 

This participant also added that, while the safety net is generally 
stronger for the elderly than for some families with children, some of 
the elderly have high poverty rates. Based on calculations using the 
National Academy of Science's alternative poverty measure, poverty 
rates for some seniors are as high as for some children, after 
accounting for out-of-pocket medical expenses, even though the elderly 
have access to health care and income supports through Medicare and 
Social Security. 

One theme that emerged in discussions of income supports is the complex 
nature of the nation's set of low-income programs that often pose 
challenges for families in need of services, as well as for program 
administrators, evaluators, and policymakers. These issues can make 
service delivery, program accountability, and program evaluation more 
difficult. More specifically: 

* Many aid programs and services have different eligibility criteria 
and application procedures that make access difficult. One participant 
noted a local effort to address these issues by using information 
technology in order to share and connect program information. 

* Tracking individuals' progress over time, and as they transition from 
one program or system to another, is difficult to accomplish, although 
it could be important in tracking outcomes and need. 

* Data are sometimes not available in a useful form. For example, in 
databases used for research, data on an individual's status or 
condition is sometimes available while data for a household is not, 
even when that is the most useful unit for analysis. 

Health Care: Participants Discussed the Need for Health Care Services 
for Disadvantaged Children and Families: 

Forum participants highlighted the importance of health care services 
for all families and children and discussed the importance of 
prevention--not just in individuals' lives but in health policies as 
well--to ensure a healthy future for our nation's children. 

In conveying findings from some of the work of her organization, one 
participant stated that young families see the lack of access to 
affordable health insurance as one of their biggest hurdles in 
achieving "the American Dream." Participants said that many families go 
without health care coverage for a variety of reasons. Some 
participants noted that the increasing cost of health care benefits is 
a growing burden to both individuals and companies. Some workers do not 
participate in health insurance programs offered by their employers 
because they can't afford their share of the premiums. Other workers do 
not have health insurance because their company doesn't offer it, 
typically because they can't afford to do so, particularly if the 
company is a small business. In commenting about health insurance 
provided by the government to low-income families, one participant 
explained that parents with children who receive TANF also receive 
Medicaid; but, once they leave, the mother's coverage, after a short 
transition period, will stop. The participant further added that, once 
the parent's coverage has been terminated, data show that children are 
less likely to receive health care services even though the child 
continues to be covered by the government's health insurance programs 
through Medicaid or SCHIP. 

Another theme raised during the forum was the need to focus on health 
prevention services, which some asserted may offer a more cost- 
effective approach to providing health care. Two participants commented 
that preventable health conditions can be costly to treat, evidenced by 
the fact that the bulk of health care spending is for a small 
percentage of chronic diseases. Another added that addressing 
preventable health issues in children might be more cost-effective in 
the long run because these early investments benefit individuals later 
in life. Adding to these points, some others stated that transforming 
the nation's health care system to a preventive one would require 
policymakers to rethink the way the system reimburses for medical 
services. As currently designed, the system focuses on paying doctors 
to treat diseases, not to educate their patients and the public about 
preventing them. 

Education: Participants Discussed the Need to Expand Educational 
Opportunities to Disadvantaged Children: 

Forum participants discussed the need for increased educational 
opportunities--specifically prekindergarten and postsecondary 
education--and a focus on helping students stay in school as ways to 
support disadvantaged children. 

Several participants noted that low-income children tend to receive 
lower quality early care and education services because they cannot 
afford the cost of quality child care. One participant said that many 
low-income families rely on federal and state child care subsidies, but 
these funds have not increased in a number of years, and substantial 
numbers of potentially eligible families do not receive assistance. It 
was also noted that some low-income families rely upon other low-income 
individuals to provide unlicensed child care, as allowed under current 
policies. These caregivers, in turn, then receive income through the 
child care subsidy system, although the care provided may not 
adequately prepare children for school. 

According to one participant, concerns about the importance of 
preparing all children for success at school is the reason that the 
Gates Foundation decided that investing in an early learning system in 
Washington State was a good use of its foundation dollars. The 
foundation looked at the research, talked with other funders, and 
decided that providing support at both the community and state level to 
build an infrastructure for quality child care and other services for 
families were the supports necessary to help children succeed. In 
building this public/private partnership, a key challenge involved 
working with the multiple agencies at the state and local levels to 
come together with a common goal and implementation strategy. The pilot 
effort also includes an evaluation component so that they can learn 
what works--and what doesn't--before implementing efforts on a larger 

Other education themes that emerged during the forum discussions were 
helping disadvantaged children stay in school and gain entrance to 
postsecondary education opportunities. These challenges are due in part 
to the changing mix of student demographics. Several participants 
stated that educating children and preparing them for college is more 
challenging today, given the growing number of minority populations and 
children who are English language learners. Yet, others mentioned that 
our understanding is limited regarding the best ways to work with 
English language learner students of different age groups-- 
preschoolers, elementary, secondary, and postsecondary. Some 
participants called for increased investments in public school systems 
with this population, including hiring more teachers specifically 
trained to work with English language learners. 

One participant made several points concerning low-income families and 
the college and financial assistance process, some of which were echoed 
by other participants as well. These points include: 

* Children from low-income families who apply for college often learn 
about the cost of a college education only months before college 
begins, or when they do find out the cost, fail to complete a Free 
Application for Federal Student Aid (FAFSA) form to apply for financial 
aid.[Footnote 20] 

* Because the parents of low-income children are less likely to know 
how to help their children apply to school or tap resources to pay for 
it, these children may not receive the kind of help or other support 
they need from home, and many low-income students with high test scores 
end up not attending college at all. It is the responsibility of 
secondary schools to do more to help ensure that low-income children 
are able to attend college. To that end, high school counselors could 
provide better information to students and their families to help them 
navigate the college process and, in doing so, perhaps help increase 
postsecondary enrollment numbers of students from low-income families. 

* Related to this, a proposal has been developed to significantly 
simplify the student aid process, which would streamline eligibility, 
combine funding sources, and get information distributed to high school 
students about the amount of financial aid they are eligible to receive 
several years before they apply to college so they can plan 

On a different note, a participant noted that studies show that access 
to college is more likely affected by the type of preparation from an 
early age than by financial aid, even for minority students, 
highlighting again the importance of starting early to prepare 

Forum Participants Discussed the Need to Address Long-term Budget 
Issues And Information Gaps in Finding Ways to Assist Disadvantaged 
Children and Families: 

In addition to addressing specific programmatic issues related to 
income supports, health care, and education, forum participants also 
discussed the need to restore the fiscal health of the federal budget 
to help ensure support for disadvantaged children and families. Dr. 
Isabel Sawhill presented one approach, which calls for reassessing 
federal policies and programs for younger and older Americans. 
Participants also talked about ways to leverage current funding; the 
need to recognize investments in human capital during budget 
deliberations; and developing and using research and national 
indicators to determine what works and what doesn't, as well as to 
assess the well-being of children. 

Forum Participants Discussed Budget Changes That Will Strengthen 
Children and Families and the Nation's Long-term Fiscal and Economic 

Dr. Sawhill presented information about the fiscal challenges facing 
the country over the next few decades and echoed similar concerns 
raised by GAO in recent years. She said that budget experts predict the 
deficit will grow to almost $700 billion by 2017. Although the deficit 
has partly been affected by health care spending, defense, and other 
initiatives, Dr. Sawhill noted that the growth in the deficit will 
accelerate when baby boomers retire and begin to use the benefits 
provided to them through Social Security, Medicare, and Medicaid, as 
they are currently constructed. Absent changes in spending on these 
programs, they will absorb an ever growing share of the budget, leaving 
less available for other domestic priorities, including programs for 
disadvantaged children and families. She also presented information 
that showed child well-being in the United States ranked below other 
developed countries on several measures, such as health, safety and 
education. (See app. IV for presentation slides.) 

Dr. Sawhill outlined a proposal to change the timing of government 
assistance for such programs as income supports, health care, and 
education, so that resources are directed earlier in a person's life. 
Changing the allocation of federal resources to Social Security, 
Medicare, and Medicaid--gradually and over time--would rein in their 
costs and allow some of these monies to be directed to programs that 
support children and families. Dr. Sawhill's expectation is that the 
individuals who reaped the benefits of these early childhood and family 
support investments would, in turn, have brighter education and 
employment opportunities. In addition, the beneficiaries could exercise 
greater responsibility for investing in their own retirement and rely 
less on government programs as they age. Dr. Sawhill said that this 
approach essentially focuses on prevention and is based on the idea of 
investing in the young, especially in their education, to yield a 
higher return in future prospects for these individuals, and thus 
reduce their need for government support later on, as well as enhance 
productivity for the nation.[Footnote 21] 

Participants offered some suggestions and reactions to this 
presentation. One participant said that pitting the old against the 
young is not a productive approach to meeting the needs of children or 
other vulnerable Americans, cautioned against framing the issues as the 
"old versus the young," and suggested that program benefits be based on 
need or income rather than on age. While acknowledging that targeting 
of benefits is appropriate, another participant discussed a strong 
preference for accomplishing targeting through progressively indexing 
benefits, as opposed to "means testing" them.[Footnote 22] 

Some noted the importance of addressing the rising costs of health care 
to make headway on the fiscal crisis. One participant pointed out that 
Social Security spending--which grows for a few years but then 
flattens--is a much smaller portion of the growing burden than Medicare 
and Medicaid. Regarding the importance of health in addressing the 
budget crisis, one participant said that "all roads lead to health," 
while another noted that changing the spending trajectory really means 
reforming both the government and private health care systems. 

Another participant cautioned against viewing America's fiscal problems 
through only one "fiscal frame" and wanted to be sure that raising 
revenues, not just reducing spending, was considered for discussion. 
Building on this point, others offered ideas such as a value-added tax 
(VAT) earmarked for health care that could provide revenues to cover 
those without health care benefits.[Footnote 23] The importance of 
paying more attention to tax expenditures' role in the federal budget 
was also raised; they should be considered when reviewing current and 
potential federal policies and investments. 

One participant commented that, as budget solutions are considered in 
the future, there should be a reassessment of federal and state roles, 
including consideration of shifting some responsibilities between these 
entities. For example, in some areas, such as education, children move 
across state lines; that is, they are prepared for school in one state, 
start school in another, and use their education and skills to obtain 
employment in yet another state. The participant raised the question as 
to what the extent of the federal government's role should be in 
preparing children for school and helping them succeed, given that the 
benefits of that education accrue to not only the individual and their 
home state, but the nation at large. 

Forum Participants Highlighted the Federal Budget Process, Research, 
and National Indicators as Important Tools in Making Decisions about 
Federal Investments: 

Participants advised that looking at the federal budget process, 
developing a solid research base, and compiling a set of national 
indicators from which to assess programs aimed at serving children and 
families would be valuable to policymakers and the public when making 
investment decisions on policies and programs. In summarizing the 
discussion, some key questions emerged: What are the nation's goals? 
What strategies and actions are needed to reach them? How well is the 
nation faring when measured against these goals? What changes or 
adjustments are needed? 

Some participants noted that the country needed a federal budget 
process designed to allow consideration of long-term investments, such 
as for human capital or intangibles like productivity capacity. One 
participant suggested that policymakers should be provided information 
during budget deliberations that enables them to make explicit 
decisions about the appropriate mix of spending for current consumption 
and long-term investments.[Footnote 24] The current budget process does 
not enable a discussion and understanding of investments in human 
capital, such as education, that can have a positive long-term impact 
on economic growth. Another stated that the federal budget has no way 
to measure intangibles like the capacity of its people to produce goods 
and services. Private firms face a similar problem accounting for 
research and development, which is measured as an expense rather than 
an investment. 

Building a sound research base and using that information to make 
informed investment decisions about programs and approaches for 
disadvantaged children emerged as a key theme. One participant asserted 
that it takes a succession of studies to really know something about a 
program or approach. She felt that, as a nation, the United States has 
built a good research base over the years to show that outcomes for 
kids can be improved. She asserted that the country needs to continue 
conducting this type of research and using the resulting evidence to 
inform policymaking, similar to the way changes were made to welfare in 
the 1990s through our understanding of work support policies. Another 
comment was made about a "second generation" of newer programs, in 
which longitudinal data are being collected about their impact on 
children's outcomes, although the window of time is shorter because the 
programs are newer. One participant added that, while it is important 
to base investment decisions on research, our data limitations should 
not paralyze us from acting on the available data at any given time. 

In addition to more and better research, some participants said that 
the federal government needs to use the results of research it already 
has in hand. One participant expressed frustration with the fact that 
the federal government spends millions of dollars on evaluations but 
sometimes does not use them. Even when evaluations are used that show 
programs are not working, the federal government sometimes faces 
resistance in changing or terminating programs from constituents who 
are invested in keeping them unchanged. Another participant added that 
these groups are very worried about how evaluations and research on 
specific programs will be used. 

Participants also discussed establishing a set of national indicators 
as one way to help policymakers determine where to invest federal 
dollars, as well as to help track the outcomes of those investments. 
One participant discussed the State of the USA indicator project. State 
of the USA is a nonprofit organization that is working with the 
National Academy of Sciences to develop a set of key national 
indicators for issues facing this country. This will include, over the 
next 12-18 months, civic input on what the public wants to know about 
children, youth and families, among other issues. The participant noted 
the importance of widely available, quality data to motivate people to 
action and to reinforce accountability. Additionally, he thought that a 
key goal for national indicators is that they be relied on by everyone-
-policymakers and the public--similar to the nation's key economic 
indictors. One participant noted a key indicator that the nation does 
track is the percentage of various population groups living in poverty 
(e.g., children and the elderly). However, he added that he thought the 
current poverty threshold is outdated and doesn't reflect the level of 
support needed by individuals and families to move out of poverty, 
reach the middle class, and remain there. Some participants raised 
questions about whether more indicators are needed given data 
collection efforts by such groups as the Annie E. Casey Foundation 
through KIDS COUNT and interagency groups at the federal 
level.[Footnote 25] Another participant called for local indicators to 
be developed, in addition to national ones because many of the issues 
related to supporting families and helping children succeed, such as 
education, need to be addressed at the local level. 

Overall, the discussion highlighted that doing more to ensure all 
children have opportunities to become productive citizens--through 
revised income support, health care, and education policies--will 
require new thinking about federal investments. This would involve a 
shift away from budgetary and policy discussions focused solely on 
current spending to those more focused on prevention and longer term 
investments. In addition, one participant sensed among policymakers and 
the policy community a growing recognition of the importance of 
investing in children and hoped that it would lead to a national 
conversation about what the nation wants for children whose parents are 
not able to provide what their children need to become productive 

[End of section] 

Appendix I: Agenda: 

8:30 a.m.: Check-in/morning refreshments: 

9:00 a.m.: Opening session: 


Participant introductions Setting the stage: 

9:30 a.m.: Session I: Understanding Future Prospects of the Nation's 

Participants will discuss their research and experiences regarding the 
current and future prospects for America's children, particularly the 

10:30 a.m.: Break: 

10:45 a.m.: Session II: Building Opportunities for All of the Nation's 

Participants will discuss their perspectives on what needs to be done 
to ensure opportunities for all children, including the disadvantaged. 
The discussion will include a range of approaches designed to provide 
opportunities for children's future successes. It will encompass the 
role of the federal government, as well as the roles of state and local 
governments, businesses, nonprofits, and public/private partnerships. 

12:00 p.m.: Working lunch: Session II continues: 

Participants discuss the need for more evaluation, data, and key 
indicators to build a fact-based foundation for federal investment 
decisions in this area. 

1:00 p.m.: Session III: Identifying and Supporting Investments in 
Children in the Context of Overall Federal Budget Priorities: 

* Presentation by Isabel Sawhill: 

Participants will discuss actions that might increase understanding of 
current federal spending priorities and the implications for 
investments in children. The overall goal is to identify steps to 
facilitate the examination and realignment of federal budget priorities 
to help ensure opportunities for future generations. 

2:30 p.m.: Wrap-up--final thoughts: 

Each participant offers one idea or recommendation that he or she would 
like to come out of this forum (1 minute each): 

3:00 p.m.: Adjournment: 

[End of section] 

Appendix II: Forum Participants: 

Gene Dodaro: 
Acting Comptroller General: 
U.S. Government Accountability Office: 

Cynthia Fagnoni: 
Managing Director: 
Education, Workforce, and Income Security Issues: 
U.S. Government Accountability Office: 

Susan Aud: 
Senior Advisor: 
Office of Policy, Evaluation and Program Development: 
U.S. Department of Education: 

Dennis Campa: 
Department of Community Initiatives: 
City of San Antonio, Texas: 

Nicole Duritz: 
Senior Project Manager: 
Health Strategy: 

Linda Gibbs: 
Deputy Mayor: 
New York City, New York: 

Ron Haskins: 
Senior Fellow, Economic Studies Program, and Co-Director, Center on 
Children and Families: 
The Brookings Institution: 

Chris Hoenig: 
President and Chief Executive Officer: 
State of the USA, Inc.: 

Susan Irving: 
Director for Federal Budget Issues: 
Strategic Issues: 
U.S. Government Accountability Office: 

Graciela Italiano-Thomas: 
President and CEO: 
Thrive by Five Washington: 
Washington State: 

Rebecca Kilburn: 
Senior Economist: 
Director, Child Policy RAND: 

Christine Kim: 
Policy Analyst: 
Domestic and Economic Policy: 
Heritage Foundation: 

Virginia Knox: 
Family Well-Being and Child Development Policy Area: 

Charles Kolb: 
Committee for Economic Development: 

Tom McCool: Director, Center for Economics: 
Office of Applied Research and Methods: 
U.S. Government Accountability Office: 

Kristin Morse: 
Director of Program Development and Evaluation: 
The New York City Center for Economic Opportunity: 
New York City, New York: 

Susan Offutt: 
Chief Economist: 
U.S. Government Accountability Office: 

Melissa Pardue: 
Deputy Assistant Secretary for Human Services Policy: 
Office of the Assistant Secretary for Planning and Evaluation: 
U.S. Department of Health and Human Services: 

Sharon Parrott: 
Welfare Reform and Income Support Division: 
Center on Budget and Policy Priorities: 

Virginia Reno: 
Vice President for Income Security Policy: 
National Academy of Social Insurance: 

Isabel Sawhill: 
Senior Fellow, Economic Studies Program, and Co-Director, Center on 
Children and Families: 
The Brookings Institution: 

Christopher Swanson: 
Research Center: 
Editorial Projects in Education: 

Albert Wat: 
State Policy Analyst: 
Pre-K Now: 

Sara Watson: 
Senior Officer: 
Pew Charitable Trusts: 

[End of section] 

Appendix III: Presentation by Cynthia M. Fagnoni, Managing Director, 
Education, Workforce and Income Security Issues, GAO: 

Comptroller General’s Forum: 
Investing in Children and Families to Ensure the Nation’s Future: 

June 25, 2008: 

Current Fiscal Policy Could Have Negative Consequences for Our Nation’s 

The "Status Quo" Is Not an Option: 

* We face large and growing structural deficits largely due to an aging 
population and rising health care costs. 

* Budget experts agree that growing entitlement costs will, absent 
fundamental reform, put intense and increasing pressure on 
discretionary spending programs, tax levels or both. 

These problems have profound implications for future economic growth, 
standard of living, and national security. They also raise issues about 
how we will invest in the well-being of our nation’s children, 
especially those who are disadvantaged. 

Growth in Spending for Entitlements Expected to Outpace Economic 

As the baby-boom generation retires, federal spending on current
retirement and health care programs is projected to grow
dramatically, significantly outpacing economic growth by 2032.


This figure is a bar graph showing the growth in spending for 
Entitlements expected to outpace economic growth. 

Gross Domestic Product; 
Growth in constant dollars 2007-2032: 71%. 

Social Security Spending; 
Growth in constant dollars 2007-2032: 127%. 

Medicaid Spending; 
Growth in constant dollars 2007-2032: 224%. 

Medicare Spending; 
Growth in constant dollars 2007-2032: 235%. 

[See PDF for image] 

Source: GAO, Making Tough Budget Choices to Create a Better Future, GAO-
08-604CG (Washington, D.C.: March 2008). 

[End of figure] 

Increasing Portion of Federal Budget on Autopilot: 

While in 1967 retirement and health care programs accounted for about 16
percent of federal spending, by 2007, they already accounted for more 
than 40 percent. 


This figure is a combination of three pie graphs showing increasing 
portion of federal budget on autopilot. 

Year: 1967; 
Defense: 45%; 
Social Security: 14%; 
Medicare and Medicaid: 2%; 
Net interest: 7%; 
All other spending: 32%. 

Year: 1987; 
Defense: 28%; 
Social Security: 21%; 
Medicare and Medicaid: 10%; 
Net interest: 14%; 
All other spending: 27%. 

Year: 2007; 
Defense: 20%; 
Social Security: 21%; 
Medicare and Medicaid: 21%; 
Net interest: 9%; 
All other spending: 29%. 

[See PDF for image] 

Source: GAO, Making Tough Budget Choices, GAO-08-604CG (Washington 
D.C.: March 12, 2008). 

[End of figure] 

Entitlement Spending Could Lead to Future Budget Constraints: 

The present value of the federal government’s major long-term “fiscal 
exposures” in 2007 totaled almost $53 trillion. 

If we wanted to put aside enough money today to cover these 
entitlements, it would take about $455,000 per American household, up 
from $190,000 in 2000. 

Without changes to this system, our federal budget will be 
significantly driven by spending on Medicare, Medicaid, and Social 
Security, with increasingly little room for other federal priorities, 
such as investments in children. 

GAO’s recent work on state and local governments found that this sector 
also faces fiscal challenges that in many ways mirror those of the 
federal government. 

Research Shows That Some Children and Families Not Faring as Well as 

The federal government has a long tradition of efforts to improve the 
conditions of those living with severely limited resources and income, 
especially children. Currently, the federal government, often in 
partnership with the states, has an array of programs, such as Head 
Start, to assist low-income individuals and families. 

Recently we noted that the poverty rate among children was higher than 
among the total population, and higher than among the elderly. 

For African-American and Hispanic children, poverty rates in 2006 were 
33 and 26.6 percent, respectively. 

Individuals living in poverty face increased risk of adverse outcomes, 
such as poor educational outcomes, poor health, and criminal activity. 

Recent Findings Shed Light on Economic Mobility of Low-Income 

42 percent of children born to parents in the bottom one- fifth of the 
income distribution stay there. 

45 percent of African-American children whose parents were in the 
middle of the income distribution in the 1960s fell to the bottom of 
the income distribution, compared to 16 percent of white children. 

Source: Julia Isaacs, Isabel Sawhill, and Ron Haskins, Getting Ahead or 
Losing Ground: Economic Mobility in America, Washington, D.C.: 
Brookings Institution, March 2008. 

These Data Raise Questions about Federal Policies for Assisting 
Individuals and Families: 

As currently configured, federal spending emphasizes support at the end 
of an individual’s life rather than at other, earlier, intervention 
points, including: 

* early childhood education and care that helps a child start school 
ready to learn, 

* K-12 policies that ensure a child leaves school on a path to 
successful employment or postsecondary education, 

* access to postsecondary education, and: 

* aid to young families to enhance their own capacity to support their 

Focus of Today’s Discussion: 

Several researchers and policymakers have called for increased federal 
attention to programs and policies at these key intervention points. 

However, calls for increased investment must take into account existing 
ongoing federal commitments that make new investments difficult. 

Now is the time to start discussing these issues and the tough choices 
and trade-offs that are involved. 

[End of section] 

Appendix IV: Presentation by Dr. Isabel Sawhill, Brookings Institution: 

The Intergenerational Balancing Act: Where Children Fit in an Aging 

Isabel Sawhill, Senior Fellow: 

Brookings Institution: 

June 25, 2008: 

Today’s Children Face Unprecedented Challenges: 

A Global War on Terror: 

Global warming and other environmental challenges: 

A less secure economic future: 

* Globalization; 
* Low savings rate in the U.S.; 

What We Should Do: 

Modify these trends where possible; 
Equip children for the future; 

The Economic Challenge: 

Low savings rate: 
– Households; 
– Federal government; 

Deficits as Far as the Eye Can See: 

The current deficit will explode once the baby boom retires, swelling 
to roughly $700 billion; 

* Aging of the population
* Rising health care costs per person; 

How are Children Doing? 

A comparison of children in the U.S. with children in other rich 

Overall child well-being: 20 out of 21; 
The U.S. ranks poorly on all 5 measures:

* Health and safety: 20 out of 21; 
* Family/peer relationships: 20 out of 21; 
* Behavior and risks: 20 out of 21; 
* Material well-being: 17 out of 21; 
* Education: 12 out of 21; 

Source: UNICEF Report Card No. 7, Child Well-Being in Rich Countries, 

Possible Solutions: 

Encourage responsible parenting; 

Invest in children’s health, education, family environments; 

Reframe the social contract between the generations; 

Current Federal Priorities: 
(FY 2006): 

Total Federal Investments in Kids: $207 Billion; 

Cost of Tax Cuts Enacted Since 2001: $233 Billion; 

* Cost of Tax Cuts for Households with $200,000 or More: $87 Billion; 

Projected Growth in Spending on Social Security and Medicare, 2006-
2009: $198 Billion; 

Cost of the Operations in Iraq, Afghanistan, and for the War on 
Terrorism: $190 Billion. 

Source: Author’s Calculations from CBO, The Budget and Economic 
Outlook: Fiscal Years 2008 to 2017, Table 3-1, January 2007; Author’s 
Calculations from CBO, The Budget and Economic Outlook: An Update, Box 
1-1 and Table 1-6, August 2007; Brookings-Urban Tax Policy Center, 
Tables T07-0213 and T06-0273; Adam Carasso, C. Eugene Steuerle, and
Gillian Reynolds, Investing in Children, 2007. 

Spending on the Elderly will Crowd Out Spending on Kids: 

Figure: The Budget Sqeeze: Fiscal Years 2000 to 2030: 

This figure is a line graph showing the budget squeezes fiscal years 
2000 to 2030. The X axis represents the year, and the Y axis percentage 
of GDP. 

[See PDF for image] 

Source: Adam Carasso, C. Eugene Steuerle, and Gillian Reynolds, Kids’ 
Share 2007, Urban Institute, 2007. 

Note on assumptions: On the revenue side, tax cuts are made permanent 
and full AMT relief is provided; on the spending side Defense plus
International is fixed at 4.1 percent of GDP after 2008. Authors 
estimates, The Urban Institute, 2007. Authors' calculations based on 
data from the Budget of the U .S. Government FY 2008; CBO's Budget and 
Economic Outlook, 2008-17and the Social Security and Medicare Trustees
Reports (2006). 

[End of figure] 

The Choices We Face: 

Raise tax burdens by 50% or more; 

Dramatically reduce benefits to the elderly: 

* 50% cut in Medicare; 
* 20% cut in Social Security. 


Revise the social contract: 

* More investment in kids paid for by revenue increases; 

* More individual responsibility on the part of this same generation to 
pay for their own retirement. 

[End of section] 

Appendix V: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Cynthia M.Fagnoni, Managing Director, (202) 512-7215, 

Staff Acknowledgments: 

In addition to the contact named above, Gale Harris, Assistant 
Director; Janet Mascia; and Jaime Allentuck made significant 
contributions to the report. Other important contributors included Kate 
Van Gelder and Kathy Larin. 

[End of section] 

Related GAO Products: 

Healthy Marriage and Responsible Fatherhood Initiative: Further 
Progress Is Needed in Developing a Risk-Based Monitoring Approach to 
Help HHS Improve Program Oversight. GAO-08-1002. Washington, D.C.: 
September 26, 2008. 

Young Adults With Serious Mental Illness: Some States and Federal 
Agencies Are Taking Steps to Address Their Transition Challenges. GAO- 
08-678. Washington, D.C: June 23, 2008. 

Long-Term Fiscal Outlook: Long-Term Federal Fiscal Challenge Driven 
Primarily by Health Care. GAO-08-912T. Washington, D.C.: June 17, 2008. 

Disconnected Youth: Federal Action Could Address Some of the Challenges 
Faced by Local Programs That Reconnect Youth to Education and 
Employment. GAO-08-313. Washington, D.C: February 28, 2008. 

State Children's Health Insurance Program: Program Structure, 
Enrollment and Expenditure Experiences, and Outreach Approaches for 
States That Cover Adults. GAO-08-50. Washington, D.C.: November 26, 

Medicaid: Strategies to Help States Address Increased Expenditures 
during Economic Downturns. GAO-07-97. Washington, D.C.: October 18, 

Welfare Reform: Better Information Needed to Understand Trends in 
States' Uses of the TANF Block Grant. GAO-06-414. Washington, D.C.: 
March 3, 2006. 

Welfare Reform: More Information Needed to Assess Promising Strategies 
to Increase Parents' Incomes. GAO-06-108. Washington, D.C.: December 2, 

Child Care: Additional Information Is Needed on Working Families 
Receiving Subsidies., GAO-05-667. Washington, D.C.: June 29, 2005. 

Means-Tested Programs: Information on Program Access Can Be an 
Important Management Tool., GAO-05-221. Washington: D.C.: April 11, 

Supports For Low-Income Families: States Serve a Broad Range of 
Families through a Complex and Changing System. GAO-04-256. Washington, 
D.C.: January 26, 2004. 

No Child Left Behind Act: Improvements Needed in Education's Process 
for Tracking States' Implementation of Key Provisions. GAO-04-734. 
Washington, D.C: September 30, 2004. 

No Child Left Behind Act: Assistance from Education Could Help States 
Better Measure Progress of Students with Limited English Proficiency. 
GAO-06-815. Washington, D.C.: July 26, 2006. 

Food Stamp Program: Steps Have Been Taken to Increase Participation of 
Working Families, but Better Tracking of Efforts Is Needed. GAO-04-346. 
Washington, D.C.: March 5, 2004. 

[End of section] 


[1] GAO, Poverty in America: Economic Research Shows Adverse Impacts on 
Health Status and Other Social Conditions as well as the Economic 
Growth Rate, GAO-07-344 (Washington, D.C.: Jan. 24, 2007). 

[2] GAO, Disconnected Youth: Federal Action Could Address Some of the 
Challenges Faced by Local Programs That Reconnect Youth to Education 
and Employment, GAO-08-313 (Washington, D.C.: Feb. 28, 2008). 

[3] Julia Isaacs, Isabel Sawhill, and Ron Haskins, Getting Ahead or 
Losing Ground: Economic Mobility in America, Brookings Institution, 
Washington, D.C.: February 2008. 

[4] GAO-07-344, 7. 

[5] GAO, Supports for Low-Income Families: States Serve a Broad Range 
of Families through a Complex and Changing System, GAO-04-256 
(Washington, D.C.: Jan. 26, 2004), 1. 

[6] Currently the calculation only accounts for pretax income and does 
not include noncash benefits, such as Medicaid, which have comprised 
larger portions of the assistance package to those who are low-income. 
Other critiques note that it does not take into account key expenses 
that individuals and families typically incur. In 1995, a National 
Academy of Sciences panel recommended changes to the poverty 
calculation by counting noncash benefits and by deducting expenses, 
such as child care. 

[7] U.S. Census Bureau, Poverty Among Working Families: Finding From 
Experimental Poverty Measures. (Washington, D.C.: September 2000). 

[8] Effective October 1, 2008, the Food Stamp Program name was changed 
to the Supplemental Nutrition Assistance Program (SNAP). 

[9] GAO-04-256, 5. 

[10] Congressional Research Service, Cash and Noncash Benefits for 
Persons with Limited Income: Eligibility Rules, Recipient and 
Expenditure Data, FY2002-FY2004 (Washington, D.C.: Mar. 27, 2006), 2, 

[11] Congressional Research Service, Temporary Assistance for Needy 
Families (TANF): Issues for the 110th Congress (Washington, D.C.: 
Jul.16, 2008), 1, 3. 

[12] Both CCDF and TANF provide funding for services other than 
subsidizing child care. For example, CCDF allows states to use a 
portion of their block grant funds to improve the quality of child care 
services while TANF provides funding to states for a broad range of 
services to eligible clients such as job search assistance and 
substance abuse counseling. 

[13] In fiscal year 2007, 51 percent of the children enrolled in Head 
Start were 4 year olds, 36 percent were 3 year olds, and 10 percent 
were under the age of 3. 

[14] GAO, No Child Left Behind Act: States Face Challenges Measuring 
Academic Growth That Education's Initiatives May Help Address, GAO-06-
661 (Washington, D.C.: Jul.17, 2006), 1, 6. 

[15] GAO, Poverty in America, 20. 

[16] GAO, Poverty in America, 9, 10. 

[17] Medicaid is a federal means-tested entitlement program that 
provides federal matching funds to states to finance the delivery of 
primary and acute medical services as well as long-term care. SCHIP 
offers federal matching funds for states and territories to provide 
health insurance to targeted low-income children. For more information 
on these programs, see GAO, Medicaid and SCHIP: States Use Varying 
Approaches to Monitor Children's Access to Care, GAO-03-222 
(Washington, D.C.: Jan. 14, 2003) and GAO, Children's Health Insurance: 
States' SCHIP Enrollment and Spending Experiences and Considerations 
for Reauthorization, GAO-07-558T (Washington, D.C.: Mar. 1, 2007). 

[18] GAO, Making Tough Budget Choices to Create a Better Future, GAO-08-
604CG (Washington, D.C.: Mar. 12, 2008). See also GAO, A Call For 
Stewardship, GAO-08-93SP (Washington, D.C.: Dec. 17, 2007), 7, 8. 

[19] For more information on this topic, see GAO, State and Local 
Governments: Growing Fiscal Challenges Will Emerge during the Next 10 
Years, GAO-08-317 (Washington, D.C.: Jan. 22, 2008). 

[20] FAFSA is a form that students fill out to determine their 
eligibility for federal student financial aid. In addition, most states 
and schools use information from the FAFSA to award nonfederal aid. 

[21] For more information about Dr. Sawhill's proposal, see Isabel 
Sawhill and Emily Monea, "Old News" Democracy: Journal of Ideas, Issue 
9 (Washington, D.C.: Democracy: A Journal of Ideas, [hyperlink,] Summer, 2008), 
(accessed Oct. 28, 2008). 

[22] Indexing is a way to link the growth of benefits and/or revenues 
to changes in economic or demographic variables. For example, initial 
benefits can be set to grow with changes in average wages or changes in 
prices. Modifications to indexing seek to slow the growth of benefits 
or increase the growth of revenues, see GAO, Social Security Reform: 
Implications of Different Indexing Choices, GAO-06-804 (Washington, 
D.C.: Sept. 14, 2006). 

[23] A VAT is a broad-based consumption tax. A VAT is a tax levied on 
the difference between a business's sales of goods and services to 
consumers or other businesses and its purchases of goods and services 
(excluding wages) from other businesses, therefore taxing the value 
added to purchased goods by each business. Today, the United States is 
the only member of the Organization for Economic Cooperation and 
Development (OECD) without a VAT. On average, VATs raise more than 18 
percent of government revenue in OECD countries that have a VAT. For 
more information on VATs, see GAO, Value-Added Taxes: Lessons Learned 
from Other Countries on Compliance Risks, Administrative Costs, 
Compliance Burden, and Transition, GAO-08-566 (Washington, D.C.: Apr. 
4, 2008). 

[24] For the context of this forum, the contrast between health care 
spending as consumption and education spending as long-term investments 
were raised. For more information on this topic see, GAO, Budget 
Structure: Providing an Investment Focus in the Federal Budget, GAO/ T-
AIMD-95-178 (Washington, D.C.: Jun. 29, 1995). 

[25] KIDS COUNT is a national and state-by-state project of the Annie 
E. Casey Foundation to track the status of children in the United 
States. At the national level, the principal activity of the initiative 
is the publication of the annual KIDS COUNT Data Book, which uses the 
best available data to measure the educational, social, economic, and 
physical well-being of children state by state. The foundation also 
funds a national network of state-level KIDS COUNT projects that 
provide a more detailed, county-by-county picture of the condition of 

[End of section] 

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