Before a child even enters the world, the conditions into which they are born are already shaping their health and future.
Hilary Hoynes, UC Berkeley chancellor’s professor of economics and public policy and co-director of the James M. and Cathleen D. Stone Center on Wealth and Income Inequality, has spent decades researching how different economic and social factors affect children’s lives, and how government policy can help address disparities. Her research on poverty, inequality, food and nutrition programs, and tax and transfer policies has helped show how the social safety net can improve children’s overall health and well-being, especially when families receive support early in a child’s life.
In a recent New York Times article, Hoynes shared her perspective on Rx Kids, a Flint, Michigan program that provided unconditional cash assistance to women during pregnancy and after childbirth. The program, which a new study found significantly improved the health of both the women who received the payments and their newborns, builds upon earlier research by Hoynes on the relationship between financial assistance and newborn health. Hoynes’ previous research had shown that women who receive larger income tax credits are less likely to have babies with low birth weight.
But many of the government programs that help families in need come with eligibility requirements, income limits or other restrictions. Rx Kids explored something Hoynes’ previous work hadn’t: What happens when financial support is given without the conditions that typically accompany social safety net programs?
Berkeley Social Sciences spoke with Hoynes about what the Rx Kids program can tell us about unconditional cash assistance, what the absence of conditions means for supporting families and the role of the Stone Center in the broader conversation. This interview has been edited for length and clarity.
Given your extensive research on how the social safety net affects families with children, what interested you about studying unconditional cash transfers during pregnancy?
Hilary Hoynes: My interest in Rx Kids comes from my ongoing research on how the social safety net affects families with children. In prior studies, my coauthors and I found that having access to food stamps through the Supplemental Nutrition Assistance Program (SNAP), as well as the Earned Income Tax Credit (EITC), a federal tax credit for low- to moderate-income workers and families, during pregnancy leads to healthier births.
Both of these programs have an element of conditionality, however. SNAP has an income test, and families must have net income below the poverty line. Further, SNAP provides vouchers that must be spent on food, though studies show that the increase in food spending that comes from SNAP is similar to what would result from cash. The EITC is conditional on work — so those without earned income are not eligible for the credit. With this background, I was interested in how a universal and unconditional cash transfer would affect births in Flint.
What was unique about the way the Rx Kids Flint program was designed, and what did that allow researchers to learn about the broader effects of providing cash support to families?
Hilary Hoynes: The unique approach used in Flint was to make the payments available to all women giving birth. This gives us a unique opportunity to study the general equilibrium effects of the program — that is, when the entire community is treated. This approach generates challenges as well, as there is no "control group" for this experiment. Instead the authors look for similar communities to Flint to form their control group.
Looking ahead, what would it take to change the way we think about financial support for new and expecting mothers, and what role can places like the Stone Center play in that conversation?
Hilary Hoynes: There is no U.S. social safety net program for families with children that does not come with conditionality (as in the EITC requiring work), means testing (as in the income test for SNAP) or vouchers (with limitations of how to spend the money). There is a large literature showing that these programs can be difficult to access, and are embedded with "administrative burdens."
In 2021, as part of the American Rescue Plan, the Child Tax Credit (CTC) — a federal tax break worth up to $2,200 per qualifying child — was expanded such that it was available to all families, even those without earnings. However, that change was not permanent. What we learn from Rx Kids will be very helpful in thinking about where we can make smart investments to expand our social safety. Pregnancy and post-childbirth is a very important time to support families given the decline in earnings post-birth and the critical early period for child development. The Stone Center can help by translating the academic research to the broader policy community.
