A Recommendation to the New President: Use Interoperability to Improve Children’s Lives

The $1.9 trillion Covid relief bill that’s headed for President Biden’s desk this week makes it very clear – wonderfully – that children will be a primary concern during his Administration. In particular, the legislations provisions will make a meaningful difference in the lives of kids in low- and middle-income families, mitigating poverty’s corrosive impact on millions of the youngest, most-vulnerable people in our country.

It’s a major step forward, to be sure, but there’s more to be done. Now we believe there’s a subsequent action he can take to engrain this progress and even-more-systemically fulfill his promise to “Build Back Better.” Our suggestion is this: Build a cross-agency coordinating council, and issue an executive order if necessary, to advance collaboration and planning among the numerous, disconnected federal programs and systems that aim to improve the health, safety and well-being of children.

Even at this deeply discordant time in our history, we believe most Americans could support that goal, just as they do the $1.9 billion rescue package. A deliberate effort to institutionally help children would be the “moonshot” of our generation, with positive impact that would last far into the future. While there would certainly be costs to fully implement it, the launch would be relatively inexpensive and the return on investment would be enormous.

The problem today is that government systems providing healthcare, social services, education, housing and other programs to assist children and families are mostly disconnected from each other. That means parents struggle to get the help they need – or even to figure out where to look for help – while service providers lack the ability to get a full picture of what needs have to be addressed. And that will remain the case even when the Covid legislation is implemented.

In short, we strongly believe the seamless, secure and confidential exchange of information is so important that it should be an explicit next step in his Build Back Better agenda.

The Affordable Care Act of 2010 (ACA) envisioned just this kind of approach to stimulate integration and coordination across the myriad agencies and organizations that serve children and families; indeed, some interoperability efforts were made during the Trump administration. Despite a broad consensus that this approach works, however, it hasn’t been widely implemented for a variety of reasons, many of them cultural and political.

Making this effort a priority, including creation of a Children’s Advocate in the White House, could induce actions in states and localities that most already believe are worth taking. Furthermore, provisions of the ACA specify that the federal government can pay up to 90% of a state’s costs of implementing interoperability, which would enable structural changes to permanently connect the relevant systems. The political lens through which some states have viewed the ACA has impeded wider use of those provisions, but presidential leadership – or, again, an executive order if necessary – could shift that reality.

It isn’t just children who would benefit. By its very nature, an interoperability initiative would lead to systemic changes that would contribute broadly to more-efficient and -effective programs and services for people of all ages, races and socioeconomic groups.

But children are the right initial focus. Helping them should be a cause that all sides of the political divide can agree upon and, quite simply, it’s the right thing to do.

The prescription we’re suggesting is not controversial. Interoperability has been enthusiastically embraced by the private sector and governments at all levels, irrespective of their leaders’ political leanings. It entails bringing a proven methodology to scale, beginning with leadership from the top, so we can get moving ASAP.

Taking this action would enhance and institutionalize the Administration’s goal of improving the lives of tens of millions of children who don’t get enough to eat, don’t have a decent place to sleep, don’t receive equal educational opportunities and, more generally, don’t have routine, equal access to the building blocks of health, well-being and life prospects.

Every politician says it: Children are our future. The President has now demonstrated that they are also his Administration’s priority. We believe that interoperability could be a key to ensuring that the changes being instigated today will endure and grow far into the future.

Daniel Stein is President of the Stewards of Change Institute. David A. Ross, ScD, is President and CEO of The Task Force for Global Health.

Daniel Stein and Dave Ross