Extending Advance Child Tax Credit Payments Is Imperative for Health Equity

BMC research shows food insufficiency jumped by 26% among households with children after Congress failed to extend advance child tax credit program
Three children with child tax credit chalk art on the pavement
Jemal Countess, Getty Images

The Bottom Line

Since advance Child Tax Credit (CTC) payments expired in January 2022, there has been a 25% increase in food insufficiency in U.S. households with children — disproportionately affecting low-income households and people of color. Reinstating advance CTC payments is a vital advocacy issue for healthcare providers because food insufficiency and poverty leads to poor health outcomes not just in childhood, but for a person's entire lifespan.


The COVID-19 pandemic increased national rates of food insufficiency — defined as a household not having enough food to last 7 days—and households with children consistently have higher rates of food insufficiency than households without.

With the pandemic and economic hardship in mind, the U.S. Congress passed a relief program, the American Rescue Plan Act, in March 2021, which included advance CTC payments. In short, this ARPA expanded the existing CTC program to include very low- or no-income families, an increase in the credit amount, and advance monthly payments of 50% their estimated child tax credit between July and December 2021.

While there is evidence of these advance CTC payments lowering national childhood poverty, U.S. Congress did not extend the changes to the CTC, and payments expired in January 2022, when the Build Back Better act failed to garner enough votes in the Senate.

Study Objective

To determine if the expiration of the advance Child Tax Credit payments after U.S. Congress failed to extend the policy affected food insufficiency among families with children.

The Details

In this cross-sectional study, researchers from Children's HealthWatch out of Boston Medical Center looked at data from the U.S. Census Bureau's Household Pulse Surveys between July 21, 2021 and July 11, 2022. They compared different "waves" of the surveys, marking different periods of time.


The research sample comprised 592,044 individuals representing households with and without children — primarily: 51% female, 62% white, 48% aged 25 to 44, 24% with an annual household income of $75,000 to $149,000.

The expanded CTC monthly payments were previously associated with a 26% decrease in food insufficiency in 2021 among households with children. Between January and to July 11, 2022 (the most recent survey data available at the time of this study), food insufficiency increased from 11.8% to 13.3% (a 13% increase) among all households. And in households with children present, food insufficiency increased even more: from 12.7% to 16.0% (25.7% increase).

The increase is even starker among low-income households with children—from 24.4% before to 31.5% after the advance child tax credit payments expired. Food insufficiency increased for all racial and ethnic subgroups, but it increased the most among Black, Hispanic, and other people of color. Because these groups are already historically underserved, this rise in food insufficiency could worsen existing heath inequities.

Pull Quote

"Without further Congressional action to extend the expanded CTC and reinstate monthly payments, reductions in food insufficiency, poverty, and inequity following the advance CTC payment introduction in 2021 may continue to erode."


Bovell-Ammon A, McCann NC, Mulugetta M, Ettinger de Cuba S, Raifman J, Shafer P (2022). "Association of the Expiration of Child Tax Credit Advance Payments With Food Insufficiency in US HouseholdsJAMA Network Open.