President Bush's choice of health care as one domestic focus for his State of the Union speech on Jan. 31, 2006 is one indicator that this troublesome issue is going to loom large this year. Corporations are questioning � and reducing—their role in providing health insurance for working families and the public is growing more concerned about the rising costs of health care and health care coverage. Medicaid expenses are now the biggest budget item in the states and the new drug benefit for Medicare beneficiaries has added a big mandatory expense item to the federal budget. The pressure is mounting for a health care "fix."

The debate will be whether the health care fix takes the form of a comprehensive approach toward some kind of system of universal health care or a market-based approach. In his speech, the president focused on strengthening health savings accounts (HSAs), promoting health insurance portability, improving electronic medical records, and reforming medical liability.

One major public health threat that affects children and teens—rising obesity rates—may generate more legislative efforts to improve school food and encourage physical activity during school hours. A federal law passed in 2004 requires all school districts receiving federal funds to have a "wellness policy" in place by the first day of the 2006-2007 school year. The 2005-2006 Healthy America initiative, led by the National Governors Association Chairman Gov. Mike Huckabee is all about reducing obesity and increasing physical fitness.

Worries that the avian flu virus could mutate into a form that can pass from human to human, thus sparking a worldwide pandemic, are generating new attention to public health disaster planning and preparations. While public opinion polling indicates Americans are only moderately concerned about the threat of a pandemic, the same poll indicates that they are also not convinced that the government is prepared to respond should one occur. The United States Department of Health and Human Services recently allocated $100 million in funding for states' preparation for an influenza outbreak, and has established a web site devoted to bird flu.

And beginning in 2006 millions of children will begin to lose Medicaid-funded health care as a result of federal funding cuts. For the first time 4.5 million children could face Medicaid co-payment charges. The Congressional Budget Office also estimates that children are likely to account for 60 percent of those denied Medicaid coverage as a consequence of being unable to pay higher Medicaid premiums.

Education Reform Moves to High School

State and national leaders are beginning to argue that in order to remain competitive in the global economy, we must do a better job of educating our middle and high school students, making sure every student graduates with the skills he or she needs to succeed. It also means making sure more students actually make it to graduation.

Margaret Spellings estimates that the million students who drop out of high school each year "cost our nation more than $260 billion dollars... in lost wages, lost taxes, and lost productivity over their lifetimes."

Early in 2005 President Bush tried to put high school reform on the national agenda by including an extension of the No Child Left Behind testing and standards approach beyond elementary school in his budget proposal. Congress rejected the President's request, which would have required cuts in other education programs, but there is growing awareness that high schools need to do better. In his 2006 State of the Union the President called for expanding the cadre of the nation's math and science teachers to keep America competitive.

In 2006, many governors will be taking the first steps on a plan to make sure that every student is tracked and kept on track through graduation from high school.

There may be a growing consensus on improving rigor, relevance and relationships in secondary education, but there is little consensus on a fourth "R"� resources. In December, 2005 the President signed a bill that cut federal spending on education for the first time in a decade. With a White House and Congressional leaders committed to more tax cuts and defense spending, the pressure to cut more in federal spending for schools, child care and college aid will continue.

Meanwhile, the No Child Left Behind law comes up for reauthorization in 2007, which means that in 2006, educators, analysts, parents and others will begin shaping and putting forth proposals for improving the good and fixing the flaws in the current NCLB law. State efforts to carry out standards-based education over the past decade have a positive, but modest, relationship with gains in student achievement, according to Education Week's "Quality Counts."

Facing an economy where it is increasingly difficult for a worker without a college education to earn a family wage, many families are struggling to meet the higher costs of college. Congress will debate student aid policies when it takes up the reauthorization of the Higher Ed Act, which was extended in late 2005 by three months, until March 2006.

Immigrants � a Growing Children's Issue

America has long prided itself on the idea of being a country that welcomes newcomers. But Americans have also had ambivalent reactions to immigrants, especially during hard times and times when immigrant numbers are rising, like now.

The demographics of immigrant families mean that millions of children are affected by U.S. policy towards immigrants, both legal and not. According to the Annie E. Casey Foundation's Kids Count over 4 million children nationwide live in an immigrant family where no adult speaks English well.

Close to 3.2 million children live with impoverished immigrant families. Two-thirds (65%) of children of recent immigrants �2.1 million�are low-income.

The majority of children of low-income, recent immigrants, across regions, have employed, married parents. These parents work and pay taxes, but because of major policy changes in key federal programs, fewer immigrant families receive public benefit supports like Food Stamps, welfare-to-work supports, or Medicaid or SCHIP health coverage.

The 1996 welfare reform law barred the majority of legal immigrants from participation in any federal means-tested benefits programs for five years after arriving in the U.S. Since then, the federal government has partially restored access to selected programs (namely SSI and Food Stamps). Still, many legal immigrants who came to the United States after 1996 remain ineligible for public assistance programs.

When President Bush was first in office he called for a reform of immigration policy that would provide a legal pathway for immigrants to stay in the workforce. Then came the attack on September 11, 2001 and the nation's attention turned first and foremost to national security. Meanwhile, the issue of protecting the U.S. from terrorists has inevitably become tangled with the issue of illegal immigrants seeking work. This has stymied a productive discussion of how to address immigration issues that affect millions of young children and teens.

One such issue involves undocumented high school graduates. Students who were illegally brought to the U.S. as infants or young children can do well in high school, but when they graduate they have a very hard time pursuing higher education. Advocates are hoping that the Dream Act, which would give such students a pathway to legalize their status and apply for student aid and admission to college, will allow these young people to contribute fully to our economic growth and national security.

The Dream Act was introduced in Congress but not approved in 2005. It will be introduced again in 2006.

Will Public Opinion Shifts Encourage Better Budget Decisions for Kids?

One of the biggest unanswered questions of 2006 is whether public dismay over the federal government's handling of Hurricane Katrina and Rita, and the renewed awareness of urban poverty and racial inequity will translate into a refusal to support continued tax cuts and reductions in services for the poor and near-poor.

Will people settle back into a "government can't get it right" mindset, or will their growing concern about the pace of reconstruction in Louisiana and Mississippi and an uneven economy lead to a demand that the administration and Congress do a better job? With midterm elections looming in Congress, there is a chance for public opinion to drive some real changes.

The Pew Research Center reports that most Americans gave the federal government a failing grade on its handling of Hurricane Katrina's aftermath. A month later, there were as many Americans who reported worrying that the government would spend too little on hurricane relief as feared that it would spend too much.

The Pew Center also reports that at the start of 2005, Americans already disagreed with White House priorities on tax cuts and tax simplification.

While public support for the Bush Administration's policies and for President Bush himself was dropping, political alliances began shifting in Congress as well. Long-fractious Democrats in Congress were finding greater solidarity, and Republican solidarity was showing signs of fraying. Democrats and moderate Republicans voted together against more tax cuts and spending cuts for social services.

At the same time election politics could make partisan politics more toxic in Washington, making it even more difficult for lawmakers to broker the kind of bipartisan compromises that can support new initiatives, like those to improve early mental health interventions for children.

Jan Richter is Connect for Kids' advocacy director.