The United States' social safety net is a patchwork at best, an ordeal by design, and adversarial to many. It is imbued with stigma, dehumanization, and a legacy of racism, reflecting an ideal that help should be temporary, if you are deserving, or simply unavailable, despite an economy with a decadeslong trend of rising inequality. We have designed programs in such a way that it takes a lot of effort for both people and the government, using burdensome paperwork and documentation that keeps many of those eligible for assistance from receiving it, with detrimental consequences for health and making health equity even harder to achieve. However, we embraced a more universalist approach with the Child Tax Credit expansion of 2021, which President Biden has referred to as "one of the most effective programs we've ever seen." 1 Elsewhere in JAMA Network Open, Nam and Kwon 2 examine how the Child Tax Credit expansion affected the mental health of low-income parents in the United States, finding a more than one-fourth decrease (27%) in the odds of self-reported anxiety symptoms among parents whose household income was less than $35 000.By early 2021, we had already lost more than half a million US residents to COVID-19, with tens of millions more at risk not (only) from the morbidity and mortality associated with an evolving pandemic, but from the collateral damage that it inflicted on our economy and our people-job loss, eviction, food insecurity, and more. The pandemic laid bare the inequities in our society-piling on more risk, disproportionate burden, and loss. We had an opportunity, need, and obligation to "think big." 3 The American Rescue Plan Act (ARPA), 4 passed in March 2021, was a $1.9 trillion stimulus bill designed to help the United States stem the tide of a pandemic-fueled recession. ARPA extended unemployment benefits; provided aid to state, local, and tribal governments and small businesses; ensured access and affordability of health insurance coverage; and supported COVID-19 testing and treatment nationwide. These were important and necessary bridges into a still uncertain future, as vaccines were just becoming available, but the shadow of the economic overhang of a still roiling pandemic loomed large. But Congress and the White House also took a big social policy swing, albeit on a short-term basis, by turning the Child Tax Credit into a "child allowance" as the National Academies, in their A Roadmap to Reducing Child Poverty, 5 and poverty scholars have recommended as part of the solution.Child poverty has been an ongoing problem in the United States, and the existing Child Tax Credit made it difficult for the poorest families to benefit. ARPA made several key changes to the Child Tax Credit for 2021 by (1) increasing the credit amount and age limit, (2) making it fully refundable, and (3) distributing half of the credit through monthly advance payments. The advance payments, made for 6 months from July through December 2021, of as much as $300 per child under the age of 6 years and $250 per child u...