As Medicaid funding cuts enacted through the One Big Beautiful Bill Act are expected to reduce health coverage among adults, researchers and clinicians from Weill Cornell Medicine, NewYork-Presbyterian and Ariadne Labs argue in a New England Journal of Medicine perspective, published Nov. 1, that children are at increasing risk of unintended downstream effects.
The bill, which became law on July 4, will cause 10 million people to lose their health insurance by 2034, the nonpartisan Congressional Budget Office estimates . Children aren't mentioned explicitly in the bill, but the authors say that many parents who lose coverage likely won't realize that their kids can retain theirs. That means the effects on adults "will have big spillover impacts on kids," said Dr. Beth McGinty, the lead author on the perspective, chief of the Division of Health Policy and Economics at Weill Cornell Medicine and co-founding director of the Cornell Health Policy Center.
The bill also puts new limits on how hospitals can recoup costs for treating uninsured children and the over 40% of kids who are on Medicaid. Experts expect this to reduce the money flowing into a field that already struggles financially because Medicaid reimburses children's services at a lower rate than adult services. "Every day I face workforce challenges, trying to recruit enough physicians, enough nurses," said Dr. Sallie Permar, chair of the Department of Pediatrics and the Nancy C. Paduano Professor in Pediatrics at Weill Cornell Medicine, and an author on the perspective.
With the funding landscape poised to become even more challenging, Dr. McGinty and Dr. Permar suggest several paths that states and hospitals can take to keep children's health care running.
First, states can try to prevent kids from being erroneously unenrolled from Medicaid when their parents lose coverage. COVID provided a practice run for this. During the pandemic, the Medicaid program dropped the requirement for recipients to prove they still qualified every year. Now, as the program returns to normal, "states are testing out a bunch of strategies to make sure they're not disenrolling people who are actually still eligible," like searching tax and labor databases for people's income, Dr. McGinty said.
Next, the researchers recommend that states invest in building up their pediatric workforce. Many medical students avoid the specialty because relatively low salaries compromise their ability to pay off student loans. "Providing loan repayment for those who choose pediatrics could be one way to combat this trend," said Dr. Permar, who is also pediatrician-in-chief at NewYork-Presbyterian Komansky Children's Hospital of Children's Hospital of New York.
But such a measure would be a stop-gap. "Long-term, what we really need is increased investment so that Medicaid reimbursement rates for children can be raised," said Dr. McGinty, who is also the Livingston Farrand Professor of Population Health Sciences at Weill Cornell Medicine.
Health systems could also shift to taking care of kids holistically by making sure they have easy access to mental health and social services in addition to physical health services, the researchers wrote. This could avoid future health problems and keep costs low in the long term both for adult health, and other government sectors such as foster care and juvenile justice.
"We value children very highly as individuals and as a country," Dr. Permar said. "But we're not prioritizing them in our policy making. And that needs to change."
