By Lisa Jarvis / Bloomberg Opinion
Republican lawmakers claim their proposal to cut hundreds of billions of dollars from Medicaid is designed to protect the country’s most vulnerable; that by focusing on work requirements, they’re simply eliminating waste from the bloated program and ensuring the money goes to those who truly need it.
In reality, anyone who relies on public insurance could be affected, including about 37 million kids, nearly half of all American children.
Some of those kids would lose out either because they are dropped from coverage or because the services they depend on are pared back as states grapple with the cuts. For others, the impact will be more indirect. Perhaps they can’t obtain mental health services because fewer providers accept Medicaid. Or maybe the pediatric dialysis clinic they use is forced to close. Or their caregiver loses coverage, and a medical emergency plunges their family into financial crisis.
Regardless of the form it takes, the result will be the same: worse health for our children, both in the near term and in their futures. The evidence overwhelmingly shows that ensuring children have access to care leads to better outcomes and that Medicaid improves their health and economic well-being into adulthood.
Yet the potential consequences for children grow more dire with each revision of President Trump’s “Big Beautiful Bill,” which proposes to cut nearly $800 billion from Medicaid over a decade. While many experts had hoped the Senate would address and soften some of the more troubling provisions included in the House version, the latest draft has instead sparked new concerns.
For example, the Senate version of the bill went beyond the House’s aggressive timeline for implementing Medicaid work requirements by broadening the category of people subject to the mandate. Under the House version, parents were largely exempt from the rule. The Senate proposal requires any parent with a child older than 14 to verify that they are working at least 80 hours a month to remain eligible for benefits.
That change belies the overwhelming evidence connecting adults’ and kids’ insurance coverage. Medicaid is a family affair: when a parent is enrolled, research shows that children also benefit from the coverage. And when that coverage is lost? Recent history shows that children can also be swept up, even if they are still eligible for benefits. When pandemic-era rules allowing people to be automatically reenrolled in Medicaid expired in 2023, millions of children lost insurance.
The Senate proposal also further restricts use of the “provider tax,” a convoluted, but legal, maneuver that states have used for decades to increase the amount of federal matching funds they receive from the government. Although these payments have been a frequent target of criticism, they are deeply embedded in the financial structure of our health care system. Any changes must be carefully planned and implemented, not hastily thrown together.
Under the current Senate plan, those federal matching payments would gradually be reduced through 2031. Health policy experts warn the change could severely impact rural hospitals, which typically serve a higher proportion of Medicaid patients. These facilities — which are critically important in providing care for pregnant women — are already struggling financially and could be driven to close as a result. Community health providers, a critical venue for meeting children’s behavioral health care needs, are also at risk.
How will these changes affect kids’ health? More health care costs will be shifted onto states, for which Medicaid is already the second-largest expense. Some 15.1 percent of every state-generated dollar went to Medicaid in 2023, the largest annual increase in 20 years, according to Pew.
“States are facing a world of pain here,” says Joan Alker, a professor at Georgetown University’s McCourt School of Public Policy and an expert on Medicaid and the Children’s Health Insurance Program.
They will have to make tough choices, ones that could mean fewer children are covered or fewer services for those most in need.
What happens when kids lose coverage? Research shows that uninsured children are far less likely to see a doctor, visit the dentist, or get an eye exam than their peers with public or private insurance. A recent study of children who lost Medicaid in 2023 also found that their access to medicine for chronic conditions like asthma or ADHD was disrupted, and some went without.
Public insurance also plays a critical role in ensuring children with complex medical needs — even those whose parents have private insurance — receive the long-term community-based services and support they need, explains Sara Rosenbaum, a professor emerita at George Washington University’s Milken Institute School of Public Health. That care is expensive, and while states won’t kick a disabled child off Medicaid entirely, they might cut corners. That could mean fewer hours of therapy, fewer interventions and paring back full-time support services, Rosenbaum says.
Lawmakers might counter that Medicaid is required to cover medically necessary services for kids. But these cuts could make it much harder to actually obtain them. Families may have to travel further for care, even out of state, creating hurdles that could delay treatment or make it inaccessible entirely.
Medicaid is one of our most vital social safety nets. It’s also an investment in our children’s future. The current legislation callously trades short-term financial savings for the long-term health and well-being of kids.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
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