Here’s a scenario that keeps adoptive and foster parent Sara Pendleton up at night: A child falls ill. The doctor is too expensive. Perhaps the child’s parents reduced or cut their coverage because the subsidies that allowed them to afford health insurance expired. Perhaps she got kicked out of Medicare or Medicaid after the GOP slashed that coverage. Whatever the reason, a policy choice forces mom and dad to keep the child home and hope for the best.
The child’s condition worsens. Her parents fear she may die. They take her to the emergency room, their last resort for some treatment. Doctors there give her the medicine she needs. They excoriate the parents, telling them their daughter needed care earlier. Now she has a host of complications that could have been prevented, they say, possibly lifelong ones. Then they call Child Protective Services.
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This isn’t just a hypothetical flash of anxiety. Pendleton has seen it happen. She’s fostered dozens of children, including those with disabilities and medical complexities. Children in foster care have the highest rate of chronic conditions of any child population.
“I shudder to think about the amount of children who could be taken into the foster care system if they’re marginal enough for the parent to not afford a medication,” said Pendleton, who lives in Biloxi, Mississippi. “Now they go to the hospital, and CPS gets called and says, ‘You were supposed to get this kid medication.’”
Insurance makes it possible for parents to manage a child’s disability, or to keep up with therapy, or even to simply attend to an illness promptly. Children without health insurance are vastly more likely to die if they fall ill, as medical scholars have pointed out for decades. Researchers in 2010 published an analysis of 23 million pediatric hospitalizations, for example, showing that nearly 40 percent of the uninsured children who died would still be alive if they’d had insurance.
Death is a uniquely horrific outcome of losing insurance, Pendleton said, but not the only one. A child can also lose her entire family.
“We say it all the time because we are foster parents,” she told me. “Death is not the worst thing that can happen when supports are cut.”
THE GOP IS DESTROYING CHILDREN’S HEALTH in multiple ways. Even before cuts to Medicare and Medicaid in the One Big Beautiful Bill Act (OBBBA), millions of children were tossed out of Medicaid and the Children’s Health Insurance Program, according to health nonprofit KFF. Between March 2023 and August 2025, 15 percent of child enrollees lost their coverage, amounting to more than six million children. Some states yanked coverage at even higher rates. Montana, for example, dropped 31 percent of child enrollees. Utah, Idaho, Texas, South Dakota, Georgia, Missouri, Florida, Alaska, and Wyoming all dropped more than 20 percent. In Virginia, 11,000 children lost their health insurance in 2025, according to The Commonwealth Institute.
This was the by-product of unwinding coverage gains built up during the pandemic period. But the future is likely to be far worse.
The end of enhanced Affordable Care Act subsidies put in place in 2021 means that at least half a million more children will lose their marketplace coverage, according to Georgetown University. Congress is holding votes this week to extend those subsidies that are not expected to pass.
Then, the OBBBA’s Medicaid cuts, some of which have already been implemented and others that roll out after the 2026 elections, will assuredly lead to more coverage losses, including for children.
The Trump regime is harming children’s health in multiple other ways, too, including Health and Human Services Secretary Robert F. Kennedy Jr.’s ongoing crusade against vaccines, which has contributed to declining vaccination rates across the country. Most recently, his Centers for Disease Control and Prevention dropped the recommendation to vaccinate newborns against hepatitis B, a condition caused by a virus that leads to liver failure and death for 9 out of 10 unvaccinated infants who contract it in their first year of life.
This cascade of GOP funding cuts is demolishing community hospitals and forcing all hospitals to save money by shuttering or reducing their less-profitable services, which often includes pediatric care, as I reported in July. The list of hospitals that have done so grows by the month. In November, officials of North Bay, California’s Santa Rosa Memorial Hospital announced the closure of their inpatient pediatric ward, the only pediatric care unit in the region outside of Oakland and San Francisco. On the other side of the country, Connecticut Children’s said they are closing their inpatient pediatric unit at St. Mary’s Hospital in Waterbury. Both hospitals cited financial pressures as reasons for closing.
Even with some of the worst impacts still in the future, the damage is already being felt. Charities that help people offset the cost of medical bills are seeing a significant increase in requests for help.
On top of this are all the other policies that will harm children’s health beyond directly cutting their access to medicine. A new report by Sen. Ron Wyden (D-OR), for example, outlines Republican policies of “slashing food assistance, weakening education and child welfare systems, and advancing immigration policies that traumatize vulnerable families,” all of which will harm children’s health.
“Despite empty promises to the contrary, Trump’s agenda is going to leave kids in America sicker, hungrier and less safe,” Wyden said in a statement. The cuts will hurt children and their families, he said, “in ways that will be felt for generations.”
GOP LAWMAKERS ARE WORKING OVERTIME to hide what they are doing by pretending they’re not doing it. Donald Trump and Speaker of the House Mike Johnson (R-LA), for example, say that health care cuts will do nothing but root out fraud and abuse. Florida Gov. Ron DeSantis, meanwhile, proclaimed without evidence that most Americans, “particularly under 50,” need only a “catastrophic plan,” not comprehensive health insurance. The man gunning for his job, Rep. Byron Donalds (R-FL), has said the same thing.
Think tanks are getting in on the cover-up, too. A report by the Urban Institute said that the end of subsidies will affect children the least out of all the age groups, because their uninsurance rates will only increase 14 percent.
But pediatricians, parents, and Democratic lawmakers say none of that is true. Children will actually be hurt worst of all.
The most obvious harm from losing medical insurance or access to a nearby medical facility is to overall health, doctors said. That can look like missing out on basic primary care and vaccines, both of which harm children long-term and put them at risk for preventable illnesses like measles and influenza, said pediatrician Dr. Katherine Peeler. It can also mean no doctor is monitoring a child’s early years to screen for potential underlying chronic diseases, resulting in a delayed diagnosis, unnecessary suffering, and a worsened condition.
“Kids who are not able to easily find a pediatrician, or not find but access for insurance reasons, they are at risk of having someone not following their development correctly,” said Peeler, who is also a medical adviser for Physicians for Human Rights and an assistant professor of pediatrics at Harvard Medical School.
Parents and doctors struggle to make sense of the GOP’s decision to enact policies that will force more children into the foster system.
“If people don’t have insurance, and we see this a lot, they will wait to bring their kid in for care. Not because they want to, but because they are making decisions about whether to pay for something out of pocket or have that money for groceries, both of which are important,” Peeler said, adding, “Kids can die if they come in too late or if they don’t come in at all.”
Dr. Ryan Jolly, who works as a nurse practitioner and owns Brain First Family Center, a full-service psychiatric practice in Lenexa, Kansas, put it like this: “Every bad thing you can think of is what happens when children are denied medical care.”
Her practice focuses on children who have dealt with “adverse childhood events,” such as physical trauma or fetal alcohol spectrum disorders (FASD), and she’s one of the few clinicians who routinely take unlimited Medicaid cases. She’s not sure how long she’ll be able to keep doing that when the cuts hit. Most practices limit the number of Medicaid patients because reimbursements are so low.
Jolly is likewise worried about how the cuts will affect her own children. She is an adoptive and foster parent focusing on medically complex children, including preteen siblings Diana and Max, who have FASD, and an eight-year-old she referred to as “Bob” to protect his identity. Bob was so violently assaulted in his home as a baby that he was not expected to survive. But in Jolly’s home, he’s been safe and surrounded by love, the only explanation his physicians can give for why he’s lived well beyond the eight weeks doctors initially predicted. His round-the-clock care is funded through an optional part of Medicaid called Home and Community-Based Services. Jolly doesn’t know whether that program will suffer cuts or how the family will handle it if it does.
“He needs 24/7, eyes-on care. He won’t stop needing that care to stay alive just because the funding stopped. That will mean that I will have to leave the workforce, close my practice, and probably end up on Medicaid myself to provide his care until I just cannot physically do it anymore,” Jolly said. If Bob ends up back at a hospital, she said, he will die.
The damage that funding cuts could mean for her family makes it almost impossible to come up with a contingency plan for next year. On top of that, the cost of Jolly’s own insurance is going up. The end of enhanced ACA subsidies means her insurance premium increased 123 percent.
Parents and doctors said they struggle to make sense of the GOP’s decision to enact policies that will force more children into the foster system and cause more children to die unnecessarily. Peeler, the Harvard pediatrics professor, noted that tomorrow, December 10, is the anniversary of Human Rights Day, which commemorates the Universal Declaration of Human Rights, drafted by a committee chaired by Eleanor Roosevelt and proclaimed as “a common standard of achievements for all peoples and all nations” in 1948. Article 25 outlines the right to medical care. But the U.S. has failed to make good on that promise. Peeler also pointed out that the U.S. is the only country in the world that hasn’t ratified the U.N. Convention on the Rights of the Child.
Instead of enacting those policies, Jolly said, “we are literally making choices that mean the death of children.”