Emerging Policy Shifts and Their Impact on Child Health

It is widely known that healthier children with greater access to care are more likely to become healthier adults. Research has shown that children from low-income backgrounds who are covered by Medicaid from birth to age six experience “significant improvements in adult health outcomes, as measured by an index combining information on high blood pressure, diabetes, heart disease/heart attack, and obesity.”²

According to a July 2025 study published in the Journal of the American Medical Association (JAMA), children’s health has significantly worsened across several key indicators since 2007 including chronic diseases, mortality rates, and mental health.³ For example, children in the United States were 15 to 20 percent more likely to have a chronic condition in 2023 compared to 2011 and were also 80 percent more likely to die compared to peers in other high-income countries over time.⁴ The ongoing youth mental health crisis also continues to loom with 15 percent of children ages 10-19 years old suffering from a behavioral health disorder.⁵ Mental health problems often compound physical health issues, putting American children at risk for worsened health outcomes in the future.⁶

Currently, we’re also seeing decreases in various social determinants of health that impact children and their overall well-being. These non-medical factors like education access, social and community support, housing, and food insecurity have been determined to impact the quality of a child’s life, which, in turn, can lead to issues well into adulthood. Consider, for example, that over 20 million children in the U.S. rely on free or reduced-price school lunches as a key source of nourishment.⁷  Severely cutting this program will directly impact children’s nutrition, potentially creating immediate and long-term health consequences such as malnourished individuals who have a harder time focusing in school and may develop other health issues that lead to hospitalizations, increased costs on the family and state, and more time out of school – ultimately leading the child to fall behind his or her peers.

Other social determinants of health that can exacerbate negative health outcomes include gun violence and youth homelessness. Research has suggested that since 2010, Medicaid is the single largest insurer of victims of gun violence.⁸ Victims of gun violence are more likely to have better outcomes in states with strong Medicaid coverage.⁹ Considering that firearms are the leading cause of death for children and adolescents, any changes to the Medicaid program will likely a severe impact on children and adolescents.¹⁰

Less coverage options for children of gun violence covered by Medicaid are not the sole impact Medicaid cuts can have on child health. Cuts to Medicaid are also slated to reduce specialized benefits like housing support, putting more children at risk of becoming unhoused.¹¹ Studies have shown that there is an association between poor health status and elevated risk of homelessness.¹² This suggests that cuts to Medicaid could put children of poor health particularly at risk, reinforcing future worsened health outcomes as child health continues to deteriorate.

In addition, families losing access to Medicaid and Supplemental Nutrition Assistance Program (SNAP) benefits as a result of the One Big Beautiful Bill Act (OBBBA) means that fewer children will be automatically enrolled in free school meals which would otherwise help students avoid poor health and improve school performance.^13,14 This “double jeopardy” will likely be exacerbated for children of color, who are more likely to receive Medicaid benefits and free or reduced-price lunches.¹⁵

Despite the fact that nearly half of all American children are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), the keystone OBBBA is expected to cut gross federal funding for these programs by $990 billion over the next decade, putting access to preventive and acute care at risk.^16,17,18 Although the law is not directly aimed at children enrolled in Medicaid, the approved cuts are expected to take a significant toll on pediatric providers and health systems by putting a dent in revenues and potentially forcing them to cut certain services.¹⁹ For instance, cuts to Medicaid and CHIP will impact maternity care. This could lead to poorer health outcomes for mothers and infants, risking decreased long-term health outcomes for children born to mothers who do not have adequate access to crucial needs like adequate health care, housing, food and nutrition, and a safe environment.²⁰ Further, anticipated changes to enrollment of Medicaid-insured adults will ultimately hurt children. For example, children are more likely to have an annual well-child visit if their parents are enrolled in Medicaid, an effect that could likely be curtailed by the OBBBA Medicaid cuts.²¹ A parent’s loss of Medicaid can be devastating to a child, threatening worsened health outcomes, delay of care, and consequences for their long-term health.^22,23

Concurrently, pediatric providers and children’s hospitals are experiencing ongoing difficulties from worsening workforce shortages – which may only be exacerbated by threats to the Children’s Hospitals Graduate Medical Education (CHGME) program that supports pediatric training – to mounting financial pressures, with nonprofit children’s hospitals seeing their profitability drop in 2023 to the lowest level in a decade.²⁴

As vulnerabilities in child health care grow larger, so does the need to invest in bolstering the pediatric health infrastructure.²⁵ Per the National Academies of Sciences, Engineering, and Medicine, investing in children and families not only “improves child health, but also health equity, education outcomes, workforce productivity, and cost-effectiveness in public spending.”²⁶ Yet, despite lawmakers’ renewed calls and vision for a healthier America, most health care investment and reform has been directed toward adults, and certain proposals and some recently enacted policies may have unintended consequences on the health and wellbeing of our nation’s children.²⁷

Researchers and medical experts have also shared concerns with this year’s unprecedented cuts to research funding, arguing that such approach will significantly stall medical progress.²⁸ Pediatric research and clinical trials that include children and adolescents are crucial to testing and developing new lifesaving treatments, prescription drugs, behavioral interventions, and more.²⁹ Additionally, children, as compared to adults, have unique physiological and treatment needs that can only be understood through research studies and clinical trials.³⁰ With cuts to research funding, these crucial levers to improving children’s health could largely disappear.

Finally, as previously noted, children in America face a dwindling pediatric care workforce. In fact, from 2019 to 2024, there was an 11.5 percent decrease in medical student applicants to pediatrics, resulting in a greater number of open pediatric subspeciality fellowship positions than applicants in 2024.³¹ The ability to meet the health care needs of every child and adolescent depends on a robust pediatric workforce, but programs intended to bolster the pediatric workforce may now be at risk. For example, one measure within the OBBBA caps federal student loans, which experts argue could make it harder for medical students to finance their education or force them to abandon their medical school plans entirely, which may only exacerbate worsening health care workforce shortages.^32,33 Additionally, President Donald Trump’s proposed budget for fiscal year 2026 aims to eliminate the CHGME program, which, as previously mentioned, provides critical support to children’s hospitals for the training of the nation’s pediatrics and pediatric subspecialists.³⁴

By prioritizing the health of our children, we can provide the necessary support and resources to enable our children to thrive and become healthier adults, securing a brighter future for our nation. FTI Consulting’s team of health care and life sciences experts is keeping a close watch on this issue and is keenly aware of the longer-term implications for our children and adolescents, our families, our country, health care organizations’ operations and care delivery, and other groups that are dedicated to the health and wellbeing of youth. Contact us for a discussion today.