What the CBO score leaves out — billions in cuts to child health coverage
© Greg Nash

The Congressional Budget Office’s score of the American Health Care Act confirms what many expected: the act would mean a cut to Medicaid of hundreds of billions of dollars.

The score does not show, however, the exact impact the act would have for children. It’s crucial that we have this information. The Children’s Hospital Association has commissioned a report that provides it.


The association is comprised of 220 pediatric institutions which are daily performing heart surgeries, administering chemotherapy and giving babies born preterm a chance at life. The majority of patients at many of these hospitals, including the one where I work, are covered by Medicaid.


The association’s report concludes that children’s Medicaid would be slashed between $43 billion and $78 billion over the next decade, depending on the exact way the American Health Care Act is implemented. That would be devastating to the 30 million children covered by the program.        

Despite the fact that they make up nearly half of all Medicaid enrollees, children account for a relatively small percentage of Medicaid spending. So any reduction to children’s Medicaid funding has a disproportionately greater impact.

Most children stay healthy most of the time. As a group, they do not spend as much money on health care as adults. Medicaid is one of the reasons why.

The program allows for screenings and preventative care to keep children from getting sick in the first place. When children do become sick – or have chronic conditions, such as congenital heart disease, requiring many resources – Medicaid provides coverage then as well.  

As a result, a reduction to Medicaid spending for children would:     

  • Reduce health care access for children who have it now

  • Condemn some children who have not yet been born to poorer access to health care

  • Potentially lead to greater future costs, if children cannot get preventative care they need

Regardless of your political affiliation, those outcomes should be unacceptable.

The bill passed by the House of Representatives will harm children. The Senate now has an opportunity to correct the American Health Care Act. Tens of millions of children are depending on it.

Steve Allen, MD, is chief executive officer of Nationwide Children’s Hospital in Columbus, Ohio and Immediate Past Chair for Children’s Hospital Association. Nationwide Children’s is one of the largest not-for-profit freestanding pediatric healthcare networks in the United States.

The views expressed by contributors are their own and are not the views of The Hill.