Every child is born with a basic need and right to healthcare. Yet whether that child receives timely preventive care, sees a specialist, or gets treatment before a disease becomes life-threatening depends largely on an accident of birth — what state they live in, whether their parents' employer offers insurance, or whether a family successfully navigates an ever-changing maze of eligibility rules. We would never accept that kind of uncertainty for our nation's seniors. Why are we accepting it for our children?
Almost half of our nation’s children are insured by Medicaid and Children’s Health Insurance Program (CHIP). The current Medicaid system is financially unstable and subject to state budget pressures and administrative turnover. Medicaid services and payment rates demonstrate incredible state-to-state variability, with most states only paying a fraction compared to Medicare payments. According to the Kaiser Family Foundation, Medicaid only reimburses a fraction for each dollar Medicare pays for a service for a patient. The recently passed One Big Beautiful Bill plans for almost $1 trillion in cuts to Medicaid over the next 10 years. Poor payment rates by Medicaid negatively impact the ability of healthcare institutions to provide care for children and disincentivize clinicians to choose pediatrics, resulting in national shortages of pediatric physicians.
This is the contradiction at the heart of American child health policy. We say children are our future, then place their care in a program that is perpetually treated as optional spending. We deliver elderly healthcare through Medicare, a national entitlement associated with predictable federal rules. In contrast, we deliver children’s healthcare through a patchwork system that is dependent on geography, state and national politics, and chronically inadequate reimbursement. Medicare was built around a basic civic premise: certain populations are too important and vulnerable to leave to the vagaries of changing politics. Why is that population only the elderly? Why would it not include our most vulnerable populations? An 8-year-old with asthma, obesity, lead exposure, depression, or poorly controlled diabetes is not simply a patient with a current problem. That child is also our nation’s future cardiovascular disease burden, cancer risk, disability costs, educational attainment, workforce productivity, and military readiness.
We need to fundamentally change how we approach pediatric healthcare. Senator Andy Kim's proposal is to automatically enroll every child in America in comprehensive pediatric health coverage through age 26. Rather than asking families to navigate the complicated patchwork of Medicaid, Children’s Health Insurance Plan (CHIP), employer insurance, and gaps in coverage, MediKids creates one simple promise: every child receives the care they need, regardless of where they live or what their parents earn. Families can continue to use private insurance if preferred, but no child would ever lose access to care because of paperwork, a parent's employment, or changing state eligibility rules.
Critics will speculate on how much MediKids would cost. To be clear, this proposal does not address the significant disparities between Medicaid and Medicare payments. Ensuring healthcare for all children and valuing that care the same way we do for adult and elderly patients is the absolute minimum we should do as a country; this proposal does not address the latter. However, it is a first and necessary step in the right direction. A better question is how much failing to insure children already costs us. Every missed vaccination, untreated asthma exacerbation, delayed developmental diagnosis, preventable hospitalization, and unmanaged mental health condition becomes a larger expense later in life. Investing in children's health is one of the few public investments that consistently pays dividends over decades through healthier adults, greater educational attainment, higher workforce participation, and lower healthcare spending. Previous studies have shown that each dollar invested in lead paint hazard control results in a return of up to $200. A report from the CDC showed that routine childhood vaccinations over 30 years prevented more than 30 million hospitalizations, saved at least 1 million people from dying, and resulted in societal savings of $2.7 trillion. The nation already spends enormous sums treating preventable adult disease; MediKids simply shifts some of that investment earlier and optimizes the return on investment. And although half of all children nationwide are covered by Medicaid and CHIP, pediatric coverage makes up only to 10%–15% of the Medicaid budget. It is not only a moral imperative; it is fiscally responsible to invest in children now to ensure healthier adults in the future.
As a pediatric intensivist, I care for children after prevention has failed. Every day I see illnesses that could have been recognized earlier, treated sooner, or prevented altogether with consistent access to pediatric care. MediKids offers an opportunity to change that trajectory. If we truly believe that children are America's future, there is no better place to begin than guaranteeing healthcare for every child.
