NEJM November 1, 2025
U.S. children are not all right, and neither is the health care system that serves them. Medicaid cuts, a centerpiece of the 2025 One Big Beautiful Bill Act (OBBBA), will exacerbate these problems. A strategy for improving children’s health care is urgently needed.
Children in the United States have faced rising rates of chronic conditions, psychological stress and psychiatric illness, and fatal injuries in recent years, and they are nearly twice as likely as children in other high-income countries to die. These trends have occurred alongside growing pediatric workforce shortages; reductions in preventive care, which have been exacerbated by misinformation and threats to vaccine access; and increases in unmet health care needs.
Medicaid, which covers 4 in 10 U.S....
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