Children’s uninsurance is once again rising at a concerning rate: 6% of children do not have health insurance as of 2024, up from a low of 4.7% in 2016. Although H.R. 1 is not fully implemented, the legislation’s Medicaid cuts are causing disproportionate harm to children as states facing steep funding losses scale back children’s eligibility, children’s benefits, and maternal and pediatric provider payments. These impacts already can be seen in dozens of state cuts to home- and community-based services for children with disabilities and a law in North Carolina that cut costs by eliminating coverage for 27,000 lawfully present children and pregnant women. Coverage for the North Carolina children was only restored after months of advocacy and passage of a new law that reversed the cuts. The Congressional Budget Office (CBO) now projects that 3 million children will lose coverage under Medicaid or the Children’s Health Insurance Program (CHIP) by 2036. Roughly 2.3 million children already have lost coverage in just the past year, an incredibly alarming statistic.
In this context, Chairman Ron Johnson of the Senate Budget Committee held a hearing, “Medicaid: The Reality,” to promote an already debunked claim that H.R. 1 did not cut Medicaid. Both the CBO and the RAND Corporation have confirmed that H.R. 1 cuts nearly $1 trillion from Medicaid over the 10-year budget window and that those cuts directly affect state budgets. Chairman Johnson next claimed that the cost of Medicaid was “out of control,” but the truth is Medicaid per-enrollee costs have only grown at half the rate of private insurance — a 51.6% increase compared to a 96% increase from 2008-2024. Lastly, Chairman Johnson claimed that Medicaid wasn’t “intended to handle 25% of the U.S. population.”
Both Medicaid and CHIP were enacted by Congress to provide coverage for adults and children who could not afford commercial health insurance. As Andy Schneider, Research Professor for the Center for Children and Families, explained in his testimony, that 25% of the population and almost half of all children are covered by Medicaid and CHIP shows that these programs are acting as vital safety nets to ensure beneficiaries are able to meet their health care needs and that commercial insurance continues to be out of reach for more and more families. KFF’s 2025 Employer Health Benefits Survey found workers pay an average of $1,440 out of pocket annually to add themselves to a commercial insurance plan — and $6,850 to cover their family, a number that jumps to $8,889 at small firms (10-199 workers). Roughly 60% of small firms offer health coverage, and 29% of those do not subsidize dependent coverage. Employer coverage for dependents is increasingly unavailable, unaffordable, under-networked, and hard to access, which is why there an estimated 23 million children remain underinsured.
In his opening remarks, Ranking Member Jeff Merkley highlighted a CBO analysis finding that every $1 spent on children by Medicaid and CHIP reduces the federal deficit by $2 in the future. These future savings come from insured kids being healthier kids who grow into healthy adults, earn higher wages, and thus pay higher taxes. Medicaid and CHIP provide the gold standard of coverage for children, offering comprehensive coverage designed to meet children’s needs, with most plans providing any medically necessary service a child needs through the Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) benefit. As a result, research shows Medicaid and CHIP lead to children being two-to-three times more likely to receive preventive care than uninsured children.
This reality of Medicaid and CHIP makes it obvious that more investment in children — not less — is needed at this time, especially in their access to health insurance through Medicaid and CHIP. To do this, First Focus Campaign for Children urged Congress in a statement for the record to take up the CHIPP Act to extend and make CHIP permanent, work to guarantee continuous eligibility for children in Medicaid and CHIP during the critical years of development from birth until age 6, perform rigorous oversight of the metrics that matter most to children to ensure H.R. 1 doesn’t undermine children’s health, and pass the MediKids Act of 2026 to ensure no child goes without insurance. Rather than giving up on the dream of an America where all children can get the medical care they need, Congress should work toward making it a reality.