Children’s hospitals across the country are warning that sweeping Medicaid cuts in the recently passed federal tax package could devastate pediatric care. With more than half of their patients relying on Medicaid, these hospitals say they are uniquely vulnerable to the legislation’s $1 trillion in healthcare spending reductions over the next decade.

Matt Cook, president and CEO of the Children’s Hospital Association, says the impact on pediatric care will be severe and immediate: “We’re going to have fewer healthcare workers because of this legislation—fewer nurses, fewer doctors.” He warns that hospitals will be forced to scale back services, lay off staff, delay critical infrastructure upgrades, and shutter programs entirely.

Emergency departments (EDs) are expected to feel the strain most acutely. With rural and suburban hospitals also facing funding shortfalls or closures, pediatric EDs could become dangerously overcrowded, increasing wait times and worsening outcomes, especially for children in mental health crises.

The bill also introduces new limits on how states can fund their Medicaid programs, compounding the pressure on pediatric systems. Many children’s hospitals were already operating on thin margins, losing money on every Medicaid patient they served. For hospitals where 70% or more of patients are on Medicaid, this tax package may push them past the breaking point.

Cook warns that the long-term consequences could be irreversible. “It’s hard to recover once you’ve done the damage,” he says.