In a group text with fellow pediatricians, I received a message asking if anyone knew where a child could get a blood draw that was not the emergency room. The question came from a colleague on behalf of another physician friend. She was worried her son might be anemic because of how he looked pale and was unusually fatigued.
She had just switched jobs and her son was not covered yet under her new health insurance. During a busy winter season, she hoped to avoid an emergency room visit if possible.
A few days later, her child was diagnosed with acute lymphocytic leukemia, a blood cancer that affects about 3,000 children and adolescents each year. What was presumed to be a routine lab test for a common childhood condition turned out to be something far more serious. Chemotherapy began the very next day.
As a mother of a three-year-old and a one-year-old, I cried. I cried for this child and his family, now facing years of treatments, hospital visits, side effects, and uncertainty. I cried for my own children, for my friends’ children, and for every family who learns, often too late, that devastating illnesses do not discriminate.
The invisible safety net of medical knowledge
And I could not stop thinking: What if this child’s mother had not been a physician? What if she did not recognize subtle warning signs, did not have colleagues to ask, or did not know how to navigate the system? What if she was working two jobs just to stay afloat, with no time or flexibility to seek care until her child became critically ill? What if she had lost health insurance altogether and was forced to choose between rent, groceries, and coverage after Medicaid subsidies expired or her benefits were cut?
The devastating impact of expiring Medicaid subsidies
The Congressional Budget Office estimates that by 2034, roughly eight million people will lose health insurance coverage, nearly one in five of them children. These losses will not just affect preventive care. They will strain emergency rooms, lengthen wait times for specialty and primary care, reduce provider reimbursement, and force hospitals and clinics to cut staff and services. Even families who remain insured will feel the consequences.
Most troubling, these cuts will cost children time, the one thing they often cannot afford. More children will have illnesses quietly developing, undetected because access to care was delayed or denied. More will present only when they are dangerously sick. Some will suffer preventable complications. Some will not survive.
We have a moral obligation to protect children and keep them healthy. Right now, we are failing to meet it. As I tuck my children into bed each night, I hold them a little tighter, grateful for their health, but deeply fearful for a future in which access to care becomes a privilege rather than a promise.
Mansi Kotwal is a pediatrician.
