Part 4: Children’s Health and Elder Care on the Brink

by Kim Bergner

This is the fourth in an IndivisiBlog series on the health crisis in America. The first was on our increased risk of disease, the second on decreased access to healthcare, the third about attacks on research and vaccines. However, the attacks on Americans’ health will continue, and so will this series. 

Destruction is the point.

This is yet another story on our decreased access to healthcare under the Trump administration and a Republican triumvirate. Under the current regime, undermining experts and disassembling healthcare infrastructure is a continuing process. Given the delayed effects of the never-ending attacks on our health and healthcare, and amid the mayhem of daily political crises and violence, this healthcare disintegration can be likened to high blood pressure, “the Silent Killer”. You may not know it’s there until you have a stroke.

U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. made an illustrative announcement on April 16 when he said he would “reform” the U.S. Preventive Services Task Force.

This task force of volunteer medical experts evaluates evidence to determine which screenings, procedures and treatments should be provided to Americans by insurance companies at no cost. Some of the care protected by the task force includes colonoscopies, mammograms, depression screening and osteoporosis tests.

Over the last year, Kennedy has been undermining the task force. The New York Times (paywalled) reports, “Doctors and public health experts have worried for much of the past year that Mr. Kennedy may purge the task force and fill it with members who are ideologically aligned with him, as he did with a vaccine advisory panel at the Centers for Disease Control and Prevention.” Millions of Americans stand to lose access to these lifesaving measures. 

In his essay, “The Logic of Destruction”, Timothy Snyder writes, “… Americans have been told that the people who provide them with services are conspirators within a ‘deep state.’ We have been instructed that the billionaires are the heroes…. Theirs is a logic of destruction…. They will take what they can and disable the rest…. As their country is destroyed, Americans must be denied the idea that anything else is possible.” 

On April 1, President Donald Trump told us, “It’s not possible for us to take care of daycare, Medicaid, Medicare, all these individual things. They can do it on a state basis. You can’t do it on a federal. We have to take care of one thing: military protection. We have to guard the country.” Here are some of the consequences for the vulnerable populations of children and the elderly.

Ideology and greed trump children’s health and nutrition.

The current regime flouts the duty of the government to serve and protect the most dependent and vulnerable groups among us — children, the elderly and the poor. Here, we break down the implications of hard right policies for the health and safety of these groups and for our society at large. These include slashing funding for safety net programs, imposing ideology and bigotry over evidence and people, and anti-immigrant measures.

Slashing the safety net endangers children and is costly for society.

The OBBBA’s cuts to Medicaid and SNAP will endanger 45% of America’s children — 37.3 million kids, who rely on these programs for healthcare and food. Approximately 2 million children will lose nutrition due to the SNAP cuts. Cuts to these programs pose particularly grave risks for children from marginalized communities and children with working parents who lack a college degree.The OBBBA ensures that children in CHIP will lose protections as well. A majority of children in the United States rely on Medicaid, CHIP or both at some point before their 18th birthday, and many experience periods without healthcare coverage at all.The Medicaid cuts will bankrupt some pediatric inpatient facilities

Children’s hospitals count on Medicaid for about half of their revenue. This is a much higher proportion than for general hospitals. In some hospitals, 70% to 80% of pediatric inpatient care is federally funded. Even before the Medicaid cuts, Medicaid reimbursement was low and caused financial strain for facilities providing pediatric care. Now, according to Whitney McKnight of Medscape Medical News, “[w]ith Medicaid spending cut by $900 billion over 10 years, and the projected number of uninsured expected to rise to 10 million, inpatient units, already spending more than they take in, are likely to shutter. Pediatric hospitals will take a hit. Access to pediatric training for medical students and residents will decline, further worsening the shortage of pediatricians in the U.S.” Programs to improve community pediatric care have lost their federal grants

In December 2025, HHS abruptly terminated $18.4 million in grants to the American Academy of Pediatrics, ending seven programs (paywalled) that support the translation of evidence-based interventions into practice. The slashed programs develop clinical guidelines, train physicians, disseminate screening tools, and implement quality improvement initiatives. 

AAP CEO Mark Del Monte said, “This vital work spanned multiple child health priorities, including reducing sudden infant death, rural access to health care, mental health, adolescent health, supporting children with birth defects, early identification of autism, and prevention of fetal alcohol spectrum disorders.” These cuts will most significantly impact children in under-resourced communities. Withdrawing these funds eliminates pediatric public health infrastructure that took decades to build.

HHS explained the decision noting language in the grants that was “not aligned with current CDC and HHS priorities.” The department stated that the AAP’s materials used what it characterized as “identity-based language,” including references to racial disparities and use of inclusive terminology.

Defunding AAP programs seems retaliatory as well, since the academy has pushed back against Kennedy’s CDC and its Advisory Committee on Immunization Practices by continuing to follow the vaccine guidelines that were in place before Kennedy fired and replaced all 17 members of ACIP. 

In response to CDC no longer recommending COVID vaccines for children and pregnant women, AAP President Susan J. Kressly said, “We won’t lend our name or our expertise to a system that is being politicized at the expense of children’s health.” AAP has filed suit in federal court, and the judge has issued a preliminary injunction.

SNAP cuts cause short- and long-term damage.

The OBBBA will reduce SNAP funding by approximately $186 billion over 10 years — a 20% cut that marks the largest reduction in the history of the program.

The act also imposes stricter work requirements on SNAP participants. Adults between the ages of 55 and 64, as well as adults with children over the age of 14, will be subject to these rules, requiring them to work a minimum of 20 hours a week.

Children and society suffer both immediate harms and long-term harms. For example, the Center for American Progress notes, “The impact of SNAP cuts would extend far beyond the SNAP program itself, as every $1 in cuts made to SNAP for families with children costs society between $14 and $20.

“These costs come from reduced future earnings and worse health outcomes for children, along with costs associated with increased crime. The bill’s reductions in spending on food assistance would, therefore, ultimately be dwarfed by long-term costs.”

Massachusetts already had a food insecurity problem before the cuts.

More than 1.1 million Massachusetts households — about 40% — experienced food insecurity in 2025. An estimated 37% of children experienced inconsistent access to food.

This can be attributed to the state’s high cost of living, inflation and the 2025 government shutdown. A record high 56% of food-insecure households relied on food charities last year even as nonprofits have lost federal funding. Alarmingly, the OBBBA’s massive reduction in SNAP funding has not even occurred yet.

Lauren Fiechtner, senior health and research adviser at the Greater Boston Food Bank, said, “Every population — from families with young children to seniors — is struggling to afford food.“

Beyond reductions in food assistance, Trump administration policies are disastrous for seniors’ health and well-being.

What kind of society doesn’t take care of its children and elders? Next, we explore some major consequences for America’s seniors.

Nursing homes, residents and staff will suffer from Medicaid cuts and immigrant deportations.

Republican-led immigrant deportations and cuts to Medicaid are having a devastating impact on healthcare for elderly Americans.

Nearly two-thirds of nursing home residents rely on Medicaid to pay for their long-term care. Hundreds of billions of dollars in federal cuts will force states to reduce eligibility, services or provider payments — likely all three. Many facilities will close, eliminating options for people who are unable to live independently.

The wages of many nursing home workers are so low that they also rely on Medicaid for their own and their families’ healthcare. Nursing aides, dietary staff, laundry staff and housekeeping staff are low-wage workers at risk of losing their Medicaid, and they might not be able to continue providing care to residents.

Staffing and quality of care are further reduced by OBBBA provisions that block the implementation of national minimum staffing requirements. 

Health economist Jonathan Gruber elucidates how the crackdown on immigrants reduces staffing and imperils nursing home residents. He said, “Immigrants are disproportionately represented in the healthcare sector in general and the caring part of the healthcare sector in particular … when there’s more immigration, there’s a large rise in the number of caregivers.”

Gruber states that elder care is labor-intensive, and “we find a significant and quite striking reduction in the odds that elderly people will die when there’s more immigration to their community.”

He cites an economic analysis showing that if there’s a 25% rise in legal immigration to the U.S. (325,000 people), there would be 5,000 fewer elder deaths per year. Haitians are disproportionately represented in the healthcare sector, and if the revocation of Temporary Protected Status leads to the deportation of 330,000 Haitians, there would be 9,000 more elder deaths per year. Gruber says, “This is really striking evidence that immigrants are just a vital part of our network that’s caring for our nation’s elders.” 

On April 16, the House voted to extend TPS for Haitians through 2029. Rep. Ayanna Pressley (D-MA), who led the effort, used a congressional procedure called a discharge petition to force a vote to the floor. “This is a monumental victory in a long-fought battle to protect the safety, dignity and humanity of our Haitian neighbors,” Pressley said. However, the bill would need to pass in the Senate, and if it does, Trump is expected to veto it. 

In “The Logic of Destruction,” Timothy Snyder writes, “Deportations are a spectacle to turn Americans against one another, to make us afraid, and to get us to see pain and camps as normal …”

My mother’s caregivers give her what I cannot.

Here are excerpts from a story that describes these effects in human and intimate terms.

WBUR “Cognoscenti”, August 14, 2025, by Judy Bolton-Fasman

“The communique from my mother’s nursing home landed in my inbox, almost whispering that there were ‘some staffing changes due to U.S. immigration policy.’ It went on to note that to comply with the law, ‘this includes ensuring that every employee has valid work authorization.’ While the tone was bureaucratic, it was also practically apologetic for the resulting layoffs.

As she fades away, she cannot feed herself or speak coherently. Her nursing aides —who are a godsend to our family — have been devoted to her. They come from Haiti, the Caribbean and Central America …”

“My mother will be 90 this month. I continue to marvel at all the ways the nursing home staff protects her dignity and shows her love …”

“The Bureau of Labor and Statistics predicts that there will be some 740,000 new caregiving positions to fill in nursing homes and individual residences by 2034. My sandwich generation is hurtling towards old age and will become dependent on an industry short on workers. Will there still be staff to offer me and my peers the love and care my mother’s aides have shown her?”

What can Indivisibles do?

Timothy Snyder writes, “The assumption of a democracy is that individuals have dignity and rights that they realize and protect by acting together.” 

Elect progressive candidates, undo the damage to the healthcare system.

Rep. Lauren Underwood (D-IL), a nurse with a masters degree in nursing and public health, spoke on a Healthcare for Action sponsored webinar about what has to happen to start to undo the damage to our healthcare system. She said it will be hard. 

The first hard task is to try to undo the damage and get matters back to neutral. Then eventually, we need better than neutral. What has to happen is, we need for Democrats to win the House and Senate by a large margin in November. The OBBBA cannot be overturned by the House alone. After those things are accomplished, then the hard work of passing new legislation begins.

Here are concrete steps to help elect progressives:

1.  To learn about the most strategic, impactful, and cost-effective approach to winning the midterms, attend webinars by Focus for Democracy and contribute to the funds, organizations and races they recommend.

2.   Support Healthcare for Action , an organization of healthcare professionals that endorses and supports Democratic healthcare providers running for office in key states and districts. “We believe fundamentally that all policy is health policy.” 

3.   Another strategic approach is offered by Force Multiplier, including recommendations for supporting legal protections for free and fair elections, which are under threat.

Protect immigrants.

Action Guide to Support the People’s PROTECT Act
The Massachusetts House passed the PROTECT Act in March, which would limit state and local law enforcement collaboration with federal immigration authorities. But the act could be stronger! Call your state senator and press for strengthening this important legislation. Learn more from this toolkit.

Donate to your local or regional food bank.

Greater Boston

Worcester County

Western Mass

Merrimack Valley

Cape and Islands

Kim Bergner, MD, is a pediatrician and co-founder of Indivisible Weston.

IndivisiBlog posts reflect the opinions of the authors and do not necessarily reflect the opinions or policy positions of Indivisible Mass Coalition.