The U.S. Supreme Court will hear arguments tomorrow related to President Trump’s plan to end birthright citizenship. Although the case centers not on the meat of the issue, but on the limits of judicial power, the harm that ending birthright citizenship will inflict on the nation’s children will loom large.

“The birthright citizenship debate is not just about immigration,” said Bruce Lesley, president of First Focus on Children. “It is a question of who we are as a country and how we value our babies and children. Stripping away birthright citizenship would create a new class of undocumented and stateless children, condemning millions of U.S. kids, who have done nothing wrong, to a life in the shadows without the protections and opportunities afforded to their peers. These children would endure life-long discrimination, denial of basic benefits and services, and an unrecoverable blow to their health, development and well-being, as both children and adults. Ending birthright citizenship is not good for kids, and it’s not good for America.”

Eliminating birthright citizenship would:

• Require every one of the 3.6 million babies born annually in the U.S. to apply for citizenship.
• Deny newborns and infants essential services like health care, nutrition, and child care — at the very moment they need it most.
• Create a massive bureaucracy to decide which babies “belong” here and which do not.
• Leave hundreds of thousands of children stateless, making them vulnerable to exclusion and exploitation, and stripping them of the opportunity to thrive.

When the question comes before them, the U.S. Supreme Court should affirm the clear language in the Fourteenth Amendment to the Constitution; affirm the 1898 decision in United States v. Wong Kim Ark; recognize birthright citizenship as part of federal law (8 U.S. Code Seciton 1401) that cannot simply be overturned by a presidential executive order; and recognize the fundamental constitutional rights and protections that babies enjoy.

First Focus Campaign for Children outlined these and other issues in a letter to Sen. Lindsey Graham and Rep. Brian Babin opposing their Birthright Citizenship Act of 2025 (S. 304/H.R.569), which seeks to radically change the Constitution’s citizenship clause in the Fourteenth Amendment, reverse several Supreme Court decisions, overturn long-standing federal statutes, and gut centuries-old procedures and practices for determining citizenship in our country.

For more on the impact that ending birthright citizenship will have on children, read “Born in the USA: The Constitution is Clear — Babies are Citizens” and “In Harm’s Way: The Consequences of Denying Birthright Citizenship for America’s Children and our Future.”

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The Trump Administration has made children a political target, which is not only immoral, it’s costly. Kids can’t vote, and they don’t have political action committees or lobbying power. But investing in children leads to better health outcomes, higher educational attainment, and increased earnings as adults. A study by the National Bureau of Economic Research suggests that every dollar the federal government invests in programs that benefit children yields $10 or more in societal returns. 

Department of Health and Human Services (HHS) 

The Administration for Children and Families (ACF): ACF, which administers some of the most important programs for children, including child care, child welfare, and Head Start, has lost 35-40% of its staff, according to recent reports. Five of 10 regional offices have shuttered, eliminating Head Start, child care, child support, and other staff in those offices. Regional offices provide near constant communication between HHS and the states and jurisdictions implementing HHS programs. This includes oversight of grantees to ensure the integrity of federal programs, fielding technical assistance and program questions, and ensuring child health and safety in these programs. Head Start, which currently serves over 800,000 children and their families, including children with disabilities, those in foster care, and children experiencing homelessness, and has served over 40 million children and families throughout its history, is under multiple attacks from this administration and lost over one-third of its entire staff. This will mean fewer services and child care slots for children and their families, which are already exceedingly difficult to find and afford. Cuts to ACF will also negatively impact child welfare efforts to keep children safe and with their families. All staff working on the Social Services Block Grant (SSBG) have been eliminated. SSBG serves 2.5 million children through child welfare services, and 13% of its funding is spent on child care. Staff that administers the Temporary Assistance for Needy Families (TANF) program, which provides states with funds that can be used for direct payments to families and for child welfare services, have also been eliminated. 

Health Resources and Services Administration (HRSA): Major job losses are being felt at the Health Resources and Services Administration, including to the Maternal and Child Health Bureau, which administers programs including the Maternal, Infant, and Early Childhood Home Visiting Program; Healthy Start; and the Maternal and Child Health Services Block Grant, which prevent infant and maternal mortality and support child development.  

Federal Drug Administration (FDA) and National Institutes of Health (NIH): The FDA and NIH are experiencing deep cuts in staff and expertise. The FDA’s Center for Tobacco Products is losing significant staff, which will hobble the agency’s enforcement efforts against illegal e-cigarette products that target children in their marketing. The head of the Eunice Kennedy Shriver National Institute of Child Health and Human Development has been removed from NIH, along with employees and researchers who do critical work on childhood cancer and vaccines. This loss of expertise will be devastating to efforts to screen newborns for disorders that harm their cognitive development, create vaccines that address infectious childhood diseases, and save the lives of preterm infants.   

Centers for Disease Control (CDC): Staff cuts to the CDC eliminate the Office on Smoking and Health. This would eliminate the National Youth Tobacco Survey, which collects data on tobacco use by middle and high school students and identifies the emergence of new threats and dangerous trends in youth tobacco use and youth access to tobacco products. These CDC cuts would also eliminate the National Center for Injury Prevention and Control, which funds vital gun violence prevention research that studies and makes recommendations on topics including preventing youth suicide with firearms and safe firearm storage. The center also funds work to prevent child drownings, car fatalities, child abuse, and other grave threats to children. The CDC’s Lead Poisoning Prevention and Surveillance Branch was also decimated by these cuts, threatening greater exposure to lead for children, which will lead to serious health impacts.  

Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA has experienced significant cuts to its staff and is slated for elimination. The Trump Administration plans to collapse SAMHSA and several other entities into a new agency at HHS. Staff cuts will impact the work of the 988 Suicide and Crisis Lifeline, including the specialized LGBTQ+ line, which was created in 2023 to provide services to LGBTQ+ youth who are among those at highest risk for mental health issues and suicide. SAMHSA funds mental health and substance use prevention efforts for youth, administers Project AWARE, which increases mental health awareness in schools, and funds work on youth social media use and mental health. These efforts for children are at great risk with the significant cuts and reorganization SAMHSA is undergoing.  

The Centers for Medicare & Medicaid Services (CMS)

CMS oversight includes Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act Marketplace. Medicaid and CHIP provide over 37 million children with health coverage. An additional 2 million children are enrolled in Marketplace coverage. CMS now faces the challenge of maintaining its critical operations with a significantly reduced workforce. 

As part of the HHS workforce reductions, CMS lost 300 staff members who help ensure children can apply for, enroll in, and maintain their health coverage and who help provide the oversight to ensure children access high quality, timely physical and mental health care. Specific CMS offices affected by the cuts include the Office of Minority Health and the Office of Program Operations & Local Engagement.  

Staff reductions in the Office of Minority Health threaten to undermine efforts to address health disparities that disproportionately affect minority children. Medicaid and CHIP are primary sources of coverage for children of color. More than half of children who identify as Native American, Black, Latino, or multiracial have Medicaid as their source of health insurance. Children of color in the United States face an array of health disparities, including higher rates of chronic conditions such as asthma, obesity, diabetes, and hypertension. Black and Native American infants have higher rates of infant mortality compared to White infants. Limited access to mental health services, higher rates of being uninsured or underinsured, and disparities in oral health are also evident among children of color. The Office of Minority Health’s work is essential for developing innovative solutions to reduce costs, prevent disease, and decrease the prevalence and severity of chronic illnesses among minority populations. The reduction in capacity will likely result in fewer targeted interventions for children, exacerbating existing health inequities.  

With substantial workforce cuts in the Office of Program Operations & Local Engagement (OPOLE), the implementation and oversight of CMS programs will likely suffer from reduced capacity and expertise. This office’s role in engaging with local stakeholders is crucial for ensuring that CMS programs effectively serve the unique needs of different communities and their children. An example of the children these workforce reductions might impact the most are those living in rural areas. OPOLE is responsible for implementing CMS’ rural health strategy at the local level. This strategy includes ensuring CMS programs and policies have a rural lens, advancing telehealth and telemedicine, and improving access to care through provider engagement and support. With fewer staff to implement the CMS rural strategy, children living in rural areas are at risk of seeing reduced access to care.

The CMS layoffs come at a particularly sensitive time for public health in the United States. The country is currently experiencing a severe measles outbreak. Just several months into 2025, the nation has recorded the most measles cases in a single year since 2019. Nationwide, there have been over 600 cases recorded across at least 21 states. The outbreak has led to the deaths of two children in Texas. 

Overall, with reductions in staff across offices responsible for program implementation, health equity, and service coordination, there is a risk of disruption to health services for children, especially those in rural areas and those who face the most health disparities. 

Department of Education (ED)

The Department of Education is the one-and-only federal agency committed exclusively to children, and it is an essential force for ensuring that all of the nation’s students receive a well-supported and equitable public education. In March, the Trump Administration fired roughly half of the Department of Education’s workforce. When President Trump started his term, The Department of Education had 4,133 employees. After these reductions, just 2,183 employees will be left. The Department of Education plays a critical role in enforcing federal civil rights laws and supporting underserved student groups. A key role of the Department is in implementing the Individuals with Disabilities Education Act (IDEA), which entitles students with disabilities to a free appropriate public education. The Administration has announced plans to move IDEA to the Department of Health and Human Services, which would take it out of the hands of seasoned education policy experts and would weaken the parent support networks currently in place. 

Even before firing half of its staff, the Department of Education was the smallest Cabinet-level agency. After the initial workforce reductions, President Trump signed an executive order aimed at dismantling the Department of Education. While he claimed he would be “returning education, very simply, back to the states where it belongs,” he did not clarify what functions would be returned to states. Instead, the plans seem to be to eliminate federal education support without providing any additional resources or assistance to states. While complete abolition of the department would require congressional action, the actions of the Trump Administration already have made it more difficult for the department to accomplish its goals. Recent staff cuts have drastically harmed the Office for Civil Rights and Institute of Education Sciences. 

Office for Civil Rights: The Office for Civil Rights (OCR) enforces federal civil rights laws that prohibit discrimination in programs or activities in schools that receive federal funding. OCR has been hit particularly hard by the layoffs, devastating many regional offices. There is an critical need for the Office for Civil Rights – In FY 2024, OCR received over 20,000 complaints. This is continuing a pattern of OCR receiving the highest-ever number of complaints per year for the past three years. 

Institute of Education Sciences: The cuts at ED disproportionately affected staff at the Institute of Education Sciences, the department’s research arm. The cuts trimmed more than 60% of IES staff. IES evaluates education programs, works to improve outcomes for all students, and is able to paint a picture of how well the U.S. is educating its students. IES plays a critical role in flagging challenges American students face, such as the bullying contributing to the youth mental health crisis.    

United States Agency for International Development (USAID) 

For decades, the United States was the world leader in ending deaths of children under five years of age due to preventable disease and malnutrition. U.S. efforts saved millions of children a year and slashed the child death rate from 12.8 million in 1990 to less than 5 million in 2024. Before January 2025, USAID led the world in the promotion of maternal and child health, nutrition, malaria prevention and treatment, HIV prevention and treatment, child protection and primary education. The U.S. spent roughly $4 billion annually on programs that kept vulnerable children alive and healthy. But the Trump Administration’s destruction of USAID has changed all that.

The complete loss of USAID and its world-class staff, and the decline of U.S. foreign assistance overall, has been absolutely devastating for children worldwide. Below are a few of the estimated impacts over the next year:

• 11,262,264 newborns will no longer receive critical postnatal care within two days of birth.
• 14,782,398 children will no longer be treated for pneumonia and diarrhea,which are among the top causes of preventable deaths in children under 5.
• 16,800,000 pregnant women will no longer be reached by life-saving services.
• 1 million children will no longer be treated for severe acute malnutrition. Before its destruction, USAID supplied half of global nutrition treatment and hunger prevention services and its dissolution has broken  any supply chains that were left to provide ready to use food packets to save the lives of starving children. Last year alone, 28.4 million children under 5 and 11.5 million pregnant women were reached with USAID nutrition-specific interventions.
• An additional 500,000 children could die as a result of AIDS by 2030, and an additional 1 million could contract HIV if PEPFAR programs continue to be reduced or eliminated. 
• 6.6 million orphans and vulnerable children previously supported will no longer be fed, in school, or protected from violence and sex trafficking. 
• The abrupt termination of USAID’s 396 basic education programs in 58 countries leaves millions of child refugees, learners with disabilities, linguistic, ethnic, and religious minorities, and children living in poverty without access to quality education and the protection and hope for the future it provides.

USAID housed the Office of Children in Adversity, which was charged with coordinating foreign assistance for children across the federal government.  The office implemented the whole-of-government and multi-sectoral U.S. strategy to advance care and protection for children around the world and addressed early child development through the Global Child Thrive Act.  USAID also funded early child development efforts such as responsive parenting programs in Cambodia, children living outside of family care, and children with disabilities. 

Department of Labor

Cuts at the Department of Labor will include the Bureau of International Labor Affairs (ILAB), whose  mission is to strengthen global labor standards and combat international child labor, forced labor, and human trafficking. Layoffs began following the cancellation  of $500 million in grants that are crucial to eliminating child labor, combating human trafficking, and supporting children at risk of exploitation.  An estimated 160 million children are engaged in child labor, with  an estimated 79 million involved in hazardous labor according to the Child Labor Coalition. Terminated grants included a project in West Africa to stop 10-year-old children from being sent to harvest cacao beans and to end the a practice in Uzbekistan of forcing children to pick cotton.

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Last week, I testified before the House Judiciary Subcommittee on the Constitution and Limited Government to speak about the crisis children in America face and urge Congress to act. But while I talked about rising child poverty, hunger, homelessness, and struggles obtaining health care, the Subcommittee majority was, sadly, more interested in stoking culture wars than solving problems for children and youth.

Maybe the majority called the hearing to distract from what the full House of Representatives was doing to threaten the health, education, development, safety, and well-being of children through the budget process. On April 9, 2025, votes were pending in the House on a parliamentary vote to move the budget forward to a final vote on passage of the budget proposal.

Those two votes set into motion the process by which Congress may cut up to $880 billion in cuts to Medicaid and the Children’s Health Insurance Program (CHIP), $330 billion in cuts to SNAP or food stamps, and $230 billion in cuts to education, including school meals – all of which would have significant negative and disproportionate consequences on tens of millions of children across the country.

Consequently, I was grateful for the invitation to testify from Democratic Committee members Jaime Raskin (D-MD) and Mary Gay Scanlon (D-PA), who serve as Ranking Members of the full House Judiciary Committee and Subcommittee on the Constitution and Limited Government, respectively. They asked me to speak to the “status of children” in this country and how we might best address their needs, concerns, and interests.

This hearing followed one in the Subcommittee a few weeks earlier on birthright citizenship in which the Subcommittee majority failed to acknowledge that President Trump’s Executive Order 14160, which seeks to gut birthright citizenship, targets one group of people for harm: BABIES.

My testimony and opening statement made the following points:

• Children face many growing threats: these include rising infant and child mortality, rising child poverty, increasing uninsured rates, a children’s mental health crisis, the reemergence of vaccine-preventable diseases (e.g., measles and pertussis), increases in homelessness and hunger, a child care crisis, increases in child abuse deaths, the on-going threat of school shootings, and the growing fear of children living in immigrant households all threaten kids.
• Our failure to care for and support children leads to poor outcomes: the failure of other systems to care for and support children is more likely to lead to problems that come before the House Judiciary Committee, including juvenile interactions with the justice system and child exploitation.
• Money matters: evidence clearly shows that investing in children has the highest rate of return of just about any federal spending for our nation’s future. For example, research by economists Nathaniel Hendren and Ben Sprung-Keyser finds that investments in children produce the highest return on investment of any category of federal spending examined.
• The Trump Administration, in just a short period of time, is failing our kids: actions by the Administration on the budget, through its executive orders, and its dismantling of government departments and agencies, have repeatedly failed kids or, even worse, targeted them for harm.
• The American people strongly support making investments in kids: on issue after issue, the American people have demonstrated that they support making investments in kids and oppose policies that would harm them in any way.
• Children have fundamental rights too: these rights and voices should be recognized and defended, but unfortunately, they are often ignored or dismissed.

What El Paso Taught Me About Why Kids Need Advocates

In speaking to the House Judiciary Subcommittee, I emphasized that I didn’t come as a lawyer, or a doctor, but as a child advocate informed by growing up in El Paso, Texas, as the child of educators and seeing firsthand the struggles that children face, including poverty, the lack of health care, underinvestment in education, and societal injustice that take root and hurt kids.

From my parents and others in my family who were educators, I learned how poverty, health care, hunger, homelessness, domestic violence, and child abuse all play major roles in a child’s education and life opportunities.

I explained:

Children are not asking for luxury. They are not lobbying for tax shelters or asking for loopholes. Their needs are focused on their health, education, development, safety, and well-being. They and their families are asking for stability, safety, and a fair chance for an opportunity to thrive.

These are the building blocks of childhood, and yet across our country, those foundations are cracking — sometimes collapsing completely.

Children’s Issues Should Be Bipartisan

Throughout its 20-year history, First Focus on Children has worked on a bipartisan basis with Democrats and Republicans alike to champion children’s health care, nutrition, education, and safety. These aren’t red issues or blue ones. They are children’s issues.

Helping children should never be a partisan issue. It hasn’t been for most of my career—and it shouldn’t be now.

Unfortunately, instead of working across the aisle to address the growing needs of America’s children, what unfolded during the hearing and on the floor of the House was something else entirely.

The House voted later that evening 216-215 (Roll Call #94) to proceed with the budget vote and 216-214 (Roll Call #100) the next morning in favor of the Republican leadership’s budget proposal that could lead to hundreds of billions in cuts to investments, programs, and services to children at the very time they are facing enormous challenges. This budget proposal is, quite frankly, an “assault” on children.

What the Committee Chose to Spotlight Instead

The Subcommittee hearing title was “Ending Lawfare Against Whistleblowers Who Protect Children,” but I remain unsure what the true purpose of the hearing was. Based on the hearing title, I would have hoped that the Subcommittee would have tackled cases involving children, such as:

• The U.S. Women’s Gymnastics Team
• The Boy Scouts
• Kids for Cash
• The Catholic Church
• Jerry Sandusky/Penn State
• The Mormon Church
• Jeffrey Epstein scandal
• Southern Baptist Convention
• Book Bans/Censorship
• The Troubled Teen Industry
• Child Welfare Failings
• Juvenile Prisons
• Child Labor
• Child Trafficking
• Migrant Children
• Attacks on LGBTQ Youth

In many of these cases, if adults had listened to the kids themselves, abuse and harm could have been averted and children protected, but the voices of young people were repeatedly ignored.

This was, once again, often true in this hearing. The topic involved Dr. Eithan Haim, who opposes gender-affirming care and sent partially redacted medical records of children’s appointments without their consent to right-wing blogger Christopher Rufo. This action led the Department of Justice to charge the physician with violating the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

I leave it to others to decide whether this particular case violated HIPAA, but it was important that Rep. Pramila Jayapal (D-WA) raised and spoke eloquently about the concerns of children and their parents with respect to medical privacy rights.

In an exchange with Dr. Haim, Rep. Jayapal also explained why adolescents and their parents should not have their medical records released without their consent.

The Congresswoman concluded with a passionate argument as to why we needed to protect the privacy rights of adolescent transgender kids.

What About Texas Child Protective Services?

One of the bombshells that went largely ignored from Dr. Haim’s testimony was that Texas Child Protective Services (CPS) was failing to protect children who were hospitalized at Texas Children’s Hospital due to child abuse.

Dr. Haim testified that he did not bother to call Texas Child Protective Services (CPS) to report his concerns because the agency never “actually protected children” in cases that he witnessed involving “dozens of children who suffered unfathomable abuse such as intentional starvation, cigarette burns, finger amputations, etc.” He said he would see the “abusers” in the room making medical decisions for those they harmed.

If protecting children was the goal of this hearing, Dr. Haim raises disturbing claims about the failure of Texas CPS to protect children from horrific cases of medical abuse. His testimony should prompt a follow-up investigation and hearing focused on the failure of CPS to protect children in the Chairman’s State of Texas.

What say you, Chairman Roy?

Turning a Hearing That Should Have Been About Kids into a Culture War

Instead, much of the time of the Subcommittee Republicans was focused on dismissing gender dysphoria and attacking gender-affirming care. Several Republican members on the Subcommittee argued in favor of government stepping into the role of banning or regulating such care, despite numerous medical societies having created evidence-based guidelines related to such care, and adolescents and their parents seeking out and consenting to such treatment.

In Texas, Governor Greg Abbott and Attorney General Ken Paxton have equated gender-affirming care with abuse and have asked Texas CPS to investigate parents and families for gender-affirming care.

We disagree.

At First Focus on Children, we joined an amicus brief before the Texas Supreme Court in 2022 that opposed efforts to label gender-affirming care as child abuse. Our position follows established standards of medical practice and defends the medical rights of young people and their parents, in partnership with their doctors, to receive gender-affirming care. The amicus brief reads:

Gender-affirming care is not child abuse… By definition, care that is recommended and appropriate pursuant to standards of care that are widely agreed upon by professionals who treat child abuse cannot be child abuse. Gender dysphoria is real. And gender-affirming care to treat gender dysphoria is appropriate under the established standards of care and practice.

Rep. Becca Balint (D-VT) made this point and explained how such care is evidence-based and has saved lives.

These attacks on such care are not just rhetorical – they have real-world consequences. When states criminalize gender-affirming care, families are forced to flee, kids are denied medical support, and a chilling effect ripples through pediatric practices and children’s hospitals.

For example, Congress is holding up extension of the pediatric graduate medical education (GME) reauthorization bill over gender-affirming care. This threatens the medical education of pediatric residents for all pediatric medical care, including pediatric oncology, endocrinology, cardiology, diabetes, pulmonology, neurology, orthopedics, prosthetics, rheumatology, nephrology, and neonatal and perinatal medicine. If funding is threatened, life-saving medical care delivered in children’s hospitals all across this country would be put at risk.

The doctors, nurses, and medical staff at children’s hospitals are heroes who save the lives of children every single day. Congress has a moral responsibility to protect and support all children, including the funding that supports their care.

Turning Attention Back to the Challenges Facing Children

Rep. Balint urged the Subcommittee to turn its attention to the major challenges that children are facing in this country, including the votes the House was preparing to make on the federal budget later that evening and the next morning.

Rep. Balint discussed with me the myriad of challenges facing our nation’s children, including infant and child mortality, child poverty, hunger, homelessness, children’s mental health crisis, and with an important addition from Rep. Raskin, gun violence. We discussed how massive budget cuts being proposed by House leadership would make these matters much worse for children.

The data speaks for itself:

• Infant and child mortality are rising for the first time in decades.
• Child poverty has more than doubled since pandemic-era relief was cut.
• Millions of children have lost health coverage as Medicaid protections ended.
• Mental health crises continue to soar, with rates of anxiety, depression, and suicide among youth climbing year after year.

These are not abstract problems. These are children with names, faces, and dreams being derailed and harmed by policy failures and budget cuts.

After the Recess

After a break for members to cast votes on the House floor, the hearing resumed and took some disturbing turns, such as Rep. Harriet Hageman (R-WY) declaring there is “zero” benefit from gender-affirming care. She wishes for government to outlaw it and, ironically, to overturn the decision-making authority of parents and adolescents with their doctors.

The American Academy of Pediatrics, the Academic Pediatric Association, the American Academy of Child and Adolescent Psychiatry, the American Academy of Family Physicians, the American Academy of Nursing, the American College of Obstetricians and Gynecologists, the American College of Osteopathic Pediatricians, the American College of Physicians, the American Pediatric Society, the Association of American Medical Colleges, Association of Medical School Pediatric Department Chairs, the Endocrine Society, the National Association of Pediatric Nurse Practitioners, the Pediatric Endocrine Society, the Society for Adolescent Health and Medicine, and the Society of Pediatric Nurses, who know the real evidence and science, disagree.

In an amicus brief they filed in February, they explicitly state “gender-affirming medical care for people under nineteen, which as this brief describes, is critical, medically necessary, evidence-based care for gender dysphoria.”

They add:

…gender dysphoria can result in debilitating anxiety, depression, and self-harm, and is associated with suicidality. As such, the effective treatment of gender dysphoria saves lives.

Finally, Chairman Chip Roy (R-TX) tried to play a game of “gotcha” in which he asked me repeatedly about the role of parents in making decisions about their children’s health care (again, ironic because it is the Subcommittee Republicans and President Trump that seek to deny parents, children, and their doctors the ability to make these decisions).

Three straight times, I repeatedly said either:

We believe that medical decisions should be made by doctors, parents, and children, Doctors, parents, and children should make medical decisions based on best practices.

He then noted, to which I affirmatively and enthusiastically agree, that I have said – more than once – that there are other occasions when health care can and should be delivered without parental consent. Examples include:

• Emergency care
• Other medical circumstances in which the denial of care would threaten the life of children, such as cancer treatment
• Services such as allowing kids to receive band-aids, medical tape for ankle or finger sprains, ice packs, or even a tissue
• Routine medical care to adolescents, testing and treatment for infectious and communicable diseases, counseling, substance abuse treatment, etc.
• Other circumstances, such as a rape kit exam related to sexual abuse by a parent or family member

I also pointed to the majority’s witness, Dr. Haim, who testified that he witnessed numerous cases in which “abusers” were being allowed by Texas CPS to make medical decisions related to “unfathomable abuse such as intentional starvation, cigarette burns, finger amputations, etc.” I added that cases involving child abuse by parents are a good example of when to leave parents out of decision-making.

Here is that exchange with Chairman Roy.

Unfortunately, the video misses me thanking Chairman Roy for putting my Substack posts and my letter to the House Judiciary Committee on these issues into the Committee record. I was appreciative that he did so – not because we agreed on the issue, but because he was making my point and that truth for children should be reflected in the Subcommittee record.

Here are the Substack posts that he put into the transcript”

• How a ‘Parental Rights’ Bill Threatens the Health, Education, and Safety of Children
• Gov. DeSantis Should Veto Florida’s Tragically Flawed So-Called ‘Parents’ Bill of Rights’

I wish he had added:

• The Dark Side of Parental Rights Laws: Risks to Child and Adolescent Health
• Childism, Under the Guise of Parental Rights, Is Detrimental to Children
• Judge Barrett, What Is Right for Children?

In the end, parental consent is the norm.

However, we diverge concerning those circumstances in which parental consent may be unavailable, unnecessary, places the child at danger or high risk, or results in the denial of medically necessary care or treatment.

While some feel that the health of children, their bodies, and their lives are at the sole discretion and control of parents in all or almost all circumstances, even in cases where children would die due to medical neglect.

I do not.

As Samantha Godwin explains:

When evaluating the extent of parents’ legal rights, we should not merely consider how ideal parents exercise their power to provide the effective care and guidance children need. The extent of what the law enables imperfect parents to do to their children must also be taken into account. The issue is not only what role we hope that parents play in their children’s lives, but how the powers actually granted might be used and abused for better or worse. Thinking only in terms of how the best parents conduct themselves is a mistake; it is also necessary to account for what the worst parents can get away with.

In such cases, I would err on the side of both protecting the health and well-being of children and recognizing that children have fundamental rights too.

Highlighting How the Trump Administration’s Cuts Threaten Children

In her closing, Ranking Member Scanlon returned the focus to the Trump Administration’s proposed massive budget cuts to programs of importance to our nation’s children.

As Rep. Scanlon and I discussed, this isn’t hypothetical. These cuts will devastate children and families.

The Trump Administration has put forth budget proposals that would:

• Slash Medicaid and CHIP by up to $880 billion.
• Impose cuts to child nutrition programs, including SNAP, WIC, and school breakfast and lunch programs, just as food insecurity has risen.
• Gut the Department of Education and scatter its responsibilities across unrelated agencies.
• Devastate the Low-Income Home Energy Assistance Program (LIHEAP).
• Eliminate Head Start.
• Defunding of public health programs that protect children from preventable diseases.

These policies don’t reflect the values of the American people. They reflect the priorities of political ideologues determined to shrink government — even if it means sacrificing children to do it.

Columnist Catherine Rampell further documents the list of attacks on children that the Trump Administration has proposed in a column that ran this morning titled Donald Trump’s war on children: The Administration is divesting from future generations. It will cost America dearly.

The Public Is on the Side of Children

Fortunately, the American people are on the side of children in the debates over the budget – overwhelmingly so.

Here’s what Americans believe:

• 83% support maintaining or expanding Medicaid.
• 72% support expanding the Child Tax Credit to fight child poverty.
• 71% oppose attacks on birthright citizenship.
• By wide margins, they believe the federal government is spending TOO LITTLE rather than TOO MUCH on children’s programs.

These aren’t partisan views. These are deeply held American values. The problem is not the people. It’s the politicians who refuse to listen to them or make children a priority.

We Can and Must Do Better

In my closing remarks, I said:

Despite being citizens who have fundamental rights, children and their voices are often locked out of political arenas and decision-making processes that impact their lives.

It is imperative that when a child cries out for help – whether it is a sick child, an abused child, a hungry child, a homeless child, or a victim of gun violence – adults should listen.

We must build a nation in which every child has a chance to grow up healthy, safe, educated, and supported.

That’s what I went to Congress to say. It’s what I’ll keep saying. And with your help — sharing this Substack post, raising your voice, pushing back against false narratives — we can help change not just the conversation, but the future for our children.

How to Help Children

1. Watch and share the clips: use them to tell others what’s really happening in Congress and the Trump Administration.
2. Contact your representatives: tell them to reject cuts to kids’ programs and defend children’s rights.
3. Support organizations like First Focus on Children: help those of us working every day to make children a national priority.

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Chairman Roy, Ranking Member Scanlon, and Members of the Subcommittee, I appreciate your invitation to testify on behalf of First Focus on Children, a bipartisan organization dedicated to making children and families a priority in federal budget and policy decisions.

I am grateful for the opportunity today to testify about the plight of our nation’s children and why you, as members of the House Judiciary Committee, should be concerned about our failed attention to and investment in our nation’s children and grandchildren and how that impacts both their and our nation’s future.

I come before you today – not as a doctor or lawyer – but as someone who has worked in the health care system, the country government in El Paso, Texas, Texas state government on behalf of both Democratic and Republican leadership, staff in the House and Senate in Congress, and nearly 20 years as a child advocate.

First Focus on Children was initially founded by Colin and Alma Powell as part of America’s Promise. In our 20 years of operation, we have always operated under the premise that children’s issues are bipartisan and should always be so. During my time on Capitol Hill, I worked on a number of bipartisan initiatives related to improvements to Medicaid, the creation of the Children’s Health Insurance Program (CHIP), and to other children’s issues, such as ensuring that medical research involving children include assent and consent, and that organ donation rules in this country must consider the unique needs of children.

The post Testimony for the Record: The Status of Our Nation’s Children appeared first on First Focus on Children.

Today, our democracy is losing its moral compass when it comes to the widening chasm between:

1. The clear and urgent needs of children.
2. The deep concerns held by the American people.
3. The callous inattention – or even harm – to children by policymakers.

Children are under siege – not metaphorically, but measurably. Their health, education, development, safety, and well-being are worsening, but fortunately, the public is on their side. Voters across the political spectrum consistently express overwhelming support for investing in children and families. They recognize the crisis and want action.

But sadly, instead of meeting this moment with courage, care, and support, many politicians are moving in the opposite direction: slashing supports, dismantling institutions, and endangering the very children for whom they claim to be concerned.

In a New York Times article by Claire Cain Miller, she writes:

As some policymakers have grown concerned about declining fertility rates, and as many Republican-led states have banned abortion, some Republican officials have said the party needs to do more to support raising children. In the presidential campaign, a Trump spokeswoman said he supported the major family policy goals.

But the Trump administration has so far focused on cutting federal programs, not starting new ones.

The Needs of Children

Children are not asking for luxury. They are not lobbying for tax shelters or asking for loopholes. They are asking for stability, safety, and just a chance to thrive. These are basic and urgent building blocks of human development but are being systemically denied and left unmet.

The list of suffering endured by today’s children is staggering — and it’s growing:

• Infant mortality is rising: For the first time in decades, according to CDC data, infant deaths are climbing. This is not just a public health disaster; it’s a moral failure.
• Child mortality is rising: This problem is being driven by gun violence, rising suicide rates, and a mental health crisis that has gone unaddressed.
• Child poverty is rising: After historic reductions due to pandemic-era relief, poverty has more than doubled since 2021 after supports were withdrawn or left to expire.
• Uninsured rates for children are rising and access to care has declined: Hospital capacities for children were shifted to adults during the pandemic but have not shifted back and pandemic health coverage protections for children have been allowed to expire.
• The mental health crises is soaring: As noted above, suicide rates are rising.
• Homelessness is up: Record numbers of children and families are living without stable and affordable housing.
• Hunger is surging: Food insecurity has returned with a vengeance as SNAP and school meal programs have been reduced.
• Measles and other preventable diseases are back: The erosion of public health capacity and increased disinformation has opened the door to old vaccine-preventable illnesses and dangers.
• Child abuse reports are increasing: Families are stressed, services are stretched, and kids are paying the price.
• Immigrant children are living in fear: Raids, anti-immigrant rhetoric, and exclusionary policies have increased both fear and trauma in children.

These are not niche or isolated problems. These are the foundational issues of childhood and human development going unmet, and worse, symptoms of a country failing its youngest citizens.

The Public Wants More for Kids – Not Less

The American people are aware of these problems and strongly support addressing the needs of children. In poll after poll, voters have made it clear that they support doing more for children, not less. Thes values are not being reflected in many of the policies being proposed by our policy leaders.

First, Americans care deeply about children’s issues.

In a Lake Research Partners poll, voters expressed their concern that we are investing too little rather than too much in addressing children’s policy issues.

For instance, most Americans support increased funding for education and early childhood programs, and consequently, an All4Ed election eve poll found that just 29% of respondents supported efforts to dismantle the Department of Education.

In a recent Kaiser Family Foundation (KFF) poll, 83% of Americans said Medicaid should be expanded or maintained, and only 17% believe it should be cut. This finding is critical for children, since Medicaid provides coverage to 37 million children and for 41% of births in the U.S.

Rather than cutting the Children’s Health Insurance Program (CHIP), a Lake Research Partners poll also found that voters overwhelmingly want to make CHIP permanent (78-14%) in order to protect the health coverage of millions of children.

While much of the focus of the tax debate is about cutting taxes for our nation’s corporations and the wealthiest among us, the Lake Research Partners poll has found overwhelming support (72-21%) for improving and expanding the Child Tax Credit in ways that would dramatically cut child poverty.

Support rises even more (78% favor) when the public is polled about whether there should be “increasing family tax relief for families with children under age 2 since that can often be the time when raising children is most expensive.”

The public also opposes harming babies, such as with proposals to undermine the Constitution’s birthright citizenship clause. In fact, by a 71-29% margin, the American people oppose gutting birthright citizenship, according to a CBS News/YouGov poll.

A YouGov poll also finds that the public supports a whole range of child- and family-friendly policies.

Second, support for children is growing, especially among Republicans.

An American Compass survey cited by House Ways and Means Committee Chairman Jason Smith (R-MO) found that support is rising when respondents are asked whether “the federal government should provide more support for families with children.” In fact, between 2021 and 2024, support rose among Democrats, Independents, and Republicans – but it rose fastest among Republicans.

This shift reflects something essential: when people look past the partisan noise, they understand that kids need and deserve support.

Third, both political parties should recognize that children’s issues are a missed opportunity.

According to a YouGov poll, voters believe that Democrats “do a better job of helping families with children in the U.S.” than Republicans by a 37-26% margin. However, 38% believe the two parties do the same or are unsure which is better. That’s a mandate waiting to be claimed.

Therefore, Republican leadership should consider a change to many of the policy proposals they are currently pursuing. The GOP entered this Administration and Congress with an electorate deeply concerned about how the “American Dream” is faring for children – both in how they are doing in comparison to previous generations and how they will fare in the future. As a poll by Lake Research Partners and Echelon Insights for Common Sense Media found, parents expressed great concern that children today are worse off than they were in the past.

Unfortunately, the President and Republican House leadership are pursuing a set of policies – such as cuts Medicaid and SNAP cuts, cuts to other investments in children (i.e., education, child care, Head Start, housing, etc.), abolishing the Department of Education, attacking birthright citizenship, etc. – that voters oppose and believe will make matters worse. They should perform better by our children and families, as it is in their political interest.

Likewise, for Democrats, exit polling indicates that Republicans made significant gains with the parents of children in the last election. In the 2020 election, voters with children under age 18 living at home voted 52-46% in favor of Biden over Trump, according to NBC News. However, in 2024, that margin flipped to 53-44% in favor of Trump over Harris. All other voters without children at home voted 50-48% for Harris over Trump.

This was not so much a problem with the Harris campaign, as Harris made a strong case for improving the Child Tax Credit and child care in her campaign but likely more about how the party’s candidates for House and Senate offices were largely silent and largely ignored speaking to children’s issues, which seems to have been proven to be a mistake.

In fact, while Democratic candidates left the needs of children and families unadressed, Republicans took the offensive and sought to frame the terms of the debate with a focus on culture war issues, such as attacks on transgender issues, and their messaging and ads took center stage.

To their own detriment, if Democrats fail to make a bolder and affirmative case for a full-throated Children’s Agenda on matters such as child health, education, child care, and child nutrition, they may continue to lose parents.

Voters concerned about the lives and future of their children and grandchildren are open to a Children’s Agenda.

As Common Sense Media writes in their polling report with Lake Research Partners and Echelon Insights on these issues:

Contrary to conventional wisdom, parents across party lines share many of the same concerns and support the same goals to improve the lives of families and children: high-quality education, proactive government policies and investments at the state and federal levels, and stronger families. Parents and young people alike believe that elected leaders and politicians are not prioritizing policies for kids and teenagers enough and should invest more in kids and families.

Parents and their children desperately want policymakers to make “younger people” in this country a greater priority but feel “their voice does not matter in decisions made by the government.”

Rather than prioritizing children and families in decision-making, one party is leaning toward policies that will fail children and families (i.e., abuse), while the other is often absent (i.e., neglect).

The disconnect is not with the public, it’s with those in political power.

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The Government’s Response: Ignoring and Harming the Very Children It Should Protect

Given the dire challenges and the public’s clarity and urgency, you might expect political leaders to act in the affirmative. But instead of stepping up, many continue to ignore or are actively doubling down on policies that harm children.

Here’s some of the proposals being put forth by the Trump Administration and Congress:

• Medicaid, CHIP, and SNAP are under attack: Lifelines for millions of children face deep and damaging levels of cuts.
• The Department of Education is facing threats to its very existence: In a strange Executive Order (EO) signing ceremony by the President accompanied with rows of children with their own fake folders, he proposed the Department’s elimination, despite opposition from the public by a 2-to-1 margin.
• Book bans and classroom censorship: A growing cadre of politicians has been interested in book bans, speech codes, the whitewashing of history, and narrative controls rather than educating students and making sure their fundamental needs are met.
• Threats to Head Start: Project 2025’s threat to eliminate the program would be a direct hit to the early learning, development, and health of low-income children.
• Slashing public investment in children across the board: From child health to education to nutrition to early childhood to housing, the DOGE is threatening programs and Congress is threatening funding.
• Efforts to undermine birthright citizenship: Those efforts specifically targeting babies born in the USA with the threat of exclusion, deportation, and statelessness.
• Attacks on immigrant families and their children. These growing threats are creating trauma, fear, and instability in the lives of children (1 in 4 children in this country live in mixed family households).
• Encouragement of child labor: These proposals threaten a return to the past that betrays progress and endangers the lives of children with a rolling back of protections created a century ago.

This is not small government. This is not benign neglect. This is deliberate harm disguised as fiscal discipline. It’s a vision where children are invisible unless they can be conveniently used for a culture war talking point or a prop for political theater.

A Democracy That Ignores or Harms Its Children Cannot Call Itself “Just”

If democracy is supposed to reflect the will of the people, then this moment reveals a dangerous erosion. Americans want to invest in and support our children. They want to improve child health and education, and expand support for children and families to reduce child poverty, homelessness, and child hunger.

And yet, far too many politicians, are pushing in the opposite direction. The result is a government not just failing to act, but actively betraying the next generation.

Children don’t vote. But they live with the consequences of every budget cut, every cruel policy, and every missed opportunity.

As the saying goes, “You can judge the soul of a society by how it treats its children.” Whether in Congress or at the household level, that moral barometer still holds true.

Right now, that judgment is damning. We are living in a moment in which democracy is choosing to fail our children and lawmakers ignore what the public wants.

We need a course correction or a new path – not just in policy, but in political will. A country that claims to care about the future must start by caring for those who are the future.

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