As president and CEO of Children’s National in Washington, D.C., Michelle Riley-Brown has a front-row seat to the federal policy decisions reshaping healthcare. She said those decisions have also made advocacy a larger part of her role, with her spending a growing share of her time educating policymakers about children’s hospitals and the patients they serve.
“Being located in Washington, D.C., I feel a unique responsibility to be a voice for pediatric healthcare for the nation,” Ms. Riley-Brown said. “That’s advocating for the most vulnerable population, children, and advocating on their behalf for policies that keep their interests at the forefront.”
In a conversation with Becker’s, she discussed why children’s hospitals are often the first to feel the downstream effects of federal funding changes, what that signals for the broader healthcare system and how Children’s National is responding.
Pediatric healthcare operates under a fundamentally different business model than most of the industry, Ms. Riley-Brown said. A significant share of patients at freestanding children’s hospitals are covered by Medicaid, and the specialized equipment, specially trained clinicians and services these hospitals require are often not financially sustaining on their own. That combination makes children’s hospitals especially vulnerable to HR 1, which caps state-directed Medicaid payments to hospitals starting in 2028 and threatens more than one-third of children’s hospitals’ total Medicaid revenue, according to the Children’s Hospital Association.
Ms. Riley-Brown said the implications extend beyond pediatric hospitals themselves.
“If children’s hospitals are weakened, the healthcare system doesn’t just lose capacity, it loses one of its most important engines for innovation,” she added. “If you think about it, children’s hospitals are where much of the nation’s pediatric rare disease research takes place. At Children’s National, we’re seeing firsthand what’s possible when there’s a sustained investment in children’s health.”
At Children’s National, a multimillion-dollar philanthropic gift in recent years allowed the hospital to advance research for children with rare brain tumors and maintain a pipeline of clinical and research talent in highly specialized fields. That kind of work depends on sustained investment, and Ms. Riley-Brown said the current funding trajectory puts it at risk.
If that trajectory holds, she expects a pediatric landscape defined by difficult trade-offs within five years: growing pressure on access, specialized services, research and workforce development.
Ms. Riley-Brown said Children’s National’s location shapes how she responds to that pressure. The organization is actively working to educate policymakers about the realities of pediatric care financing, and she said being near Capitol Hill has made advocacy an increasingly central part of her role.
“The decisions being made today will influence the health and well-being of an entire generation of children tomorrow,” she said. “That’s why it’s so important for us at this moment in time to focus on advocacy and to shed light on all the impacts.”
Alongside that advocacy work, Ms. Riley-Brown said Children’s National is investing in areas it can control, including apprenticeship programs that build internal talent pipelines through pathways from patient care technician roles to nursing, developed in partnership with nursing schools.
“We are creating apprenticeship programs within the organization just to make sure that we are controlling our own destiny,” she said.
She said one point bears repeating for the broader healthcare field: children are not simply small adults. Their conditions, treatments, technologies and care teams require specialized expertise and resources, particularly for those with complex and rare diseases.
“I remain optimistic about the future of pediatric healthcare,” she said. “This is a critical moment, but it’s also a moment of opportunity for all of us to think differently and lead differently.”
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