Although the Patient Protection and Affordable Care Act (hereafter referred to as the ACA) of 2010 does not explicitly target the health care needs of children, its significant reforms and cascading effects throughout our complex health system are likely to directly and indirectly affect children’s health care. The ACA increases insurance coverage for children and their families by covering comprehensive preventive services with no cost sharing, eliminating exclusions for preexisting conditions, prohibiting lifetime dollar limits, extending dependent health benefits to 26 years of age, and expanding coverage to many previously uninsured parents. Despite these advances, some provisions of the ACA have the potential to compromise children’s health care in unanticipated ways. Because children account for a disproportionately small percentage of overall health care spending, the effect of the ACA on children is not on the radar of those individuals implementing the ACA who are more focused on insurance expansion and cost control among adults. Thus, it falls to children’s health advocates to monitor the ACA’s effect on child health care, to both minimize harm and maximize opportunities for improvement.