Updated 3/24 5:10 p.m.
Congress has backed away from voting on a bill to repeal Obamacare and restructure Medicaid, but it's important to recognize that the health care decisions made on Capitol Hill could well have a profound impact on schools and their most vulnerable students.
How? The most obvious answer is financial. By now we know that Congress is not content to simply repeal the health care plan then-President Barack Obama pushed through seven years ago. The bill Republican leaders were trying to push through the House would have changed the way all Medicaid funding is distributed, effectively cutting federal dollars by as much as $880 billion over the next decade.
Given that half the recipients of Medicaid are children, students would suffer and so would schools. Altogether more than a third of U.S. children rely on the federal-state partnership for their health coverage—from early screenings and immunizations to treatment for asthma and other chronic conditions. Half the babies born here are covered by Medicaid, which insures children in families below the poverty line.
The bill crafted by House leaders and backed by President Donald Trump would have gutted health coverage for these children. Amendments offered some protection to elderly and disabled Medicaid recipients, but not to children and families.
Whether through block grants or per-capita caps, the bill would have cut federal Medicaid spending and dumped more health care costs onto state and local governments. That would have left less money for other priorities, such as education. Already 35 states provided less overall education funding per pupil in the 2014-15 school year than they did in 2008-09. Medicaid cuts would add to the stress on local governments, which would either have to cut school budgets, layoff teachers or raise taxes.
Fitch Ratings, which evaluate government bonds, reported in February: “Local governments also face risks, notably reduced K-12 funding, revenue-sharing programs, and social service support due to over-extended state healthcare funding responsibilities.”
Beyond the overall budget, Medicaid pays $4 billion to $5 billion a year directly to schools. This is a tiny fraction of the program’s spending but provides critical support for the personnel and equipment needed to serve students with disabilities and, in some instances, to pay for school nurses and counselors.
Without these dollars, school districts could have to dip into general education funds to meet federal mandates to provide special education services. A national survey by AASA found 68 percent of superintendents use Medicaid reimbursement to pay direct salaries for professionals who provide services to students. These include occupational and speech therapists as well as aides for special ed students. About 45 percent of school leaders use Medicaid to expand mental- and physical-health services in their districts.
Recognizing this more than 50 education organizations released a letter emphasizing the unintended consequences of health care cuts.
The most profound impact of such cuts to health coverage would be a decline in student achievement. Research shows us that students eligible Medicaid are more likely to graduate from high school and complete college than students without access to health care.
A big factor in that is regular school attendance. Illness is still the No. 1 reason that students miss school, and too many absences contribute to weaker social-emotional skills in kindergarten, poorer reading skills in third grade and higher dropout rates. Attendance also factors into state funding formulas and, in many places, is considered an accountability metric for school success.
Medicaid also plays a big role in identifying students who might struggle in school and providing the treatment they need to succeed. The EPSDT child-centered benefits package screens and treats young children for hearing and vision problems, developmental delays and disabilities such as autism that can affect learning.
Medicaid block grants could turn EPSDT into an option that states choose not to provide. That could end up costing local districts more money or leaving children with undiagnosed and untreated learning issues. And it could thwart early education initiatives aimed at getting all children ready for kindergarten and broader efforts to ensure every child masters reading by the end of third grade.
Put simply, Medicaid insulates disadvantaged children from some of the adverse experiences that keep them from succeeding in school. Families are less likely to struggle financially and go bankrupt when they have health coverage. Children are more likely to have access to preventive health care, good nutrition and medication to control health problems.
All of those benefits add up to stronger, healthier students—boosting both school achievement and economic prosperity. Cutting Medicaid would have impacts far beyond the health care system.