Trump’s health care bill puts millions of children in harm’s way

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by Félix Pérez; image courtesy of Nigel Sandridge

To students who live with hearing loss, low vision or blindness, autism, a cognitive disability, a developmental disability, a behavioral disorder, juvenile diabetes, a physical disability, or some other disability or illness, public schools perform a vital role in their health care, thereby opening the door to an education.

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More than 36 million children receive health care through Medicaid, a joint federal and state program. But Trump’s heath care bill, known as the American Health Care Act, passed by Republicans in the U.S. House last month, would slash health care services provided by schools and drastically reduce the number of school-based health care professionals who provide them.

ACHA, or Trumpcare, would cut Medicaid by $880 billion over 10 years. Overall, Medicaid covers 49 percent of all children, according to the Kaiser Family Foundation. Medicaid is particularly important for children with disabilities and special needs. Because of Medicaid and Children’ Health Insurance Program (CHIP), the uninsured rate among children has declined substantially over the last decade.

Under the Individuals with Disabilities Education Act (IDEA), Medicaid reimburses schools for mental health care, vision and hearing screenings, diabetes and asthma management, wheelchairs and hearing aids, and more. Federal support is substantial — for example, in 2015 California schools received about $90 million from Medicaid, Florida schools about $63 million, New York schools about $137 million, Pennsylvania schools about $131 million, and Texas schools about $250 million. Capping federal support for Medicaid will shift costs to the states, jeopardizing services essential for students to learn and thrive, especially those with disabilities.

Among the school-based positions on the chopping block are nurses, social workers, speech therapists, counselors, psychologists and physical therapists. For many children, schools are the primary point of entry to receiving needed health, social services and medical devices.

According to an analysis conducted by the Institute for Child, Youth and Family Policy (ICYFP) at Brandeis University, nearly 5 million children ages 6 to 19 will lose their federal Medicaid eligibility with the cuts in Medicaid.

ICYFP’s Erin Hardy, who led the analysis, said:

The findings are important because they tell us that the proposed Medicaid rollback plan is certainly not a ‘marginal’ change that will affect a handful of children in a handful of racial/ethnic groups or places. Instead, the results tell us that a relatively modest change in the federal eligibility threshold for Medicaid, if realized, would have a sweeping impact that would be felt by millions of school age children of all races/ethnicities, in all states across the U.S.

Michael Doonan, director of Brandeis University’s Heller School’s Master of Public Policy Program, added, “The changes in the American Health Care Act passed by the House of Representatives disproportionately affects families and individuals with low incomes and high health care costs. The proposed $880 billion Medicaid cut would come down hard on the most vulnerable in support of tax breaks for the most affluent, with some deficit reduction.”

U.S. Sen. Sherrod Brown, OH,  said that under the House plan to cut Medicaid, Ohio schools could be cut by as much as $12 million each year. Sherrod said the Cleveland Metropolitan School District, for example, could be cut by $500,000 each year – the salary of 10 teachers. He wrote, “Whatever your opinion of the Affordable Care Act, we should all agree that forcing schools to choose between laying off special education therapists that students depend on and increasing class sizes, or reducing AP and elective classes for other students is wrong, Instead of forcing Ohio schools to cut services for our kids, let’s work together to lower costs and make health care work better for everyone.”

Federal spending on school-based Medicaid would decrease by $24.6 million in Ohio, concluded the Center for American Progress. Some 1.2 million students in Ohio are enrolled in Medicaid and CHIP.

The Save Medicaid in Schools Coalition, said Trumpcare would force states to “ration health care for children.” It continued, “School-based Medicaid programs serve as a lifeline to children who can’t access critical health care and health services outside of their schools. However, the projected loss of $880 billion in federal Medicaid dollars will compel states to ration health care for children. Under the per-capita caps included in the AHCA, health care will be rationed and schools will be forced to compete with other critical health care providers — hospitals, physicians, and clinics — that serve Medicaid-eligible children. School-based health services are mandated on the states and those mandates do not cease simply because Medicaid funds are capped by the AHCA.

“Our nation’s vulnerable youth deserve better. We urge the Senate to reject these harmful proposals in AHCA and preserve the availability of comprehensive Medicaid services, including those provided at school.”

The U.S. Senate is drafting a bill to repeal the Affordable Care Act. It’s unclear what portions of the House bill the Senate will keep.

Reader Comments

  1. I am a speech-language-pathologist who has worked in the school system for 22 years. I absolutely know that students need support. I also have worked mostly in low income districts and see how my students live. Without the support from Medicaid, my students would not have any services to allow them the education they deserve compared to their typical peers. Many of my students are medically fragile and/or have extreme cognitive impairments from birth or medical diagnosis. They struggle with simple tasks (many both physically and educationally). If Medicaid is decreased, many, many students will go without services they desperately need to improve, advance, and even survive. My students want to be like everyone else and they deserve to learn like everyone else. I am excited to see my students graduate and go on to gain employment. Isn’t that what education is all about?? Let’s figure out a way to make this happen. What if this was your child? Wouldn’t you fight for him/her?

  2. First in foremost I am not a Republican or Democrat, left wing or right, I am an educator and do not enjoy politics whatsoever. I read something like this and it really saddens me. What we need to do as a nation is to come together and stop bickering like a bunch of individuals! Our fore fathers would be rolling in their graves if they saw us thinking about cutting funding for students with severe disabilities, we have come a long way as a nation, and now this is what it has come to, absolutely absurd. I am not blaming any one person, we are all to blame for allowing this to even be considered. I am a direct service provider for students with severe disabilities, we do not bill medicaid for my service (so if any of you think that this has self-interest you can stop right there), but I see quite a few services that are absolutely necessary to in some instances keep children alive and safe while they are in school. If you have never seen a student that has a feeding tube at lunch than you should, if you have never seen a student who has cerebral palsy swim for the first time in their life, than you should, or a student who suffers from Grand Mal seizures while in the classroom. If you never have seen these incidences than you probably should not be making these crucial decisions that consequently decide a students path who might not have the ability to articulate for themselves! Let us not fall so low, but rise up as a nation, and do what is right for our children. USA now and forever!

  3. First let me say that support for special education and special needs students is super important.

    However, this article has the usual leftist alarmist approach without actually coming up with a solution to the larger problem.

    We, as a nation,spend too much. Period. We are 20 trillion in debt and if dems had anything to do with it,we soonwould be 40 trillion in debt.

    Yes, companies (which employ millions of people) will indeed get tax breaks so they can employ millions more. The dems way of taxing companies to the max and restricting them from doing business and therefore putting less in the coffers is what is causing all this. Now the dems say just borrow more but they’re not worried about whose going to pay for this borrowing.
    We are already spending more on interest payments than the entire supposed cut. Why not reduce the spending for a few years so we can get the deficit under control and reap the benefits of fiscally responsible spending.

    I don’t go on vacation every year. I am not going more in debt every year just because I can. Eventually I am going to have to pay for it. If I did spend the money on a vacation , that means giving up some else in its stead. That’s responsible.

    The state and school districts should look at cutting wasteful spending that’s rampant. When I look what is being paid for goods and services by districts, I cannot believe the waste. Is it because it’s not their money and they just say I need it and I need it now and therefore I am getting it regardless of the cost?

    I can guarantee that each and every school district can employ a full time person at $60,000 minimum salary and all that person would have to do is buy for the district any items and research which would be the least expensive.

    It is appalling how things are overpaid and over charged. And certain vendors know that governments aren’t checking prices. I’ve seen “codes” government employees have to use to rent a car from budget that makes the price 30-40% more expensive than the regular price. Go figure.

    Another cost cutting measure that should be implemented, especially in sunny states is solar panels. It is unbelievable how few schools there are in California with solar panels.

    Be smart. Stop complaining and stop implying 36 million kids will be affected. Be part of the solution, not part of the problem. Try and solve the deficit so we can spend more on programs that need support instead of wasting money on interest!

    1. The federal budget for war would be a great place to start. Lets defund some of that and put it back into our children.

    2. It sounds like you have a number of excellent ideas for cost saving. Solar panels are an excellent idea. Sadly the purchase and installation of such things are well out of many schools’ budgets given the vast number of such urgent needs for things such as new buildings, buses, safer playgrounds, and technology upgrades. Hunting for the best price is an excellent suggestion as well. In fact, it is so good that virtually every teacher and school district is already doing it. Providing essential health services to our country’s most vulnerable is not equivalent to a vacation. I agree that our country’s ever growing deficit is a problem, but the solution needs to restore balance in a way that is equitable. Millions of corporations benefit from the basic education that is provided by our nation’s schools. Perhaps if they contributed to the cost of this essential training, we might all be in a better place.

    1. Then let’s start by not spending their money or giving them so much debt they can’t dig themselves out of

  4. Almost every year that I worked as a special ed teacher I had at least one student that depended on a school nurse to monitor their medical condition during the school day. Our children need medical supplies at school.

  5. For shame. As a special education teacher I find your budget advisers to be ill informed when it comes to the needs of children with disabilities, both short and long term. Parents especially, worry about the future when they maybe physically unable to tend to their beloved children

  6. Thank you for your wonderful support to out school children. It is really shameful what the new crowd is trying to do! I guess that if all these precious special children would change their attitude, as per Dr. Ben Carson, we would not have a need for additional assistance. He too really fits into the new group very well- I am really broken hearted that such a great surgeon has such an absent mind. I feel like I am in another nation that I do not know. Shame, shame on all of them in the white house for sure.

  7. Please realize that many students have physical, mental or emotional disabilities! With proper staff exceptionaL students can learn and experience life successes! With.proper placement many are able to go into low paying jobs and succeed!

  8. I substituted in a relatively affluent school district in the Kansas City, MO area and I was always saddened by the number of students, often special ed students, for whom it was obvious that the only medical attention that they were able to access was through the school nurse. Many of these same students received free lunches, and on weekends and holidays, the big-hearted cafeteria ladies would send food home for them (and for their siblings).

  9. My grand daughter has to have a nurse with her
    which is paid by the school district, although I don’t know how. She has a trach and oxygen and feeding tube. These are necessary for her life.

  10. This is so true. I am a Special Educator and deal with children having either cognitive and…or physical disabilities. Medicaid is crucial for their success. Please don’t let this budget proposal through, my resource kids don’t have the finances to seek these services themselves. Please, they need this.

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