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.