Four K-12 Issues to Watch in Health-Care Overhaul
The Trump administration and congressional Republicans are in the midst of trying to replace the Patient Protection and Affordable Care Act—better known as Obamacare. And the process could have big implications for the nation's schools when it comes to special education funding, teacher benefits, and more. The House of Representatives passed its version of a health-care bill in May, and the Senate is wrangling its own legislation to replace the ACA this week.
What are the major issues at stake for K-12 educators, and how do these two GOP bills—the Senate's "Better Care Reconciliation Act" and the House's "American Health Care Act"—differ from the law now in effect?
• What happens with Medicaid and special education?
• What happens with the '30 Hour Rule' for employees?
• What happens with so-called 'Cadillac' health plans?
• What happens with mental-health coverage?
• Medicaid helps school districts cover the costs of services to eligible students, including those in special education. (Think speech therapy, occupational therapy, even devices like wheelchairs.) In fact, AASA, the School Superintendents Association, estimates that school districts get about $4 billion a year through Medicaid. That's about a third of federal special education state grants and roughly the size of the Obama administration's Race to the Top program.
• The ACA enticed most states to expand eligibility for Medicaid, a big federal and state partnership program that helps low-income people, including children, get access to health care. The House bill phases out that expansion, and GOP-backed legislation in the Senate takes a similar tack.
• Legislation debated in both chambers would distribute Medicaid funds on what's called a "per capita" basis, dependent on how many people a state has from particular groups, including children and the elderly. It's unclear how much money schools would stand to lose from the cuts, and the amount may vary wildly from state to state.
• School health jobs could be on the line. AASA surveyed 1,000 educators in 42 states and found that two-thirds of districts use their Medicaid funds to cover salaries of professionals who work with students in special education.
• Services for children also could be cut. In some states, districts use Medicaid to help cover things like vision and hearing screenings for eligible children. And about 68 percent of districts surveyed say they use the money to pay the salaries of health professionals who serve students.
• Scaling back Medicaid could also have an indirect impact on K-12 spending, advocates argue. Medicaid and K-12 education are typically the two biggest-ticket items in state budgets. If states try to make up for federal Medicaid cuts by using their own money, they may have to trim school budgets.
• This is a technical part of the Obamacare law that requires employers to offer health coverage to any eligible employee who works an average of at least 30 hours a week. GOP-backed bills under consideration in Congress leave the 30-hour rule on the books. But they would scrap penalties for employers that don't provide the coverage, advocates say.
• Some school district advocates argue that the 30-hour rule has made their lives difficult, since so many of their employees work between 30 and 40 hours. (Think long-term substitute teachers, paraprofessionals, or, say, a bus driver who is also a football coach.) Substitutes, paraprofessionals, and others would like to be able to keep their health care, even if they work fewer than 40 hours. This provision effectively pits different education groups against one another.
• The ACA taxes “high cost” health plans, defined as any plan that costs more than $10,200 a year for an individual. Teachers' unions see that tax as unfair because it could disproportionately hit employees in states with high health-care costs and plans that cover a lot of women and older employees—many of their members. The unions are fans of Obamacare overall, but they'd love to see this tax go away. The House GOP bill doesn't get rid of the tax, but it would push back its start date, from 2020 to 2025.
• ACA requires all insurance plans to include certain components, including mental-health coverage. Legislation under discussion in both chambers appears to keep that requirement in place but would allow states that don't want to offer those benefits the option of getting a waiver.
• That could affect what kinds of benefits children get under their parents' health-care plans. For instance, if states don't call for plans to cover mental-health services, a child with attention-deficit hyperactivity disorder may no longer be covered for psychiatric and other mental health care.
• School districts would try to make up for the loss, advocates say, in part by hooking students up with free or inexpensive community providers. But some of those providers may not have the capacity to take on a bunch of new clients, and some children may not get the care they need.
Vol. 36, Issue 37, Page 19Published in Print: July 19, 2017, as Health-Care Overhaul: The Stakes for K-12