Student Well-Being

Education Groups Put Muscle Behind Health-Care Overhaul

By Alyson Klein — August 25, 2009 5 min read
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Education organizations—including both national teachers’ unions—are putting their muscle and money behind an effort by President Barack Obama and congressional Democrats to revamp the nation’s health care system.

The National Education Association and the American Federation of Teachers both are supporting advertising and grassroots advocacy campaigns in favor of the overhaul effort, as lawmakers gather public input on the proposals in advance of a legislative push expected this fall.

Generally, the measures now on the table—a bill approved by three House committees and another being worked on by a Senate panel—wouldn’t have a direct impact on schools. One exception is a provision in both proposals that would seek to expand school-based health centers, which deliver health care in schools or on school grounds.

For education interests, however, the goal of “do no harm” seems to be in order.

Health Reform Legislation

The debate over how to reshape the nation’s health care system currently centers on a handful of bills in various stages of the legislative process. Chief among them:

House of Representatives: “America’s Affordable Health Choices Act” (H.R. 3200)—Three House committees—Energy and Commerce, Ways and Means, and Education and Labor— have approved this legislation, which has yet to be considered by the full chamber. It seeks to expand access to health care, in part by providing subsidies to lower-income Americans and offering individuals a public health-insurance option, which would compete with private insurance companies.

U.S. Senate: “The Affordable Health Choices Act”—This bill has been approved by the Senate Health, Education, Labor, and Pensions Committee. Like the House measure, it would provide subsidies to lower-income Americans and offer a public option. Like the House bill, it would impose stricter rules on private insurance plans.

NOTE: The Senate Finance Committee is working on its own version of health-care-overhaul legislation, which has not yet been introduced.

SOURCE: House Education and Labor Committee; Senate Health, Education, Labor, and Pensions Committee

The 3.2 million-member NEA is giving a substantial boost to the health-care overhaul effort, in part because the bills steer clear of changes to members’ current coverage as negotiated with their individual school districts and wouldn’t include a tax on benefits.

Both the NEA and the 1.4 million-member AFT are wary of any plan that might pay for expanded coverage by taxing workers or employers who have particularly rich health care insurance plans. By some definitions, that could mean teachers and other school employees.

So far, none of the proposals includes such a provision. But the Senate Finance Committee, which will have a key role in crafting any Senate measure, still has not released its version of a bill.

And if this attempt to revamp health care does not pass, Congress could consider an overhaul that might tax benefits at some point in the future.

Bill Raabe, the NEA’s director of collective bargaining, said such a funding mechanism would amount to “double taxation” of moderate-income workers, including teachers and other district employees. Often, those workers “give up their salary increases” in exchange for more comprehensive, affordable benefit packages, Mr. Raabe said.

More broadly, greater availability of health care coverage, particularly for uninsured children, could help more students come to school prepared to learn, Mr. Raabe contends.

“We see health care reform as an education issue,” he said.

Opening the Door

But Michael Podgursky, a professor of economics at the University of Missouri, in Columbia, who specializes in teacher labor markets, thinks the unions’ enthusiasm for the health-overhaul bills is misplaced. The eventual cost could squeeze spending on education and other domestic priorities, he said.

Public plans, such as Medicaid, which helps cover the cost of health insurance for the disadvantaged, and Medicare, which insures the elderly, have “huge, unfunded liabilities,” Mr. Podgursky said. “That’s a big problem that isn’t solved here.”

Frederick M. Hess, the director of education policy studies at the American Enterprise Institute, a free-market think tank in Washington, said the effort, if successful, may not settle the health care debate. Instead, it could lead to continued tinkering of benefit plans in coming years, he said. That could ultimately hurt teachers, who nowhave access to some of the best employee benefits available, he said.

“Once you’ve universalized health care, you’ve probably set in motion a series of adjustments and readjustments downstream,” Mr. Hess said. “People who currently have the most attractive benefit packages in health care stand to lose the most.”

He said teachers’ unions most likely support the health-care-overhaul effort because they feel an ideological kinship with the measures’ supporters, most of whom are Democrats, the party that has traditionally been more closely aligned with organized labor.

“I think it’s a case of the teacher unions absolutely trying to be good allies,” he said. “Government expanded [health care] has long been a high priority [for progressive Democrats], so quite sincerely a lot of them just think it’s a good idea.”

Grassroots Campaign

The NEA remains active on other K-12 issues, but it is putting considerable resources into health care overhaul, Mr. Raabe said.

“Right now, in Congress, health care is the top issue,” he said.

For instance, the NEA is planning to spend nearly $300,000 on radio ads that will run in Nevada, the home state of Sen. Harry Reid, the Democratic majority leader, and the district of at least one Democratic House member, Rep. Baron P. Hill, who may face a tough re-election battle.

“Educators stand firm with Reid because he knows we need a health care plan where doctors—not bureaucrats—decide what’s best for us,” says a female voice in the Nevada ad.

School-Based Centers

Bills in both the House and Senate would establish a federal grant program to help expand school-based health centers. These clinics, located on school grounds, provide students with a range of health services, sometimes including nutrition and mentalhealth counseling.

• A bill approved by three House committees (H.R. 3200) would include a $50 million authorization for one year for the centers and would ensure that they are reimbursed by Medicaid and the State Children’s Health Insurance Program, or SCHIP. After that, there is no defi ned spending level.
• The House bill would give grant priority to centers that serve areas where students have trouble getting access to other health care.
• The measure being considered by the Senate Health, Education, Labor, and Pensions Committee (“The Affordable Health Choices Act”) would create a similar grant program, but does not include a specifi c funding level.

SOURCE: National Assembly on School-Based Health Care

And the NEA, in partnership with the Main Street Alliance, a coalition of small businesses, has sponsored another ad that will run in districts of seven DemocraticHouse members whose support of a health care overhaul may cost them conservative swing votes.

That TV spot does not mention education. Instead, it touts the benefits of the bill for small businesses, which, the commercial contends, would be able to better afford health insurance for their employees.

According to Federal Election Commission findings, in 2009, through the month of June, the NEA has given at least $28,700 to lawmakers and organizations that have championed health care overhaul. That includes donations to organizations, such as the Blue Dog Coalition, a group of conservative House Democrats, that could be key to passing health-care legislation.

Some of the recipients, including Sen. Christopher Dodd, D-Conn., who leads the Senate subcommittee on education, also play a major role in K-12 issues.

Janet Bass, a spokeswoman for the AFT, said that the union has launched a Web site devoted to the health-care-overhaul effort and sent representatives to lobby congressional offices. It also has placed advertisements supportive of the undertaking in publications aimed at Capitol Hill staff members.

Both unions are members of the National Coalition on Health Care, which is working to champion the health care overhaul. Other members include child-advocacy groups, such as the Children’s Defense Fund, based in Washington. The coalition’s membership dues are $10,000 to $250,000.

Bills being worked on in both the House and Senate also include language that would create a grant program to expand school-based health centers.

Such centers offer a range of services, sometimes including mental-health and nutrition counseling. They often are in low-income areas, where students are less likely to have access to high-quality health care. There are about 2,000 nationwide.

“It’s location, location, location,” said Divya Mohan Little, a spokeswoman for the National Assembly on School-Based Health Care, a nonprofit group based in Washington. Adolescents in particular often are reluctant to seek out medical care if it isn’t “catered to them,” she added.

Library Director Kathryn Dorko contributed to this story.

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A version of this article appeared in the August 26, 2009 edition of Education Week as Education Groups Put Muscle Behind Health Care Overhaul


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