Common Core and Medicaid Expansion: Comparing Big Decisions by States

By Andrew Ujifusa — February 07, 2014 8 min read
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As the debate over the Common Core State Standards and aligned assessments continues or grows in many states, one of the most prominent arguments from foes of the common core is that the federal government coerced states into adopting the standards.

According to this argument, states facing dire budget circumstances in the wake of the Great Recession were so desperate for the federal cash on offer in Race to the Top that they felt compelled to adopt the standards. And this argument holds that the cold-eyed, unsmiling department was only too willing to twist states’ arms in this fashion, or blackmail them, to get what it wanted. The argument touches on the sensitive topic of states having their authority trampled by an overbearing Uncle Sam, and it has traction across ideological lines. Earlier this week, on Feb. 5, U.S. Rep. Phil Gingrey, a Georgia Republican, announced that he would introduce legislation that would bar the U.S. department from “mandating or incentivizing” states to adopt standards, and he singled out common core in his proposal.

But does the widespread rebuke by states of the Medicaid expansion show that states are not so easily coerced by the federal government--and its money--after all? Can common-core adoption be compared to decisions states faced regarding Medicaid expansion?

The expansion of Medicaid was a major feature of the Affordable Care Act, known as Obamacare. But the U.S. Supreme Court ruled essentially that states could decide on their own whether or not to use federal funds to expand Medicaid, which provides health insurance for low-income individuals and families. As my colleague Mark Walsh wrote back in 2012 on The School Law Blog, the Medicaid expansion in the original Obamacare law was deemed too coercive by the court because refusing it could have endangered a state’s entire federal Medicaid funding.

Let’s lay out the basic information. On Jan. 14, CNN Health put together this map on the decisions states made with respect to expanding Medicaid:

So that’s 21 states that have declined to expand Medicaid. And from a classic 2010 article by my Politics K-12 colleague Michele McNeil, here’s the list of 40 states (plus D.C.) that applied to the first round of the federal Race to the Top grants:

As for round two of Race to the Top, the deadline for which was June 1, 2010? A total of 35 states and D.C. applied. By the time the third round of Race to the Top winners were announced in December 2011, every state that ended up adopting common core had done so already, except Wyoming.

So far, so good. Next, let’s consider the adoption of common core. As you may know, all but four states (Alaska, Nebraska, Texas, and Virginia) adopted the standards, with Minnesota only adopting the ELA standards from common core, not the math standards. What’s less well known is that all the states to adopt common core did so after those 40 states applied for Race to the Top cash in the first round. My colleague at Curriculum Matters, Catherine Gewertz, has the common-core adoption timeline very neatly laid out in cartographical form. The first state to officially adopt, Kentucky, didn’t do so until February 2010.

However, it’s important to point out that in a 2009 memorandum of agreement, all but four states (Alaska, Missouri, South Carolina, and Texas) signaled that they were on board with the concept of common core before the standards were finalized. And Tennessee, for example, a winner of Race to the Top’s opening round, told the U.S. department in its application that it would be adopting common core before it officially did so:

What’s my point here? Let’s identify the states that fit both these categories:

1) Sought Race to the Top funds in at least one of the first two rounds and also adopted (or planned to adopt) common core in roughly the same time period

2) Declined to expand Medicaid after the 2012 Obamacare ruling

Here’s the result in map form, with the states fitting both categories highlighted in blue:

The total by my count is 17: Alabama, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, North Carolina, Oklahoma, South Carolina, South Dakota, Utah, and Wisconsin.

I’ve left out Wyoming because it officially adopted the standards in June 2012, nearly two years after the second round of Race to the Top grants were awarded, by which time common-core adoption had already taken place in roughly three-quarters of all states. Of those 17 states I listed, Maine was the last to adopt common core, doing so in April 2011. But Maine had signed onto the 2009 memorandum of agreement for common core. Also, a few states on that list that applied in Race to the Top’s first round declined to do so in round two, like Indiana and Kansas.

So if a state adopted common core as part of a quest for Race to the Top dollars, but subsequently declined to expand Medicaid through Obamacare, does it demonstrate that the state was exercising its autonomy and independent decision-making in both cases, and didn’t have its arm twisted in either case?

There are a lot of questions and issues that this comparison brings up.

• Content standards, while an important piece of Race to the Top applications, technically wasn’t the only factor in whether states ultimately got federal cash. Teacher evaluations and tests, for example, are two controversial policies that played major roles in the Race to the Top scoring rubric. With Medicaid, on the other hand, the key question has been relatively clear for states: Do you want to expand the program or not?

• The adoption of “college- and career-ready” standards was also an issue for states when they sought waivers from portions of the No Child Left Behind Act. Those waivers didn’t involve grants of federal dollars, just flexibility from federal law that many states felt they strongly needed. A major question during the waiver-intense period was whether a state that had not adopted common core would ultimately be granted a waiver, given the U.S. department’s strong support for the standards. Texas and Virginia, both non-common core states, did receive NCLB waivers in the end. Medicaid expansion hasn’t faced dual pressure points (Race to the Top and waivers) in the same way.

• This is related to the previous section regarding Texas and Virginia receiving NCLB waivers without common core. Could a state have won Race to the Top without adopting common core? Ultimately, that question can’t be answered now, although given how few points separated Race to the Top winners from losers, and how many points “standards” were worth in the scoring rubric, it seems unlikely. Nor can this question be answered: How many states would have adopted common core if Race to the Top did not exist? However, if you look at Gewertz’s map from 2010 below, and compare it to Race to the Top winners from the first two rounds, those winners had adopted, or were at least right on the verge of adopting, common core when they won their grants.

• State budgets were in worse shape in 2010 than they were in 2012 or 2013, when states were making their minds up about Medicaid expansion. In theory, states were therefore more desperate for any form of federal aid to shore up any part of their budgets in 2010 than 2012 and 2013. At the same time, Medicaid expansion in total involves substantially more dollars than Race to the Top offered. Race to the Top funding for states (not counting Race to the Top competitions for districts or for early learning) added up to $4 billion. In 2012, the Center on Budget and Policy Priorities reported that the total cost of Medicaid expansion from 2014 to 2022 would be $1 trillion. This created a greater incentive, in theory at least, for states to agree to expand Medicaid.

• As controversial as common core has been, Obamacare blows it out of the water when it comes to the explosive political passions involved. And Race to the Top trails both of them on that score by a country mile. So it’s not totally unexpected that more states would refuse to be associated with Obamacare if given the chance, even if they refuse federal dollars in the process.

• Just as some on both sides of the political spectrum see common core as an initiative that purports to lead to big things but won’t deliver them, some see Medicaid as a big federal program that won’t hold up over time:

• Michael McShane at the American Enterprise Institute has argued that the true costs of implementing common core were not as clear as the costs of implementing Medicaid for states, although the Medicaid expansion isn’t totally cost- or hassle-free for states despite the federal dollars provided.

• Finally, in many if not all cases, Medicaid expansion has required the approval of state legislatures, whereas common-core adoption has mostly been the work of state boards of education. They’re different parts of state government with different responsibilities, desires, and pressures. However, in the end, they’re both part of state government.

There are other aspects of, or problems with, the comparison I’m sure I haven’t thought of. No comparsion of this nature can be dispositive. And this comparison is ultimately a philosophical exploration. The push to win Race to the Top dollars tied to standards-adoption is a part of history now. And most states, for now at least, have made decisions about Medicaid expansion one way or the other. But it’s likely that the debate over when the federal government crosses a line into coercion will go on hot and heavy for the foreseeable future.

A version of this news article first appeared in the State EdWatch blog.