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What’s at Stake For Schools in the Debate Over the Affordable Care Act

By Alyson Klein — March 07, 2017 4 min read
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The Trump administration and congressional Republicans are in the midst of trying to figure out whether to tweak, or toss the Obama administration’s biggest domestic achievement, the Patient Protection and Affordable Care Act—or “Obamacare” to the haters. (In fact, the House GOP released an ACA overhaul plan late Monday.)

Believe it or not, the law has had big implications for school districts and kids—and getting rid of it or changing it significantly could end up being a big deal for educators.

What exactly are we talking about? Check out a quick list of things to watch for in the debate over ACA below, and then head over to this story for even more detail:

What happens with Medicaid?

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. It’s not clear if that expansion will continue if ACA is scrapped.

What’s more,some Republicans in Congress have signaled they may want todistribute Medicaid funds on what’s called a “per capita” basis, based on how many people a state has from particular groups, including children and the elderly. (The proposal released by the House GOP Monday goes this route, according to published reports.) Fans of this approach argue that it will spur states to think more innovatively about how they structure their Medicaid programs. But detractors, including a lot of education advocates, worry that it will mean big cuts to the program over time.

Here’s why school districts should care: They get a lot of money from Medicaid, which helps cover the cost of services to eligible kids 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 not chump change. In fact it’s about a third of federal special education state grants, and roughly the size of the Obama administration’s Race to the Top program.)

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. And about 40 percent use the money to hook kids up with other health services. In some states districts use the money to help cover things like vision and hearing screenings for Medicaid eligible kids. AASA’s chart here:

And thanks to ACA, there was a ton of more attention on signing up for health insurance. That meant that more kids were signed up for Medicaid, as well as ACA’s health insurance exchanges. The uninsured rate for those under 18 dropped from 7.1 percent to 4.8 percent as ACA implementation got going, one expert said. The Urban Institute has estimated that some 4.4 million kids could end up losing their health insurance if ACA is repealed without a replacement.

What happens with the ’30 Hour’ Rule?

This is a pretty technical part of the new law that requires employers to offer health coverage to any eligible employee who works at least an average of 30 hours a week. Some school district advocates argue that this has made their lives difficult, since so many of their employees work somewhere between 30 and 40 hours. (Think long-term substitutes, paraprofessionals, or say, a bus driver who is also the football coach.) Some districts in Indiana have sued the federal government over this provision of the law. The suit is pending. And legislation has been introduced in Congress that would officially make the work week 40 hours, which is supported by AASA, the School Superintendents Association, among others.

Of course, substitute teachers, paraprofessionals, and others would like to be able to keep their health care. So this provision pits different education groups against one another.

What happens with ‘Cadillac’ Health Plans?

The ACA taxes so-called “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 the ACA overall, but they’d love to see this tax go away.

The House GOP plan would delay the tax, which is slated to go into effect in 2020, until 2025, according to published reports.

What happens with mental health coverage?

The law required all insurance plans to include certain components, including mental health coverage. If Congress ditches the law completely, there’s no telling what will happen with that requirement. But some advocates are already worrying that the end of the ACA could mean some kids would lose coverage for mental health services that could impact their ability to learn. For instance, a child with Attention Deficit and Hyperactivity Disorder may no longer be covered for psychiatric care. School districts will try to make up for the change, advocates say, in part by hooking kids 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.

Photo Credit: Getty

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