Last week the Save Medicaid in the Schools Coalition, a group of 58 organizations and advocacy groups – from the American Association of School Administrators to the United Way – wrote a letter to congressional leaders detailing the damage the American Health Care Act (AHCA) will do to vulnerable children.
Republican representatives ignored that plea, just as they ignored the warnings from almost every American medical organization, a number of whom joined in this statement: “Our organizations, which represent over 560,000 physicians and medical students, are deeply disappointed that the U.S. House of Representatives today passed the American Health Care Act, an inherently flawed bill that would do great harm to our patients.”
Of all the people who will be harmed if the bill becomes law, children may be the hardest hit.
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Beginning in 1988, schools have been reimbursed by Medicaid for some medical services provided to children who qualify under the Individuals with Disabilities Education Act (IDEA). Medicaid also reimburses school districts that offer diagnostic screening and treatment for eligible children as a proactive and efficient way to head off more serious, more expensive-to-treat problems.
About two-thirds of the Medicaid reimbursements to schools support the work of speech-language pathologists, audiologists, occupational therapists, school psychologists, school social workers, and school nurses. Children living in poverty also benefit from these funds with access to more immediate, consistent health care. School districts can use Medicaid money to buy medical equipment such as wheelchairs, walkers, special playground equipment, and assistive technology for students with disabilities.
Under the AHCA, districts would lose much of their Medicaid funding. Instead of the current funding formula based on per capita income, the AHCA imposes a per capita cap or block grants. States will no longer have to consider schools as eligible Medicaid providers, although schools will still be legally obligated to service students who qualify under IDEA.
IDEA is already underfunded, and the projected loss of $4 billion in Medicaid reimbursements schools currently receive would be disastrous to all children, not just those covered by Medicaid. To make up for the loss of funding, schools will have to divert money from other general educational programs to meet the mandates of IDEA.
School health care workers such as therapists and nurses whose salaries are paid for by Medicaid will lose their jobs. Vision, hearing, and mental health screenings will cease. Districts attempting to make up for the loss of Medicaid money will be forced to raise property taxes or levy new fees to afford special education services.
The projected loss of total Medicaid funding under AHCA is $880 billion. The cost in human misery is even greater. Addressing the very real medical needs of poor and disabled children while they are in school is not only good business sense, it is the humane thing to do.
But doing the humane thing – or even the sensible thing – doesn’t seem to be the primary motive of the representatives who voted for the AHCA. Chalk that up to political posturing – and wanting to look like a winner – even as all of us lose in the end.
McSpadden teaches high school English in York, S.C. Email: firstname.lastname@example.org