Education Week - March 1, 2017 - 19


Key K-12 Issues
In ACA Debate

HEALTH-CARE
LAW'S OVERHAUL

CONTINUED FROM PAGE 1

4.8 percent, said Tricia Brooks, a senior fellow at
the Center for Children and Families at Georgetown University. That's partly because some children receive coverage along with their parents
through ACA's health insurance marketplace.
But the law also helped most states expand
Medicaid, which covers some 33 million children,
according to a 2015 analysis by the Henry J. Kaiser
Family Foundation.
What's more, enrollment in both Medicaid and
the State Children's Health Insurance Program,
or S-CHIP, ticked up when parents started signing up for the ACA's insurance exchanges, thanks
in part to increased outreach efforts spurred by
the new law-something Medicaid experts call
the "welcome mat" effect.
"I really do think if eligibility is rolled back, or
we make the system more complex [and make it]
harder to enroll ... there could be a reduction in
coverage to kids," Kenney said.

What to Watch For
President Donald Trump and
congressional Republicans have
promised to repeal-or at least
make big changes to-the Affordable
Care Act, President Barack Obama's
signature domestic achievement.
School district officials and childhealth advocates are watching
to see how changes to the law
shake out, including in
these key areas:

Medicaid Makeover
MEDICAID: The ACA expanded
this government-financed health
program in most states. In some
places, school districts use
Medicaid dollars to cover the cost
of some services for children who
are eligible for the program. Those
services are often geared towards
students in special education,
such as speech therapy or
occupational therapy.

Getty

As part of their efforts to repeal or rework the
ACA, Republican leaders in the U.S. House of Representatives are contemplating broader changes
to Medicaid.
Those include limiting federal funding for
Medicaid through set block grants or per capita
amounts based on how many people a state has
from a particular eligibility group, such as children or individuals with disabilities. Currently,
federal funding is available to match state expenditures, which may shrink or increase as the
health care needs of the state change, Brooks
explained.
Allowing Medicaid dollars to flow as block
grants to states would "really cut out the fraud,
waste, and abuse" in the program, Kellyanne Conway, a White House senior adviser, said on the
"Today Show" earlier this year.
But advocates fear such changes could eventually lead to diminished financing for Medicaid,
said Bruce Lesley, the president of First Focus, a
nonprofit organization that aims to make children
and families a priority in budget decisions.
And that in turn might have serious ramifications for school districts, according to AASA, the
School Superintendents Association. Schools receive roughly $4 billion from Medicaid a year, or
more than a quarter of the amount of funding
districts get under the federal Title I program for
disadvantaged children.
Those dollars reimburse schools for covering the
cost of services to students in special education
who are eligible for Medicaid, including speech
therapy and occupational therapy.
"Schools are an ideal place to offer health care
services because they are where children are almost
every single day," said Sasha Pudelski, the assistant
director of policy and advocacy at the AASA.
In fact, the AASA, along with the Association
of School Business Officials International and
the Association of Educational Service Agencies,
surveyed almost 1,000 educators in 42 states, in
part to find out how they are currently employing
Medicaid dollars.
Two-thirds of the respondents said they use
Medicaid to help cover salaries for professionals
who work with students in special education, for
example. And a quarter of respondents said they
use Medicaid money to finance equipment for students in special education, including walkers and
wheelchairs.
The ACA also required all health plans to
have a certain set of "essential health benefits,"
including pediatric care and mental and behavioral health, said Kelly Vaillancourt Strobach,
the director of government relations for the National Association of School Psychologists.
If that provision is repealed-or reshaped

EXCISE TAX: The law includes
a tax, slated to go into effect in
2020, on insurance providers that
offer especially generous health
plans, defined in 2018 as any plan
for an individual costing more
than $10,200 a year, with some
adjustment for inflation.

THE "30-HOUR"
RULE: The law
requires most
employers to offer
health insurance to
eligible employees
who work 30 hours a
week or more-or pay
a penalty. That's been
a struggle for some
school districts and
colleges that have
considered cutting
hours of substitute
teachers or adjunct
faculty to ensure that
they don't hit the
30-hour threshold.

MENTAL HEALTH: The law calls for
all health plans to include certain
components, including mental
health services. If that provision is
dropped, some students could lose
access to private providers, including
psychologists and psychiatrists.

SOURCE:
Education Week

significantly-students who are covered either
through their parents' insurance or through the
ACA could lose access to a psychologist or psychiatrist, she said. That means that conditions
that can impact a child's ability to learn, such
as Attention Deficit Hyperactivity Disorder or
depression, may not be addressed appropriately.
"That's one of the biggest things we're afraid
of," Strobach said. Schools will do what they can
to make up for the loss, she said, including utilizing school-based or community health services
But, she said, some school-based professionals
may not provide all of the services some children need, such as psychiatric care. And many
community health-service agencies are already
strained, with long waiting lists.
And there are some smaller provisions of the
law that can help schools beef up mental health
services for students. For instance, ACA provides
grants to finance internship stipends for health
professionals-including school psychologists
and social workers-who want to train in highneeds schools, Strobach said.
Teachers' unions are also keeping a close eye
on a provision of the law that isn't slated to kick
in until 2020, but could hit health plans for some
school district employees.
Part of the overall cost of the ACA was covered
by an excise tax on high-cost coverage offered
by employers, sometimes nicknamed "Cadillac"
coverage. That's defined by the law as $10,200
for an individual or $27,500 for a family, pegged
to 2018 and adjusted after that.
The National Education Association sees the
tax as unfair. The union points to analyses that
show the tax would disproportionately hit employees in states with high health-care costs and
plans covering more women and older employers, including many of its members.
Sometimes educators are "forced to forgo raises,
in exchange for fewer changes to their benefits,"
said Joel Solomon, a senior policy analyst for NEA.
And if health-care costs are slimmed down,
thanks to the tax, teachers may not necessarily get a pay bump to make up for diminished
benefits, said Al Campos, a federal lobbyist for
the union.
"Health care is one of the most important benefit features of a teachers' compensation package," Campos said.
Even though NEA supports the ACA overall, the union would like to see the excise tax
stripped out. The American Federation of Teachers also sees the tax as "harmful" and has applauded policymakers who have supported getting rid of it.

Staffing Concerns
School district advocates also are tracking
potential changes to the so-called "30-hour
rule," a requirement in the law that most employers offer insurance benefits to eligible employees who work more than 30 hours a week-
or pay a penalty.
That's caused headaches for some school
districts, some of which have considered cutting hours for employees who work more than
30 hours a week but fewer than 40 hours,
including substitute teachers, bus drivers,
paraprofessionals, and cafeteria workers.
Schools might decide, for instance, not to
hire a long-term substitute when a teacher is
out for an extended period. Instead, the district might opt to rotate different substitutes
in and out of a particular position, so that no
one hits the 30-hour threshold, triggering the
requirement for medical coverage.
That's not ideal for student learning, said
Noelle Ellerson Ng, the associate executive
director for policy and advocacy at the AASA.
The provision "undermines the control districts have in their staffing patterns," Ng said.
The NEA though, said the provision helps
make sure that employees who spend most of
their time-an average of at least 30 hours a
week-working for a school district can get
covered. They'd like to see the provision remain, with some tweaks, Campos said.
EDUCATION WEEK | March 1, 2017 | www.edweek.org | 19


http://www.edweek.org

Table of Contents for the Digital Edition of Education Week - March 1, 2017

Education Week - March 1, 2017
Districts, Advocates Warily Await Health-Care Law Overhaul
DIGITAL DIRECTIONS: Teachers Turning To Digital Games For Civics Lessons
Educators Join New Fight to Stop Gun Bills
A State of Limbo for DACA Teachers
News in Brief
Report Roundup
More Students Take AP Tests—and More Are Low-Income
District Leaders Weigh How—and Whether —to Engage DeVos
Can Schools Offer Sanctuary?
Attention Turns to Courts in Battle Over Transgender Rights
Congress May Turn Focus to Higher Education Law
Spec. Ed. Aid a Candidate For Choice?
High Court Backs Family in Case Of Service Dog at School
Transition Update: Trump Administration
Funding Formulas: States Wrangle Over K-12 Aid
State of the States
Maria Ferguson: In Standards Battle, States Should Stay the Course
Jia Lok Pratt: ‘Why Can’t All Schools Succeed?’
Ron Wolk: End the Charter Schools War
Letters
TopSchoolJobs Recruitment Marketplace
Anthony Kim: Predictions for American Education in 2017
Education Week - March 1, 2017 - A State of Limbo for DACA Teachers
Education Week - March 1, 2017 - 2
Education Week - March 1, 2017 - 3
Education Week - March 1, 2017 - News in Brief
Education Week - March 1, 2017 - Report Roundup
Education Week - March 1, 2017 - More Students Take AP Tests—and More Are Low-Income
Education Week - March 1, 2017 - District Leaders Weigh How—and Whether —to Engage DeVos
Education Week - March 1, 2017 - 8
Education Week - March 1, 2017 - 9
Education Week - March 1, 2017 - 10
Education Week - March 1, 2017 - 11
Education Week - March 1, 2017 - Can Schools Offer Sanctuary?
Education Week - March 1, 2017 - 13
Education Week - March 1, 2017 - Congress May Turn Focus to Higher Education Law
Education Week - March 1, 2017 - Spec. Ed. Aid a Candidate For Choice?
Education Week - March 1, 2017 - High Court Backs Family in Case Of Service Dog at School
Education Week - March 1, 2017 - Transition Update: Trump Administration
Education Week - March 1, 2017 - State of the States
Education Week - March 1, 2017 - 19
Education Week - March 1, 2017 - Jia Lok Pratt: ‘Why Can’t All Schools Succeed?’
Education Week - March 1, 2017 - Ron Wolk: End the Charter Schools War
Education Week - March 1, 2017 - Letters
Education Week - March 1, 2017 - 23
Education Week - March 1, 2017 - TopSchoolJobs Recruitment Marketplace
Education Week - March 1, 2017 - 25
Education Week - March 1, 2017 - 26
Education Week - March 1, 2017 - 27
Education Week - March 1, 2017 - Anthony Kim: Predictions for American Education in 2017
Education Week - March 1, 2017 - CW1
Education Week - March 1, 2017 - CW2
Education Week - March 1, 2017 - CW3
Education Week - March 1, 2017 - CW4
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