Education Week - July 19, 2017 - 19
The Stakes for K-12
By Alyson Klein
The Trump administration and congressional Republicans are in the midst
of trying to replace the Patient Protection and Affordable Care Act-better known
as Obamacare-in a process that could have big implications for the nation's
schools when it comes to special education funding, teacher benefits, and more.
The House of Representatives passed its version of a health-care bill in May, and
the Senate is in the throes of wrangling its own legislation to replace the ACA.
What are the major issues at stake for K-12 educators, and how do these
two GOP bills-the Senate's "Better Care Reconciliation Act" and the House's
"American Health Care Act"-differ from the law now in effect?
What happens with the
'30 Hour Rule' for employees?
* This is a technical part of the Obamacare law that requires employers
to offer health coverage to any eligible employee who works an average of at least 30 hours a week. The House and Senate bills leave the
30-hour rule on the books. But they would scrap penalties for employers that don't provide the coverage, advocates say.
What happens with Medicaid
and special education?
* Medicaid helps school districts cover the costs of services to
eligible students, including those 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 about a third of federal special education state
grants and roughly the size of the Obama administration's Race
to the Top program.
* The ACA enticed most states to expand eligibility for Medicaid,
a big federal and state partnership program that helps lowincome people, including children, get access to health care. Both
the House and Senate bills appear to phase out that expansion,
although the Senate does so at a slower pace than the House.
* Both the House and Senate bills would distribute Medicaid funds
on what's called a "per capita" basis, dependent on how many
people a state has from particular groups, including children and
the elderly. But increases to Medicaid would grow more slowly
under the Senate measure, potentially leading to deeper cuts
over time. It's unclear how much money schools would stand to
lose from the cuts, and the amount may vary wildly from state to
* Some school district advocates argue that the 30-hour rule has made
their lives difficult, since so many of their employees work between 30
and 40 hours. (Think long-term substitute teachers, paraprofessionals,
or, say, a bus driver who is also a football coach.) Substitutes, paraprofessionals, and others would like to be able to keep their health care,
even if they work fewer than 40 hours. This provision effectively pits
different education groups against one another.
What happens with so-called
'Cadillac' health plans?
* The ACA taxes "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 Obamacare overall, but they'd love to see this tax
go away. The House GOP bill doesn't get rid of the tax, but it would
push back its start date, from 2020 to 2025. The Senate measure
includes similar language.
What happens with mental-health coverage?
* School health jobs could be on the line. 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.
* ACA requires all insurance plans to include certain components, including mental-health coverage. Both chambers' bills
appear to keep that requirement in place but would allow
states that don't want to offer those benefits the option of getting a waiver.
* Services for children also could be cut. In some states, districts
use Medicaid to help cover such services as vision and hearing
screenings for those who are eligible. And about 68 percent of
districts surveyed say they use the money to pay the salaries of
health professionals who serve students.
* That could affect what kinds of benefits children get under
their parents' health-care plans. For instance, if states don't
call for plans to cover mental-health services, a child with
attention-deficit hyperactivity disorder may no longer be covered for psychiatric and other mental health care.
* Scaling back Medicaid could also have an indirect impact on K-12
spending, advocates argue. Medicaid and K-12 education are
typically the two biggest-ticket items in state budgets. If states
try to make up for federal Medicaid cuts by using their own
money, they may have to trim school budgets.
* School districts would try to make up for the loss, advocates
say, in part by hooking students 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, and some
children may not get the care they need.
EDUCATION WEEK | July 19, 2017 | www.edweek.org | 19