The nation’s schools, already reeling from plunging test scores and culture war controversies, now face another major hurdle — an $880 billion cut to the federal Medicaid program, the source of health care coverage for as many as 40 percent of the nation’s students.
House Republicans approved a budget resolution last Tuesday that would reduce by about 11 percent the federal-state partnership that provides health coverage for nearly 80 million Americans. About half of them are children, accounting for as many as two in five public school students nationwide.
The consequences for students are clear. Without Medicaid coverage, children could lose access to screening protocols that detect vision and hearing problems and learning disabilities. Without regular access to preventive health care, they would be more likely to miss school through illness, contributing to the high absenteeism rates plaguing schools.
That would likely compromise academic performance. Research shows that students with Medicaid coverage are more likely to finish high school and graduate from college than students without coverage. Another study found a connection between fourth and eighth grade reading scores and expanded Medicaid eligibility at birth.
Beyond the impact on students, Medicaid cuts could also hurt school funding. Medicaid is the top source of federal funding for state budgets, with Washington currently paying for at least 50 percent of the health care costs that states incur. An $880 billion cut would leave state governments scrambling to make up the difference.
That would almost certainly result in reductions to services for Medicaid’s core populations — people with disabilities, low-income children and parents, pregnant women and the elderly. But states would likely have to squeeze other priorities. Education budgets would be particularly vulnerable, given the share of state funding that goes to schools.
What’s more, Medicaid funds more than $7.5 billion in school-based services, and schools are reimbursed for billions in spending annually on personnel, equipment and technology. Until 2014, schools could only seek reimbursement for the needs of students with disabilities. In the last decade, that has expanded to services provided by school nurses, mental health counselors and others serving all students enrolled in Medicaid.
Currently, 25 states take advantage of the expanded reimbursement rules, with others contemplating changes, in part because research shows that attendance and achievement improves when schools offer access to nurses and other providers.
School-based health care is particularly important in rural communities where a visit to the doctor can mean a long drive and where a greater share of students rely on Medicaid for their health coverage. As a result, the Republican-proposed cuts would hit many rural red-state students hard.
The congressional leaders advocating Medicaid cuts don’t talk about children or schools. Instead, they frame the issue as cutting waste, fraud and abuse or capping the spending for each recipient or putting parents back to work. But the only way to cut $880 billion is to cover fewer people, provide fewer services and shift costs to states.
The irony of a populist president cutting a program proven to help vulnerable students to fund tax cuts for the wealthy is as glaring as it is troubling.
Thomas Toch is director of FutureEd, a non-partisan think tank at Georgetown University’s McCourt School of Public Policy
