Saturday, July 8, 2017

What's Medicaid got to do with it anyway?

What’s Medicaid Got to do with it anyway?

Both the House and Senate versions of a new health care law contain steep cuts to Medicaid.   The Senate version does include an increase in gross dollar amounts over the next several years BUT, there are sharp cuts to the people who are eligible for Medicaid.   So how does that impact education?   Plenty!
There are basically three groups who use Medicaid.   These are the economically disadvantaged, (many of whom are the working poor) children with disabilities, and indigent older Americans.   Medicaid is a health care provider plan that is made up of both state and federal funds.    Under the Affordable Care Act, states could chose to expand Medicaid eligibility and get more federal matching funds to do so.  Many states did that, including those led by Republican governors and legislatures.
There is a notion that if we do not “give” health care to poor Americans, we the people can save a lot of money.   I am not sure how that is true.   I really do not think that even the most conservative among us could stomach allowing people who did not have the funds for health care to just die in the streets.  So what actually happens is that people without health care insurance wait until they are very ill or ill enough to seek treatment in a hospital ER.   Without being paid for these ER visits many rural hospitals have said they may have to close.  As long as a hospital is open it needs to provide treatment to all who need the ER.  Since there is no such thing as free treatment, what we wind up with is cost-shifting treatment.  Hospitals can’t collect from the poor so they turn to shifting the cost for that treatment to increasing the costs for the folks who either have insurance or can afford to pay out-of-pocket.  When costs to insurance companies go up, premiums paid by those who can afford private insurance also go up.  And since getting medical treatment later rather than sooner is more expensive, these shifted costs to private insurance payers are higher than they need to be.
Children who attend school when they are sick do not learn very well.    In thinking of human hierarchy of needs, people (including children) attend to getting food, avoiding pain and illness, and shelter before they are concerned with the subtleties of algebra or literature.   Sick kids in school also infect other kids in school, including the kids whose parents do have health care.
Then there are the direct services to children with disabilities.   Federal and most state laws require that schools provide what are called related services to children with disabilities.  These services are things like occupational therapy, physical therapy and speech therapy as well as transportation to school to receive these services.   School districts can collect money from Medicaid to augment the cost of providing these services.   Some districts receive many millions of dollars in Medicaid assistance to provide these services to children with disabilities.   If the Medicaid dollars are reduced, these services would still need to be provided to these children according to the law.  Two things would occur.  Either children would not get the full amount of service they need or the cost for providing these services would come out of other parts of the education budget.   Again, nothing is free and cost-shifting would take away from other programs to provide those mandated by law.
Reductions in Medicaid would also seriously impact people who rely on that for nursing home residence.   That is a moral question for each individual, how well do we want to take care of older, indigent Americans.

Medicaid has a lot to do with our responsibility to others.  It is a reflection on how we believe we should care for those who have the least among us.   But reduction in Medicaid is also going to have a tangible impact on the children in our schools.

Thursday, July 6, 2017

Don't let the stars get in your eyes

Don’t Let the Stars Get in your Eyes

Those of you who are old enough might remember that as a big hit for Perry Como.   For contemporary times, check out the new 5-star rating system that the State Board of Education has recently put into place to rate the schools of Maryland.
The system is in response to the federal Every Student Succeeds Act (ESSA) the successor to No Child Left Behind (NCLB).   ESSA requires the states to develop a system to evaluate and grade the public schools.   The details still need to be worked out but this is how it is supposed to go.  The system uses several factors in the calculations, such as surveys of parents and teachers and the attendance rate of the students.  However, 65% of the rating will be based on academic measures, primarily test scores.  All of these data will create a score for each school.  Those scores will then be translated into percentile rankings.  Percentile rankings are not percentages.  The percentile score tells the percentage of schools that scored below the percentile ranking.  So, a percentile score of 75% would mean that a particular school did better than 75% of the schools on the list.  The score does not tell you what the range of scores was or what the scores were of the schools at the top of the range and what the scores were of the schools at the bottom.   Hypothetically, if the total possible score is 150, and the top score is only 80, a school could have a very high percentile ranking BUT still have a very low overall score.
The next question the Board needs to figure out is how many stars will each percentile ranking get.   The State Department of Ed staff recommended a 4-star system with schools between the 24th-74th percentile ranking would get 2-stars.   The State Board rejected that approach for a 5-star system. 
While on the surface, the rating system may appear to be objective, it is not.  The Board has already agreed to reward schools that show increased equity for some groups such as students with disability or students of color.   If a school shows too wide an equity gap, their star rating could drop.  The converse would be true is a school showed equity improvement, the star rating would rise.
Secondly, the basing stars on percentile rankings can easily reward schools that are the best of the worst rather than the best.  Percentile rankings inherently measure in comparison to the group.  If you are good in a bad group, your percentile ranking will go up.  The same score in a good group could deliver a much lower percentile.
Some citizens who are more interested in property values than they are in improving schools are already complaining that going public with the star rating of schools will lower the property values for people in those communities with bad schools.   In truth, the star system just makes public and official what it is everyone already knows.   Most real estate websites also informally rate schools.
We already know that in the top 20 percent of what are considered the “best schools” by popular consensus only show a PARCC testing pass rate of 50%.   What if those schools get lots of stars, how will that be explained to the community.

Perhaps the Maryland State Board of Education should contact Michelin and see how they handle restaurants.   Or barring that, dig out that very old Perry Como tune and don’t let the stars get in their eyes.

Tuesday, June 27, 2017

The teacher is always right

The Teacher is always right.

Whether a teacher thinks a child is going to do very well or the teacher thinks the child is going to struggle, she is right.  Teachers are hugely powerful.  They send clear messages to the other students about how to treat each child.  
One of the first things any child looks for is to see if he or she belongs in this environment.   Are there kids who look like me in my books?    Are there kids who have less mainstream names than the average kid?  Are there people in authority who look like me, the teachers, the aides, the administrators?   Do any of them have names that sound like mine?
Too often for far too many of our children the answer is no.   It is currently considered a good idea to fully include children with learning challenges in the mainstream classroom.   If I have a disability, how does my teacher feel about having me in her class.   Does she see me as just one more burden thrust on her by an administration that has no idea of everything with which I need to deal.  Does he see me as potentially dragging down the class test scores and making him look like a bad teacher?  If I am an English language learner, does my teacher realize that I might be very smart and that it is just my lack of facility with English that makes it hard for me to answer questions?
Maybe my teacher is very well-intentioned.   Perhaps she believes that with a lot of effort on her part she will “save” me from my community.   Maybe I don’t want to be saved.  Maybe I want to be respected for the good things about my community and even about my disability. 
The teacher sets forth the social order in the classroom.   Whether it is a sigh when I don’t process language as quickly as she thinks I should or a comment such as “we need to move on here”, he is sending a message that my presence is a burden.   When another student asks something about my name, my attire or my learning disability and the teacher responds as if I weren’t present rather than suggesting that the student just ask me- a message about my belonging is sent forth.  None of our kids needs to be saved.   Everyone of them knows something they could teach the teacher.   Every child comes from a place of value.   It is up to us the educators to feel the value of difference and to teach that value to all of the children in the classroom. 

Teachers teach many subjects, math, English, history-but the most important thing they can teach and convey to their students is why each and every student is of value and can bring something of value to the other children.   Because we all know the teacher is always right- it is just not always clear what the teacher is teaching is also right.