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.

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