NAPT News & Views — What Does Health Care Reform Have to Do With School Transportation?

If you’re confused about the current status of congressional efforts to repeal and replace Obamacare, you’re not alone! Health care is a complicated subject, the politics very contentious, and the stakes high in terms of what choices we ultimately will have and at what cost.

Here’s a brief situational overview, as of mid-May:

The 2010 Affordable Care Act, approved by a Congress with a Democratic majority and signed into law by then-President Obama, was an effort to extend the availability of health care to more citizens and reign in burgeoning costs. It expanded Medicaid, the government insurance program for the poor, and provided income-based tax credits to help the poor buy insurance on individual insurance markets set up by the law. It also required everyone to buy insurance or pay a penalty.

Republicans blame Obamacare for driving up health care costs, and they argue that it has since failed, with many insurers pulling out of state health care markets.

Following the election of President Trump, who made the repeal and replacement of Obamacare a central campaign issue, a Congress with a Republican majority is now examining ways to amend the law.

On May 4, the House of Representatives passed its version, called the American Health Care Act. It would repeal most Obamacare taxes, roll back the Medicaid expansion and slash the program’s funding, repeal the penalty for not purchasing insurance, and replace the law’s tax credits with age-based credits.

The Senate is now crafting its own version of a new bill, and before all is said and done there will certainly be heated debate.

To my knowledge, pupil transportation is not being discussed specifically in the health care reform efforts because we do not get any direct federal funding. But, depending on what any final legislation stipulates, it could significantly impact the ability of students with disabilities and in poverty to receive necessary health services in public schools — and that impact could filter down to pupil transportation.

According to Erica Green of The New York Times, “School districts rely on Medicaid … to provide costly services to millions of students with disabilities. … Medicaid has helped school systems cover costs for special education services and equipment, from physical therapists to feeding tubes. The money is also used to provide preventive care such as vision and hearing screenings, for other Medicaid-eligible children.”

Green explains that the bill passed by the House to repeal and supposedly replace the Affordable Care Act “would cut Medicaid by $880 billion, or 25 percent, over 10 years and impose a ‘per-capita-cap’ on funding for certain groups of people, such as children and the elderly — a dramatic change that would convert Medicaid from an entitlement designed to cover any costs incurred to a more limited program.”

Stephen Koff of the Cleveland Plain Dealer explains the problem in plain language: The bill “would change Medicaid … and lead to a cut in Medicaid funding. … Medicaid helps support special education programs in schools. The Medicaid in Schools program helps pay for services to children with an Individualized Education Plan (IEP), ‘including but not limited to behavioral health, nursing, occupational therapy, targeted case management and specialized transportation,’ state documents say.”

As I’ve learned from Dr. Linda Bluth, Part B of the Individuals with Disabilities Education Act (IDEA) guarantees children ages 3 to 21 a free appropriate public education, including access to special education and related services. But funding for Part B falls well below the cost for services, and school districts use a combination of other local, state, and federal funding sources to meet children’s needs.

Estimates are that each year, school districts collectively rely on $4 billion to $5 billion in Medicaid funds to support special-education services for children eligible for Medicaid. Schools use these funds to pay critical personnel, such as speechlanguage pathologists and occupational therapists, as well as to provide assistive technology and transportation service for children with disabilities.

As I mentioned above, the Senate is currently working on its own version of a bill to repeal and replace the Affordable Care Act. Although some advocacy groups did raise concerns about threatened cuts in essential special-education services paid for by Medicaid when the House debated its health care plan, many of us have remained unaware of the problem. And that’s a problem itself — a big problem.

The vast majority of Americans want quality health care that’s easily accessible and affordable. But as taxpayers, many also worry about spiraling government spending, massive debt, and tax burdens for children and grandchildren. As school bus professionals dedicated to the safe and efficient transportation of all children, we are also concerned about the impact on the children, families, and schools we serve.

I therefore encourage you to ask your local school district officials to include you in their discussions about the potential effects of changes to the current Medicaid program. I also urge you to ensure that your colleagues understand what you do, how it’s connected to the health care debate, and why it’s important to monitor closely the deliberations in Washington.