Court Healthcare Decision Protects Some Early Childhood Priorities

Politicians revving up for the November elections are still parsing the impact of last week’s Supreme Court healthcare ruling. But for some policymakers in the education world, the focus has been not on campaign rhetoric, but on students.

One potential effect of the Court’s decision is a rewriting of the relationship between states and the federal government. Chief Justice John Roberts wrote in the Court’s opinion that the federal government cannot withhold all Medicaid funding from states that choose not to participate in the program’s expansion. The court ruled that requiring states to expand their coverage in order to continue receiving federal funds is coercive, given that states rely so heavily on federal funds to support Medicaid.

With this move, the Court cast constitutional doubt on the “carrot-and-stick” approach frequently used by the federal government to influence state policies. (Think, for example, of the 1984 law that required Congress to withhold all federal highway funds from states that didn’t raise the legal drinking age to 21.) Jennifer Cohen, senior policy analyst for our sister blog Ed Money Watch, asked, “What is the difference between taking away funding for Medicaid and taking away funding for education, as would have happened had any state opted out of [No Child Left Behind]?”

Others argue that the narrow legal wording in the Medicaid decision will make it hard to read the decision in a way that applies to transportation or education funding. And many federal education programs are civil rights-related, which puts schools on different legal ground than Medicaid, and would presumably make the “coercion” argument harder to justify.

Leaving aside the legal implications the decision may have on federal education policy-making moving forward, the law could also have significant impacts on uninsured children.

Under the Affordable Care Act as originally signed, the Congressional Budget Office estimated an additional 30 million Americans would gain access to health insurance. Most low-income children are already covered through the State Children’s Health Insurance Program (CHIP), but 17 percent of uninsured Americans are children under the age of 18. An Education Week post last week outlined some of the research on the connections between healthcare and education. Children with insurance have demonstrably better health statuses than uninsured children – and better academic outcomes. If those children gain access to healthcare through the Affordable Care Act, it could improve their odds of doing better in school, graduating from high school, and even attending and finishing college.

Health problems, which are more common among uninsured children, have been shown to cause greater rates of absenteeism from school. An analysis of CHIP state health insurance programs found that as children became insured at higher rates, they missed school at lower rates. Through the Affordable Care Act, CHIP and Medicaid were both reauthorized through 2019.

The Obama administration has several other programs that prioritize the link between healthcare and education. The Promise Neighborhoods program – funded at $60 million in fiscal year 2012 – was designed by the White House to provide comprehensive neighborhood-based services, including healthcare services. According to U.S. Secretary of Education Arne Duncan, “Promise Neighborhoods recognizes that children need to be surrounded by systems of support inside and outside of the classroom to help them be successful in school and beyond.”

Finally, another early childhood program included in the healthcare reform law – $1.5 billion in mandatory funding for the Maternal, Infant, and Early Childhood Home Visiting Program – was upheld by the Court. That means the home visitation program, which provides information for low-income mothers and mothers-to-be, will continue to operate.