Trumpcare and Telemedicine: Possible Cuts Raise Concerns

For numerous students and their families in rural and underserved communities, the more than 2,000 school-based health centers in the United States, many of which use telemedicine to care for patients, provide a lifeline. Yet despite their popularity among the communities they serve, school-based telemedicine programs could be one of the many potential casualties of the ongoing efforts in Washington to repeal and replace the Patient Protection and Affordable Care Act (ACA), a.k.a. Obamacare. What’s more, as Politico’s David Pittman highlights in a new piece, many of these centers are located in decidedly “red,” Trump-supporting states and districts. As Pittman simply puts it, “The Trump administration and the GOP-led Congress are pushing policies that could undermine telemedicine’s future in schools.”

The ACA allotted $200 million for school-based health centers, allowing for the construction of new centers and the refurbishment of existing ones. Medicaid is another key source of funding, given that, among the 70 million Americans currently enrolled in the program, most are children. But the Senate ACA “repeal and replace” bill, the Better Care Reconciliation Act (BCRA), would drastically cut back on Medicaid funding, with approximately $772 billion slated to be stripped from the program during the next decade if the bill were to become law. The House legislation, known as the American Health Care Act (AHCA), would also turn Medicaid into a block grant to states; President Trump’s FY 2018 budget blueprint proposes doing the same thing, which would leave states with far less flexibility when it comes to investing in new, innovative programs. Steve North, medical director and founder of the Center for Rural Health Innovation, put the importance of Medicaid in stark terms: “If the Medicaid reimbursement isn’t there, you’re not going to make it.”

Studies, Pittman explains, have demonstrated the positive impact that school-based health programs can have. A 2014 Brigham Young University study, for example, identified cost savings to families as well as lower rates of absence from school. Similarly, a May Slate article on potential casualties of the AHCA also highlighted the safety net that the programs often provide for working families in rural areas—and the bipartisan support that they tend to have among lawmakers who recognize their value. “They’ve all been here to our ribbon-cuttings, they’ve written letters to help us get grants—they’ve all been very supportive,” an Ohio woman who helped to set up one local school-based health center told Slate of area legislators. Indeed, as Pittman notes, telemedicine in general has traditionally enjoyed broad support from lawmakers on both sides of the aisle. (The current Congress, for example, has seen the introduction of a number of bipartisan telemedicine-related bills, along with the formation of the bipartisan Telehealth Caucus, even amid talks of ACA repeal.) Health and Human Services (HHS) Secretary Tom Price, too, has voiced support for telemedicine in the past, even mentioning its potential during his confirmation hearings. For their part, the people Pittman interviewed emphasized the crucial role that school-based health centers play for students with limited access to medical care. “In many of our situations … the school nurse is the only health care provider a child ever sees,” Kelli Marie Garber, the operator of a school-based telemedicine program out of Charleston, South Carolina, told Politico. Stay tuned as the “repeal and replace” talks continue.

Click here to read the Politico article on school-based telemedicine programs and Trumpcare.

Click here to read the Slate article on school-based health centers. 

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