Increased federal funding directed at school-based health centers is designed to increase the quality and quantity of care received by students at schools across the country. But there are concerns the grant-based federal funding could also increase the states’ financial burden for supplying such care, while removing parental involvement in directing the health of their children.
The Department of Health and Human Services has announced the rollout of $95 million in federal grants to school-based health centers (SBHCs) nationwide as part of President Obama’s health care law. That legislation allocated $200 million in SBHC funding between 2010 and 2013.
Originally introduced in the 1970s, SBHCs functioned outside of the health care system, relying primarily on private and local funding. In the past decade, the number of SBHCs has continued to rise, in step with public funding to them. Approximately 1,100 of the centers were open in 2000, and there are 1,900 today.
Increasing State Financial Burdens
Rep. Michael Burgess (R-TX) practiced medicine in Texas for nearly 30 years before his election to Congress. He worries the spiked SBHC funding will not only deepen the nation’s debt but also fatten states’ financial burdens.
“I’ve supported the concept in the past, but we are up against a really tight spot with the deficit,” Burgess said. “Why in the world would you push an additional $95 million out the front door with obligations if you weren’t sure where the funding was going to come from?”
The new federal funding, announced July 14, will support center construction, expansion, and equipment, but operational costs must come from states. Texas has 89 SBHCs and will use the new funding to construct more.
“The funding for the construction was mandatory, the funding for a doctor or nurse is discretionary, and in the 2012 budget the president zeroed that [discretionary] funding,” Burgess said. “We already have over-tapped schools, communities, and states.”
Doubt over Spending Transparency, Outcomes
SBHCs offer services similar to or sponsored by Medicaid, which costs the nation about $333 billion a year. Medicaid covers doctor visits, prescription drugs, dental care, eye exams, vaccines, and more, at little or no cost to enrollees.
“Will there be an audit, for lack of a better tem, in a year or two, to see how these funds were used, whether they were used, and if not, would there be a way to recapture those funds?” asked Merrill Matthews, a resident scholar at the Institute for Policy Innovation.
Matthews said he doubts building funds endanger parents’ rights, as they focus on nonoperational costs, but he worries schools may not have to disclose their use of funds to taxpayers.
Independent consultant Ellen Kisker worked on one of the earliest studies of SBHCs in the late 1980s. Kisker and her colleagues followed a group of students in 19 schools with centers to assess their feasibility. They compared these students to a national sample of urban youths for changes in sexual activity, contraception use, alcohol and drug use, and academic achievement.
Though the centers did increase students’ access to care and health education, Kisker said, they did not make a statistically significant reduction of risk-taking behaviors that endanger health.
Shifting Responsibility from Parents
Shifting healthcare responsibility from the parent to the school reduces parental responsibility and weakens parents’ natural interest in caring for their own children, said Chuck Donovan, a senior research fellow at the Heritage Foundation.
“It continues to move the responsibility of healthcare away from the family,” Donovan said.
Healthcare should put the consumer in charge and preserve the doctor-patient relationship, he said.
“This is a new program that could end up consuming billions of federal dollars,” Donovan said. “It’s also a way for the government to fund delivery of services instead of people attaining them for themselves.”
List of recent school-based health center grantees: http://www.hhs.gov/news/press/2011pres/07/20110714grantee.html