A statewide youth health advocacy group is pushing to create a school-based health center at Southeast Raleigh High School to treat uninsured and underinsured students. But critics say it is bad business to inject government health care into the classroom.
Youth Empowered Solutions plans to submit more than 2,000 petition signatures and 400 postcards supporting the center to the Wake County school board next month.
The nonprofit hopes to apply this summer for a grant of up to $500,000 through the federal Affordable Care Act for capital costs such as a modular building on a school campus, classrooms upfitted as a doctor’s office, and large supply items.
The Wake County Health Department, UNC Health System, Rex Healthcare, and Wake Med are possible staffing, operational, and funding partners, said Parrish Ravelli, leader of the Access to Health Care Team under Raleigh-based YES.
YES will submit a formal proposal to the school board by the end of this school year and hopes to be operational by the end of the 2012-13 school year, Ravelli said.
But the proposal has its critics, who say that the centers will do much more than serve as infirmaries for students. “In our opinion, all of this is about being intrusive on the family and building dependency on government services” among malleable youths, said Twila Brase, president and co-founder of the Citizens’ Council for Health Freedom in St. Paul, Minn.
“We believe that parents are responsible for their children, so we believe that government shouldn’t be expanding its reach into the families through the schools, where parents are out of the picture” during school hours, Brase said.
“It’s not about starting a new social program at the school,” Ravelli said. “While I understand the desire to keep education siloed and separate and focused on grades, the reality is no matter how good a school is, if the student is not healthy, they are not going to be in their seat.”
Immunizations, flu shots, sports physicals, nutritional services and “basic level of care” might be available before and after school and during the school day, he said.
“In Wake County there are a significant amount of students being suspended for behavioral and mental health reasons,” Ravelli said. “Mental health clinicians could work with those students to reduce suspensions. A nurse practitioner [who] can diagnose and write prescriptions and a registered dietitian would be part of the program. A physician’s assistant might be on staff.”
Parents would sign consent documents for students to be seen at a school health center.
But that “doesn’t mean they know what they’re giving consent to, or what all a school-based clinic can do,” Brase said. “Students may not tell their parents that they went to a clinic.”
In some states, school-based clinics have transported students across state lines for abortions, she said.
“These are the sort of things that can happen when you have a government clinic in a government institution,” Brase said.
In North Carolina, Department of Health regulations on school health centers prohibit release of students’ medical records on pregnancy, substance abuse, emotional disturbances, and sexually transmitted diseases except in life-threatening circumstances. A court order or student consent is needed for a parent to access a child’s alcohol and substance abuse treatment records.
Health Department spokesman Mark Van Sciver said contraception is not an issue at North Carolina school health centers. The department partially funds 22 of the state’s 50 school clinics. One employee provides technical assistance, contract monitoring, and credentialing for those 22 centers, which are required to report performance data at mid-year and end of year, Van Sciver said.
By state statute, “No reproductive health services are offered at SHCs located on school campuses,” Van Sciver said. “Contraceptives, including condoms and other devices, shall not be made available or distributed on school property.”
But Colorado-based health policy analyst Linda Gorman cautioned, based on experience in her state, that parents should remain vigilant.
“They swore up and down they would not dispense contraceptives. And they didn’t,” said Gorman, senior fellow and director of the Health Care Policy Institute at the Independence Institute, a free-market think tank. Instead, she said, the centers “were dispensing vouchers to Planned Parenthood next door.”
School clinics “mostly serve low-income people who have much bigger [health] issues” than those that will be treated at school, Gorman said. That drives up the costs in the finite Medicaid funding pool.
She said many of the mental health components are “a bunch of nonsense,” such as a girl being upset over a fight with her boyfriend. Medicaid is billed at the same rate for that lover’s spat as for a quadriplegic who needs home health care to survive, she said.
“They’re throwing all of these resources at basically healthy children,” Gorman said. “If a kid is sick he should be seeing a doctor, not some kind of weird medical setup.”
She also warned that schools might see school health centers as a source of revenue if the school were allowed to receive a percentage of the Medicaid payments. Massachusetts experienced “incredible amounts of graft,” she said, including billing for services on days when schools were closed, before the state instituted reforms of its school-based centers.
“In some places, notably where I am, the school district gets to keep 30 percent of the Medicaid billing,” Gorman said.
“We are unaware of any Medicaid payments made to local education agencies for hosting SHCs” or any other financial windfall, Van Sciver said.
Marvin Connelly, Wake County Schools assistant superintendent for student support services, said the district needs “to look at the fiscal implications” to determine whether there would be costs to host a health center or school revenue generated from it. The district has two representatives on the YES task force.
“We would want to look at the needs assessment in general” for students and the medical community, and where school health centers may be best placed, Connelly said.
Brase said the tax-subsidized school health centers intrude on private market urgent care clinics and doctors’ offices because they accept private insurance. And some parents might drop private insurance in favor of school-based care under Medicaid, she said.
Shawn Scott, deputy executive vice president of operations and administration at the North Carolina Medical Society, said she is not aware of any society position on school-based health centers or any research to determine if they siphon business from doctors and clinics.
“A great deal of the private sector is not seeing patients that are uninsured or on Medicaid,” Ravelli said. “These are youth that are not being seen by anyone anyway.”
If a student is on Medicaid, it would be billed for services and there could be a co-pay, he said. Uninsured students would pay on a sliding scale based on family income.
Private insurance, foundation grants, the Health Department and community partners would help sustain the school clinics, Ravelli said.
Brase is skeptical the school clinics would be self-sustaining.
“The feds give them money to start whatever program they want, and then it builds a constituency who go to the state and say ‘Now you’ve got to fund us’ ” when the federal money dries up, Brase said.
“We have no knowledge of SHCs leading to higher costs or higher taxes,” Van Sciver said.
Dan Way is a contributor to Carolina Journal.