Senate Majority Leader Mitch McConnell’s health care bill is getting failing grades from red-state school leaders — even in his home state of Kentucky.

Fleming County Schools Superintendent Brian Creasman was taken aback when he discovered the bill would make cuts that could devastate his ability to provide health services to needy and disabled kids.


Here in rural Kentucky, the heart of Trump country where three out of four voters cast ballots for Donald Trump and many regard McConnell as their political protector, Creasman initially thought the bill’s potential cuts to school districts must be a misunderstanding.

Only they weren’t.

About $4 billion in annual Medicaid spending goes to U.S. schools to pay for school nurses, physical, occupational and speech therapists, and school-based screenings and treatment for children from low-income families, as well as wheelchairs and even buses to transport kids with special needs.

The funds make up just 1 percent of Medicaid reimbursements, but school leaders in economically depressed parts of Appalachia, the Rust Belt and elsewhere say they are critical to providing services they are required to provide to special education students. Creasman said he’s seen firsthand how mental health services funded by Medicaid have connected families to help at a time when his state is struggling with an opioid addiction crisis.

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“I wonder what the senators think is going to happen?” Creasman said. “Do they think everything is just going to go away? It doesn’t. … What happens is we either have to cut something or increase taxes.”

Creasman is joining scores of other school superintendents — many, like him, from red states critical to Trump’s presidential victory — in writing letters and making calls.

The school leaders have become an unexpected and forceful voice opposing the deep Medicaid cuts in the Senate’s health care bill. AASA, The School Superintendents Association, is organizing what it estimates could be thousands of letters and emails to senators.

And there are signs they may be getting traction with Republican lawmakers who have been on the fence.

Joseph J. Roy, a superintendent in Bethlehem, Pennsylvania, who was that state's 2017 superintendent of the year, joined Democratic Sen. Bob Casey at a recent news conference to highlight what a reduction in the annual $600,000 his district receives in Medicaid funding would mean.

“It’s a major impact on us, and it’s kids who are most vulnerable,” Roy told POLITICO. “They have mental health issues or physical issues that require assistance, and they are the ones that receive services.”

“It just seems completely wrong,” Roy said.

Sasha Pudelski, assistant director for policy and advocacy with the superintendents group, said some Republican senators' offices have heard from so many people connected to the effort that they’re getting angry about it, asking for it stop.

“We are getting under their skin about this issue,” Pudelski said.

A GOP aide said they are “absolutely” hearing from superintendents and other educators — and listening to their concerns.

“It makes a difference because it helps us to go back and say, ‘OK, is there something more that should or could be done?’” the aide said.

The initial Senate draft, yanked last week for lack of support, would end Medicaid as an open-ended entitlement and, beginning in 2020, cap federal funding to states based on their number and type of enrollees. The federal government would spend 35 percent less on Medicaid in two decades if the bill becomes law, the Congressional Budget Office projected Thursday.

Even though the bill does not spell out cuts to school-based services, school leaders say the erosion in Medicaid funding would put schools in competition with hospitals and doctors' offices for coveted funds — a shift they say that’s sure to leave them short-changed.

Creasman said he appreciates that McConnell and Kentucky Sen. Rand Paul have been to Fleming County and believes they support the schools. But, he adds, “I don’t think they really understand how it impacts schools.”

That this fight on Capitol Hill follows proposed Trump administration cuts to career and technical education programs, teacher training and after-school funding only adds to school leaders’ frustration.

“It’s going to make a massive impact in what we’re trying to do in each of those areas,” said Allen Pratt, executive director of the National Rural Education Association, based in Chattanooga, Tennessee. “We’re already behind, and now you’re going to cut more and you’re going to be further behind.”

While Republican leaders were forced to pull a procedural vote due to the lack of support, McConnell is hoping to find agreement on a new draft.

Supporters of the Senate health bill have said the gradual phase-in gives states and school districts time to adjust to the funding changes. In addition, they say that stopping Medicaid’s juggernaut growth would free up money for other important issues, such as education.

The superintendents say informing the public and Congress about the importance of Medicaid to schools has been an important part of their effort.

Rebecca Malamis, deputy executive director of the Bucks County Intermediate Unit in Pennsylvania who helps connect 13 districts with state services, said she doesn’t think many congressional members or their staffs realized that schools used Medicaid funds until the recent push.

But she’s noticed a shift when calling lawmakers’ offices.

“I know that some of the staff that I’ve talked to, they’ve been very respectful, and they too have been concerned about making sure that now that they are aware ... this program remains intact,” Malamis said.

Still, Malamis said she understands the political realities when it comes to protecting school services amid the larger health care debate.

“Health care is overwhelming and it’s complex, and we’re just one small part of it,” Malamis said.

Brad Seamer, a high school principal in Salem, South Dakota, is also planning calls even as he tries to rein in his own expectations.

The chairman of the advocacy committee of the National Association of Secondary School Principals says he will contact his home state senator, John Thune, even though he’s not optimistic he will change his mind.

Seamer said his high school, with 225 kids, is so small that a county nurse across the street provides hearing, vision and scoliosis screenings for all the students — and Medicaid helps pays for the services.

“I’ve always been supportive of expanding Medicaid, not reducing Medicaid,” Seamer said. “As an educator, I want all my students to have every resource possible.”