Opinion – Col Owens: How do we value education and health care?

I write to address the jeopardy that two major enterprises Northern Kentuckians care very much about are facing: education and health care.

The Trump Presidency is now three weeks old. In that brief period we have seen a concerted effort to completely eliminate the federal Department of Education. Along with a budget premised on trillions of dollars in cuts to the federal health care programs, Medicare and Medicaid. And the announced intention to repeal the Affordable Care Act (ACA).

I should disclose at the outset my personal associations relevant to this essay. Aside from my own educational experience at Dixie Heights High School, Harvard College, Harvard Divinity School, and Boston University School of Law, I served on the Covington School Board, the Kentucky School Boards Association Board of Directors, the School Board Members Advisory Committee to the Commissioner of Education, and the Prichard Committee for Academic Excellence.

With respect to health care, I served for 36 years as a legal aid attorney, during which service I helped organize and co-chaired a statewide health care reform advocacy condition, which involved serving on several of Gov. Ted Strickland’s health care reform committees, and Gov. John Kasick’s Payment Reform Task Force.

I have had and continue to have an active interest in both these arenas.

It is instructive to review what these agencies and programs do, and who they serve.

The Department of Education was established by President Jimmy Carter. It distributes billions of dollars each year to public and private school systems and colleges around the country, to promote student achievement, education excellence, preparation for global competition, and equal access for all students.

Those served in the elementary and secondary levels include students with disabilities along with low performing, low income, minority and other vulnerable populations of students. Department-funded programs have been successful in reducing achievement gaps between majority and minority students.

College-level students benefit from Pell Grants to help address the costs of higher education. They also receive financial assistance through the Department from the nation’s $1.6 trillion student loan program. Finally, the Department administers Title IX of the Education Amendments of 1972 that prohibit discrimination on the basis of gender in federally funded schools.

Medicare and Medicaid were both established in 1965 during the presidency of Lyndon Johnson. Medicare is an entirely federally funded health care program that serves senior citizens over 65 and persons with disabilities. It is funded by a Medicare tax that all employed persons pay along with their Social Security tax.

Medicare provides healthcare and hospitalization services, prescription drugs, and minimal dental and vision care. It served 66 million Americans in 2023.

Medicaid is a joint federal state program that provides a range of health care services to low-income persons, persons with disabilities. pregnant women, children, and those requiring long term care.

Funding of Medicaid is shared by the federal and state governments according to a formula taking into consideration each state’s economic condition. The federal share is at least 50% for all states but is substantially higher for poorer states. Kentucky’s federal share is 70%, with the state providing the other 30%.

Health services provided include basic health services, hospitalization, prescription drugs. vision and dental care, and behavioral health including mental health.

Medicaid provider payment rates, unlike Medicare rates, are set by each state. Because of that, payments tend to be low, as states are loath to increase Medicaid spending.

Under the Affordable Care Act (ACA), states have the option of adopting a significant expansion of Medicaid, to cover many of the working poor. The federal share of the cost for the expansion was extremely generous, 100% for the first three years, then notching down over three years to a permanent 90% for all states. Forty-one states and the District of Columbia have adopted the expansion.

Medicaid serves over 70 million Americans. In addition, it provides billions of dollars in federal funding into states’ economies. For example, it provides 64% of all federal funding that comes into Kentucky. It is a critical component of our economy, as those dollars flow through it to all economic sectors.

The Affordable Care Act (ACA) was enacted in 2010 during the Barack Obama Presidency, to help Americans ineligible for Medicare or Medicaid to purchase health insurance. It does this through federal or state established marketplaces, or connectors. Eligibility is income based with the federal government providing subsidies. Insurance coverage offered through the marketplace must meet a prescribed set of criteria to keep out cheap but inadequate policies. The ACA provides coverage to over 20 million Americans.

It should be clear that these programs provide critical assistance to Americans of all circumstances. Some services are defined by age, some by socioeconomic status, some by gender, some by ethnicity, some by health status.

What should also be clear to all is that these services are expensive. To provide education services to all eligible Americans in both the K-12 and post-secondary levels is expensive. The ever-increasing costs of college necessitate high levels of financial assistance.

Thus, if the Department of Education is eliminated, a similar department would have to be established or coopted to administer those programs. Alternately, if these programs are eliminated, the millions of Americans who rely on them to pursue their education goals will face sudden and irrevocable loss of the opportunity to pursue those goals.

Similarly with health care. It is very expensive. But cost is cost. People cannot pay those costs on their own. Virtually everybody requires assistance. Those who can afford it cover costs with health insurance. But that is expensive, which is why the federal government established Medicare. Medicaid, and the ACA. Which collectively cover 160 million Americans – just short of half the country.

I conclude with some observations about the impact of the Trump initiatives here in NKY. Our commitments as a community to education and to health care are universally known, and valued. Our 15 public school systems, with a handful among the highest performing districts in the state; our universities and colleges, NKU, Thomas More, and Gateway; and St. Elizabeth Hospital system, which serves the entirety of NKY, along with a large number of primary care and professional physician services. All of these are known to all of us.

We not only know them, we rely on them for our well-being.

Could there be improvements? Of course – and they are being pursued every day. Could there be waste, fraud or corruption? Certainly – and if they are present, they should be ferreted out immediately. But in lawful ways, that protect the rights and interests of all parties – those who pay, those who benefit.

This is the key problem with the Trump approach. Aside from the practical and legal problems raised by having Musk serve in almost a co-President role, there is the approach itself – ready, shoot, aim. There are existing lawful procedures for finding and dealing with waste, fraud, and corruption, that are being ignored in the current onslaught. They are there for a reason. They should be followed.

To conclude: education and health care are two of the most important areas of our lives. They impact all of us. They deserve to be treated carefully in our efforts to improve them.

Col Owens is a retired legal aid attorney and law professor, author of Bending the Arc Toward Justice, longtime Democratic Party activist, and member of the Boards of Directors of Kentucky Voices for Health and the Kentucky Board of Elections.