Posts tagged with School

Obamacare a concern for school districts, particularly rural ones

Kansas school officials are preparing for new costs associated with implementation of the Affordable Care Act. The new fees and insurance coverage requirements are expected to hit all employers of more than 50 people to some degree, but smaller, rural school districts are struggling to figure out how they can afford to make it all work. Dropping employee health plans altogether might be the best solution for some, officials say. At larger districts such as Topeka USD 501, officials say they'll be able to handle the new requirements OK but are still "wading through" what all they need to do for 2014.

Kansas school officials are preparing for new costs associated with implementation of the Affordable Care Act. The new fees and insurance coverage requirements are expected to hit all employers of more than 50 people to some degree, but smaller, rural school districts are struggling to figure out how they can afford to make it all work. Dropping employee health plans altogether might be the best solution for some, officials say. At larger districts such as Topeka USD 501, officials say they'll be able to handle the new requirements OK but are still "wading through" what all they need to do for 2014. by Phil Cauthon

School administrators here say they are alarmed and confounded by the looming, new costs they face with the implementation of the Affordable Care Act.

“We've been talking about it (in anticipation) the last two years. I wish there was somebody smarter than me to find a solution,” said Chris Hipp, director of the North Central Kansas Special Education Cooperative Interlocal 636.

“We are not built to pay full health benefits for non-certified folks who work a little over 1,000 hours a year. I've spent hours and hours running every possible scenario. We can't pay for any of them, so it’s all kind of an academic effort really," he said.

As part of the federal health reform law, commonly referred to as Obamacare, larger employers across the country have a new set of insurance coverage obligations and fees they must pay. The new rules apply to commercial enterprises with 50 workers or more but also to public employers such as cities, school districts and the state of Kansas.

Kansas officials estimate the new fees alone will cost the State Employees’ Health Benefit Plan at least $4.7 million in 2014, or about $63 per worker. That’s without reckoning the added costs of the law’s new coverage requirements, much of which the plan already is absorbing.

For many businesses and larger governmental units, the new obligations are unwelcome but not unmanageable because they can be passed through either to customers or, at least partially, to health plan policyholders.

And for some governmental units, the expected costs represent a small percentage of overall spending. Lawrence officials, for example, estimate the new Obamacare fees will cost the city $137,200 in 2014, which could be considerably less than the potential costs of complying with a new conceal-carry firearm law passed earlier this year by state lawmakers.

Rural school districts

But the new health reform rules are particularly challenging for rural school districts and special education cooperatives, where officials say they have little or no place to turn for additional money, especially since state school aid has been held flat or reduced and more often than not the so-called “local option” school budget authority already has been maxed out.

“A lot of the districts and co-ops are looking at various options, including the option of getting out of offering health insurance and acknowledging that the most economical step for them is to pay the penalty and have their employees go to the exchange and get what's available through the marketplace. But a lot have not made that decision yet,” said David Shriver, assistant executive director for insurance services at the Kansas Association of School Boards.

The situation at the Phillipsburg special education cooperative offers a stark example of the complications many Kansas schools are facing, Shriver said.

The interlocal co-op is funded by 11 participating school districts that together cover an area of about 4,500 square miles spanning eight rural counties slightly west of the geographic center of the conterminous United States. It is square in the heart of the heartland. The districts collectively serve about 3,700 students, of which about 670 are in the special education program.

Hipp said NCKSEC Interlocal 636 has about 85 “certified” employees (mostly teachers) but also employs about twice that many people as “non-certified” teacher assistants or “paras” and other support staff.

Those workers, earning close to minimum wage, also are offered health benefits by the co-op. But about 100 of them don’t take it because it is too costly for them. The imbalance between their wages and their health insurance costs is so pronounced, Hipp said, that some of the para-educators who use the co-op’s health plan end up writing checks to the co-op two or three times a year just to cover their share of the benefits.

Under the health reform law, Hipp said, the interlocal must offer health coverage that meets the federal standard of affordability or pay a penalty for each employee that gets insurance through the subsidized federal exchange. The exchange — sometimes called a marketplace — is scheduled to be in operation by Oct. 1, with the coverage effective for policyholders beginning Jan. 1, 2014.

The dilemma

Here’s the dilemma for the co-op and similar organizations: On one hand, they can’t afford to pay their “non-certified” workers enough to make premium costs an affordable percentage of their incomes. But nor can the organizations afford to maintain a health plan and pay the annual penalties that must be paid by employers that have workers who opt for coverage through the insurance exchange.

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KU officials seek state help for new medical school

The KU School of Medicine has a few practice rooms intended to simulate for students the clinical conditions they would experience in a hospital as doctors. Mannequins can be programmed to display certain heart patterns and other conditions. Cameras are mounted in each of the practice rooms so instructors can monitor and later critiques the students' work. KU officials say a new building with more of these types of spaces that encourage learning by doing and by working in teams are needed for the school to maintain its accreditation. Dr. Glen Cox, right, is a dean at the medical school and is among the few faculty members who remember the last time the school had accreditation problems in the 1990s.

The KU School of Medicine has a few practice rooms intended to simulate for students the clinical conditions they would experience in a hospital as doctors. Mannequins can be programmed to display certain heart patterns and other conditions. Cameras are mounted in each of the practice rooms so instructors can monitor and later critiques the students' work. KU officials say a new building with more of these types of spaces that encourage learning by doing and by working in teams are needed for the school to maintain its accreditation. Dr. Glen Cox, right, is a dean at the medical school and is among the few faculty members who remember the last time the school had accreditation problems in the 1990s. by Phil Cauthon

The people who run the state’s only medical school say its national accreditation falls in jeopardy or is lost, if money isn’t raised for a new, $75 million structure at its Kansas City campus.

“If you're not an accredited medical school, your students can't take board examinations. Your graduates cannot get into residency programs that are accredited. And in most jurisdictions if you can't sit for your boards and you don't graduate from an accredited residency program you can't practice (medicine), you can't get a license. So accreditation is a huge deal,” said Dr. Glen Cox, the dean in charge of keeping the school OK with the Liaison Committee on Medical Education, the national group that certifies medical schools.

The current education building on the school’s Kansas City campus was built in 1976 and officials here say if it isn’t obsolete it is nearly so, especially given the changes happening in the ways doctors and other health professionals are trained.

“A building built in the 1970s just can't fit the technology needs of today,” said Dr. Steven Stites, acting executive vice chancellor of the University of Kansas Medical Center, which includes the medical school. “We have a structural problem and we can’t renovate it. It would cost more to fix it up than it would to replace it.”

Lecture halls, even in the first year of study, now are considered less important to learning than small practice rooms that allow for simulations that mimic the conditions students — as doctors — will face when they encounter real patients. Also, with growing emphasis on coordinated care within the health care industry, schooling now focuses increasingly on teamwork, not just among fellow medical students but also drawing in nursing students and other health-care trainees.

The school has some spaces for that sort of teaching by doing in small groups, but not enough, according to the people in charge. The accreditation process is so meticulous, as described by Cox, that it even dictates how much private space and storage must be allowed for each resident.

Cox said he is among the few people at the medical school to remember the accreditation problems it experienced in the 1990s, a years-long ordeal he said he would prefer not to live again. And that was before he was the administrator tasked with keeping those things in order.

Need for more docs

Besides warding off accreditation woes, a new school would allow for training more doctors, KU officials said. Experts across the country for years have warned of doctor shortages that have since arrived and are growing and of the need to expand medical schools to slow or reverse that trend.

KU between 1998 and 2007, according to medical school statistics, graduated an average of about 165 medical students per year and 41 percent (an average of about 67 graduates per year) stayed in the state.

The new building would allow the school to have 25 more students per class year in Kansas City and — after counting graduates from expanded satellite campuses in Wichita and Salina — the state should see 96 new KU-trained doctors a year practicing in the state by 2016, according to projections prepared by KU. That would be a net gain of almost 30 doctors a year.

With a generation of baby-boom doctors retiring or soon to retire, many Kansas towns struggle to recruit new doctors. A disproportionate number of the doctors working in the state’s rural and underserved areas are KU graduates.

There are about 259 doctors per 100,000 U.S. residents. In Kansas, however, there are only about 213 doctors per 100,000 residents. The state also is below the national average when it comes to primary care doctors.

According to KU estimates, the state will need 213 new doctors a year by 2030 just to maintain the state’s current below-average ratio. To match the national average, it would need about 285 new doctors a year by 2030.

The tricky part

It’s been known since Coronado traipsed the Plains that gold doesn’t always turn up in Kansas. And, unfortunately, Dr. Glen Cox did not win the Lottery last week (he said), so KU is struggling to come up with a way to pay for the school building that KU and other higher education officials say it must have and that the state needs.

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Some say new meal guidelines should be scrapped

On Sept. 27, Daily Show host Jon Stewart lampooned last week's media coverage of the video made by Kansas students protesting the new school lunch standards.

On Sept. 27, Daily Show host Jon Stewart lampooned last week's media coverage of the video made by Kansas students protesting the new school lunch standards. by Phil Cauthon

Though this year’s new school lunch guidelines are generally a hit with nutrition experts and school officials, Kansas Congressman Tim Huelskamp, a Republican who represents the state's largely rural 1st District, said that’s not what he’s hearing from parents and students.

“Parents are frustrated that the lower calorie limits are leaving their children hungry, and therefore unable to concentrate in the classroom or without the energy they need to participate in after-school sports,” Huelskamp told KHI News Service.

Weeks after the guidelines went into effect, some students in his district made a music video protesting the guidelines:

Give me some seconds I need to get

some food today My friends are at the

corner store Getting junk so they

don’t waste away.

The video — called “We Are Hungry,” spoofing a pop song by the band Fun — has been viewed nearly 800,000 times already, and last week was covered widely by the national media and was featured on Comedy Central's The Daily Show.

Much of the video shows student athletes without energy and passing out en masse.

However, federally funded school lunches are not intended to serve as a sports training table for student athletes, said Cheryl Johnson, who heads the Child Nutrition and Wellness program at the Kansas State Department of Education.

She said the guidelines were intended to make sure school lunches provide one-third of the average daily calorie needs of students, by age group.

Johnson said that additional helpings of fruits and vegetables remain available and federally subsidized for those who want them and that students who want seconds of other items can always purchase them.

Push to repeal the guidelines

The new guidelines were championed by First Lady Michelle Obama, in part to help stem the rising tide of childhood obesity in the United States. According to the Centers for Disease Control, more than a third of all children in the U.S. were overweight or obese in 2008.

The new guidelines include the first-ever caps on calories provided in school meals, which Huelskamp said were misguided.

“Childhood obesity is certainly a problem in America, but it is not the prerogative of the federal government to put every child on a diet,” Huelskamp said. “It is the right and responsibility of the parents to counter their children’s health issues.”

Huelskamp is co-sponsoring legislation that would repeal the new nutritional guidelines and reinstate the old ones, which had been in place for 15 years.

"The USDA's new school lunch guidelines are a perfect example of what is wrong with government: misguided inputs, tremendous waste, and unaccomplished goals. Thanks to the Nutrition Nannies at the USDA, America's children are going hungry at school," Huelskamp wrote in press release unveiling the “No Hungry Kids Act,” co-sponsored by Iowa Republican Rep. Steve King.

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