The Department of Education was Gutted and Medicaid is on the Chopping Block
What exactly is at stake for caregivers?
Writing about anything political right now is daunting and frankly, depressing. There is so much content out there, and the destruction is coming at a pace most of us can barely keep up with - especially when we’re just trying to get through the day juggling care and paid work. I imagine, though, that many other caregivers are particularly concerned about the recent dismantling of the Department of Education (DOE), and the proposed massive cuts to Medicaid. Both of these moves will have devastating impacts for caregivers, and doubly so for those of us in the sandwich.
What exactly could happen if some of the main governmental support systems we depend upon as caregivers go away overnight? We now know this is a very real possibility, though how exactly it will impact us directly still feels unclear.
As I’ve shared here before, both my mom and brother depend on Medicaid. My brother is severely disabled and my mom worked her whole life and saved for retirement, but ended up with health issues and dementia at a relatively early age. Even a decent retirement savings wasn’t enough for the care she needed. My children go to a public school that receives Title 1 federal funding - a federal subsidy for schools with a high percentage of low income families.
Naturally this has me thinking a lot about what’s at stake for my family, but also for all of the families that in some way depend on these critical services and supports - which realistically, is most of them.
What does gutting the Department of Education mean for children and families?
While states do have significant control over their schools, the federal government has historically run several programs that, in a nutshell, leveled the playing field. I mentioned Title 1 above, which supplements schools with significant financial need to provide things like math and reading tutors and free school lunch to improve the likelihood and rate of educational attainment for its students.
A significant proportion of the cuts to the DOE personnel were those who worked in Federal Student Aid and the Office for Civil Rights, which is tasked with “preventing, identifying, ending and remedying discrimination against America’s students.”
This matters because 1) socioeconomic status is highly correlated with educational outcomes and 2) schools in wealthier areas end up with incredibly well-resourced schools, and PTAs that can pay entire additional staff salaries and purchase fancy equipment, while low income schools may just hope to have enough to cover back-to-school supplies so that kids don’t go without the basics that they need.
I wonder if progressive(ish) Seattle (and maybe other areas) would consider going back to the bussing system it implemented to de-segregate schools between the 1970s and 2000. The program was ultimately phased out with pressure from wealthy, white families who claimed all-too-familiar arguments of “discrimination.” I’m sure this would be a consideration today, with a bussing program putting the district at risk of losing any remaining federal funding. While the bussing system did mean long rides for some, it also meant diverse, integrated and more equitable schools.1
My dad and stepbrother both got bussed from white areas to mostly black Garfield High School in South Seattle (where, side note - my dad was in school with none other than Jimi Hendrix!). I’ve heard them both speak very positively of Garfield and their experience. It’s a different landscape now though, with many wealthier (white) families opting out of public school entirely.
In addition to supporting low income schools, the Department of Education collects and acts upon national educational data, oversees programs for students with disabilities and ensures they get the support needed, manages federal student loan programs, and provides teacher training programs in needed areas (notably special education).
Without the DOE overseeing these aspects of public education, it’s very likely that many districts will have no oversight with regards to equity issues. This will particularly impact already disadvantaged schools and districts, and will be worse in red states - which already have the worst educational outcomes.
And what about Medicaid?
Trump’s budget resolution is aiming for $880 billion in Medicaid cuts over ten years. Medicaid is jointly funded by the federal government and states, and is the largest source of federal funding for states overall. The program provides long term, emergency, primary, behavioral health and specialty care for 80 million low income and disabled people - that’s one in five Americans.2
Nursing homes and eldercare costs are skyrocketing beyond what any normal person can pay over the long term. In more than half of nursing homes nationwide, 80-100% of residents are on Medicaid, which is about 63% of nursing patients overall. Where, exactly, will these sick, elderly people go without Medicaid? Or with payments significantly reduced, how will nursing homes - that already struggle with staffing - continue to operate?
Add this to the fact that with Baby Boomers aging and the percentage over 80 set to peak in 2027 and hold steadily high over the next fifteen years - which is set to be a crisis even without cuts to medicaid.
It’s not just eldercare at stake though. Many children in low income families benefit form Medicaid, and low income women’s births are covered by the program. One in four childcare providers depends on Medicaid for health insurance - a loss that would deepen the existing childcare crisis. Disabled individuals who are unable to work are supported by Medicaid. It is one of the most stable, successful, long-term US government programs that has had bi-partisan support for decades.
What exactly will happen? Inequality and homelessness, which is already a problem in Seattle and other major cities, will get worse. I can imagine more people - women in particular - will be pushed out of the workforce in order to care for family members.
My brother and my mom, along with millions of others, are both able to live simple, yet dignified lives despite significant disabilities, and this is because of Medicaid. They are not taking advantage, they are getting fed and cared for because they cannot provide for themselves. My children are getting a decent free education in a diverse learning environment. These are the most basic things that our taxes should pay for, right?
Could governmental agencies be more efficient? Of course they could - just as most businesses could be. Does room for improvement justify burning entire agencies to the ground at the expense of kids’ education and disabled folks’ lives? Of course not. What do we do about it? I don’t know - if you have ideas beyond incessantly calling our elected officials, or moving to Europe, please share them.
While we have yet to see what kinds of challenges these actions will face in the courts, what we do know is this: the impacts will disproportionately fall on the most vulnerable members of our society - children, low-income populations, and the elderly. And by default, on caregivers to those populations.
Whew. That was a depressing one. So I’ll end with a quick positive piece of news that a judge has ruled Musk’s dismantling of USAID as unconstitutional, based on a lawsuit filed by a group of AID workers. I know that there are carers and readers of this newsletter who were directly impacted by the USAID shutdown, and while it is unclear what long term impact the ruling will have, for now it is a win to be celebrated.
I’d love to hear from you - what are your concerns, predictions, or plans if your families depend on these federal agencies/services?
This article in the Stranger is nine years old but provides a great history of the bussing system in Seattle and what happened when it ended.
The Century Foundation