Now, parents, policy makers, and health providers are holding their breath as Republicans in Congress weigh potentially billions of dollars in cuts to Medicaid. Federal dollars pay for more than half of MassHealth’s $20 billion annual budget.

“MassHealth is a cornerstone for children’s health in Massachusetts,“ said Katherine Howitt, director of the Massachusetts Medicaid Policy Institute, an independent policy analysis program of the Blue Cross Blue Shield of Massachusetts Foundation.

The consequences of significant cuts to Medicaid, and the potential for voter outrage, have some doubtful Congress will ultimately cut from the public insurance program.

The information coming out of Washington is too vague to act upon, said Mike Levine, assistant secretary for MassHealth.

“We do not have specific contingency plans around what services we offer kids and what we might do if Congress or CMS takes actions we don’t like,” he said in an interview Monday.

Still, the possibility frightens Bernard. When her daughter, Victoria, was 2, before doctors had figured out what prescriptions and dosages would best control her epilepsy, she routinely had multiple seizures a week, her mother said. The child’s speech is delayed, but with the therapy MassHealth pays for, she is learning to express herself verbally.

“Without MassHealth I don’t know how I would do,” Bernard said. “I’m very concerned about it.”

Congressional Republicans have said they want to balance tax cuts by, in part, eliminating $880 billion in federal spending over 10 years. Leading Republicans, including President Trump, have said that won’t include cuts to Medicaid benefits. US House Speaker Mike Johnson has said his party is seeking only to reduce “fraud, waste, and abuse.”

But experts on health policy say there’s no way Republicans can achieve their budget goals without impacting Medicaid. At more than $600 billion a year, the program is among the federal government’s largest expenses.

“We know that the only way to achieve $880 billion in cuts is through catastrophic cuts to the Medicaid program as we know it,” said Megan Cole Brahim, a Boston University professor and co-director of the school’s Medicaid Policy Lab. “There’s really no way it wouldn’t have harmful implications for children.”

Massachusetts expanded MassHealth in 2006 to include children in households earning up to 300 percent of the federal poverty level, extending coverage to more children than in all but a few states.

As of 2023, only 0.6 percent of Massachusetts children were uninsured, according to a report from the state Center for Health Information and Analysis on insurance coverage in the state.

The state’s post-pandemic review of MassHealth eligibility led to about 363,000 people removed from membership last year, including almost 59,000 children ages 17 and younger, the state reported.

Even if Congress took a hatchet to Medicaid, Cole Brahim said she anticipated Massachusetts would seek to protect children from the brunt of the consequences. Officials could be forced to reduce access to some optional benefits, such as physical therapy, case management, and community health workers, and could reduce the kinds of prescription drugs, or the dosage amounts, covered by MassHealth.

Losing even partial Medicaid reimbursements would be devastating to community health centers and hospitals. On average, the health centers receive about 31 percent of their revenue from MassHealth, according to the Massachusetts League of Community Health Centers. MassHealth paid about 18 percent of all hospital revenue in the state as of 2022, according to the Blue Cross Blue Shield of Massachusetts Foundation. Boston Children’s Hospital reported roughly 46 percent of its Massachusetts patients are MassHealth members. Substantial cuts to Medicaid, hospital officials said, would create financial aftershocks that would affect every patient in the hospital.

“The danger for any children’s hospital in the country, [if] you start cutting Medicaid, you’re going to affect care delivery for every patient,” said Joshua Greenberg, Boston Children’s vice president of government relations.

On Monday, Governor Maura Healey and her partner, Joanna Lydgate, toured Children’s to highlight how potential cuts to Medicaid, as well as halts to millions in National Institutes of Health research grants, could affect patients. Kevin B. Churchwell, the hospital’s president and chief executive, said federal funding cuts have already disrupted clinical trials and research, including work with vaccines.

“We have patients in clinical trials who had their treatments stop because of this,” Healey said. “Can you imagine the cruelty of that?”

Among the groups Medicaid supports, including seniors and some people with disabilities, children are a relatively inexpensive clientele. They account for about 16 percent of the state’s total MassHealth expense. The families of some children enrolled also have private insurance but rely on MassHealth as secondary coverage to help with medical-related bills their insurer doesn’t cover.

For many children, MassHealth membership means more than covered doctor visits. The program pays whatever is needed to ensure children with disabilities have the equipment, care, and support they need. It allows children to receive Medicaid-covered services through their school’s health services and pays for behavioral health care in the community or home.

In addition, families on MassHealth get screenings to identify dental, aural, visual, or developmental concerns. Such wide-ranging and widely accessible insurance coverage can benefit children their whole lives. Children with good health care do better in school, a 2021 Blue Cross Blue Shield of Massachusetts Foundation report stated, and those with access to Medicaid tend to have fewer hospital stays, emergency room visits, and chronic conditions in adulthood.

Victoria Bernard’s doctor, Laura Livaditis, director of pediatrics at Mattapan Community Health Center, said about 90 percent of the children treated at the center are enrolled in MassHealth. Most of her patients are also from families living at or below the poverty line. MassHealth’s wide-ranging coverage has helped them to avoid evictions, she said. And for immigrants, the program has helped them make connections to ensure they have stable food and housing.

“I’m continuously impressed with the breadth and depth of services MassHealth covers for my patients,” Livaditis said. “I can’t remember the last time I had to fight with [MassHealth] insurance for needed services.”

Correspondent Emily Spatz contributed to this report.

Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.

As Massachusetts students remain stubbornly behind their pre-pandemic levels in math and reading scores according to the 2024 National Assessment of Educational Progress, the Massachusetts Teachers Association’s recent focus of attention is instructive.

The teachers’ union, also known as the MTA, pushed successfully for a ballot initiative in November that torpedoed a longtime graduation requirement that students pass the state’s MCAS exam. And in December, it released an extensive list of resources it compiled for its members on “Israel and Occupied Palestine.”

Among the so-called pedagogical aids? A poster showing dollar bills folded into a Jewish star and another featuring a keffiyeh-clad, rifle-toting fighter that proclaims, “What was taken by force can only be returned by force.”

The almost 100 resources are an overwhelmingly demonic portrayal of Israel, Zionism, and Jews, even with two links containing those posters ultimately deleted. It speaks to a broken system of oversight, emblematic of similar education issues in other parts of the US. 

Jewish and non-Jewish members of the grassroots group Massachusetts Educators Against Antisemitism had tried repeatedly to have the union remove the material but were rebuffed by MTA board members’ accusations of “censorship.” For many teachers, the entire undertaking is a pernicious diversion from their core classroom struggles.

“I have 15 kids reading six years below grade level, so I don’t know why we’re talking about a country that’s 0.1% of the world population and a 10-hour plane ride away,” one told me.

It took nothing less than a Massachusetts State House hearing held by a recently formed commission on combating antisemitism for the MTA to budge after union president Max Page was grilled about the posters and other materials and after commission co-chair State Sen. John C. Velis referred to them as “a recommendation for educational malpractice.”

That a teachers’ union has the capacity to ply uninformed educators with material bereft of factual accuracy and balance is troublesome, given its powerful platform.

But it is part of a much larger problem acknowledged during that hearing and a subsequent one held last week: Curricular vetting and accountability are virtually nonexistent at the state level. It leaves schoolchildren vulnerable to ideologies subversively inserted locally, and it is not unique to Massachusetts.

Jewish students exposed to high levels of antisemitism

Jewish students “are being bullied at record levels with the positioning of Zionism as an epithet,” said Katherine Craven, chair of the Massachusetts Board of Elementary and Secondary Education, which governs the state’s education department for K-12.

And the board is hearing anecdotally that children as young as first and second grade are being exposed to antisemitic curricula. However, according to state law, its role is limited to initial teacher certification, bullying, and the state’s curriculum frameworks, which are only standards.

“If you folks at the board, [if] your job is not to provide that oversight, I view that as a really, really big problem,” Velis told her. “Am I missing something?”

“No, you are not,” Craven replied while noting its duties are not “prescriptive,” instead offering districts recommendations and guidelines.

So even as Massachusetts, with its reputation for inclusivity, ranked an astonishing fifth among states in the number of antisemitic incidents in 2023 according to the Anti-Defamation League, the state’s inability to intervene heightens the probability that kids will learn with MTA “curriculum resources,” like “Handala’s Return: A Children’s Story and Workbook.”

Antisemitic ideologies and conspiracy theories

It draws on antisemitic conspiracy theories portraying Jews as predators targeting non-Jewish children, who in this narrative are “having their homes taken by Zionist bullies… always scaring” and “arresting them,” and instructs kids to name what they will chant “at a Palestine protest.” 

Nor are there “any kind of approval rights” over professional development at the board or department level, Craven said, describing it as “very locally driven.”

It was a professional-development webinar hosted by the MTA’s Anti-Racism Task Force that raised the alarm after teachers in attendance reported that Zionism was equated with settler colonialism and presentations were replete with antisemitic tropes like the claim that Zionism is a “multi-million dollar, Israeli state-funded propaganda machine.”

Registrants were surveyed about whether they feel supported by their administration “in teaching anti-Zionist narratives about Palestine.” Notably, the MTA, as a Professional Development Provider, furnished certificates of participation for the webinar, which can be used for teacher re-licensure.

Those views on Israel reflect ideologies “deeply embedded” in other MTA initiatives, according to a report by the American Jewish Committee New England. 

It noted the union’s recent launch of Revolutionizing Education, a journal the MTA states is “dedicated to advancing education policy and practice in Massachusetts,” to advocate “for transformative practices that dismantle power hierarchies” and “envision education as a tool for liberation.” 

It is yet another worrisome development in the union’s laser-focused mission to influence teachers.

Antisemitic and antizionist narratives embedded into curriculums

BECAUSE EDUCATION in America is consigned to “very local control,” ultimately, most classroom resources are designed and developed by teachers with the autonomy to introduce problematic material into the curriculum with little to no oversight, said David Smokler, a former public school teacher and administrator and now the executive director of the K-12 Fairness Center at StandWithUs. When teachers are stretched, they often turn to educational websites that are entirely unvetted.

“It’s a minefield out there in terms of resources,” even if teachers are acting in good faith, said Smokler. The market for such classroom resources is huge, often with little scrutiny over who is funding them.

What’s more, ethnic studies and its more radical relative, liberated ethnic studies, are penetrating teachers’ lessons and professional development in many US districts with scarce oversight of material. With themes of oppression, colonialism, and resistance, ethnic studies educators describe the discipline as “not just curriculum” but a “movement” for “action” to effect “social change.”

But oftentimes, blatantly antisemitic and anti-Zionist narratives are found within these studies, particularly in the liberated model, a link to which is listed among the MTA resources.

Such issues are multiplying throughout the US.“We’re seeing many of our teachers and schools indoctrinating students with materials designed specifically to tailor to left-leaning people so that a lot of the indoctrination can be done invisibly,” Smokler told me.

“It’s designed to attract people who care about social justice. But it’s not just about antisemitism. It’s about liberal Western values in general. Some of the same teachers who are teaching that Israel is a genocidal apartheid state say the same about America. There’s illiberal indoctrination going on now that is pretty shocking.”

A course correction is necessary to protect our children. Massachusetts lawmakers should give their education arm broader mandates to enact meaningful oversight paired with accountability. Ditto for other states grappling with such challenges. Parents, teachers, and taxpayers must regain trust that public education isn’t eroding into a mere platform for indoctrination.

How this legacy is cemented will ripple through future generations of kids as they launch from classrooms to leadership positions, with global consequences.

The writer is an award-winning reporter and the recipient of a journalism fellowship that supported her graduate education at the Harvard Kennedy School. She is a former writer for The Boston Globe, reported for the Associated Press and is published in the Wall Street Journal and the National Review.