Last month, Arkansas Gov. Asa Hutchinson vowed to make third-grade reading a top priority, building on the impressive work the state has already done to bring more children into early education programs.

Now the federal push to scrap the Affordable Care Act (ACA) and change the way we provide health care to families threatens to undermine that goal.

To keep children learning, we need to keep them healthy. Without regular access to doctors and dentists, children can fall behind in the early grades – creating a cycle that leads to lower graduation rates and higher unemployment across the state.

These important links between health, education and the economy are why expanding health coverage to families just above the poverty line was so critical in Arkansas. As a result of Arkansas Works, the state’s expanded coverage program for low-income adults, the proportion of uninsured residents here dropped a full 10 percentage points, one of the biggest declines in the nation. We have had even more kids enroll in coverage with their parents.

That means repealing the federal health care act without an adequate replacement could hit Arkansas particularly hard.

It’s not clear yet what form the repeal and any replacement plan would take, but judging from what Congress proposed a year ago, 361,000 Arkansans would lose their insurance, according to an Urban Institute analysis. Six out of 10 would come from working families. Among those losing insurance, 34,000 would be under age 18, and 7,000 would be under age 4.

The projections look even more dire if the Trump administration follows through on its proposal to cut or place caps on Medicaid funding to states. This move, pitched as a way to give states more flexibility, would actually limit the federal contribution to our state to support health care spending for children and families living in poverty, children with special health care needs, the disabled and low-income seniors living in nursing homes.

What does this have to do with third-grade reading?

Kids need access to comprehensive health care, and they need it early to help them thrive.  Children don’t learn to read well if hearing problems keep them from recognizing the sounds that make up words or if poor vision keeps them from focusing on their letters. Toothaches can distract children in the classroom or keep them home from school. So can asthma, which nationwide is linked to as many as 14 million school absences annually. Important health benefits like regular screenings help ensure problems can be identified and treated early, which has been a key focus of recent work in Arkansas.

In Arkansas, 13 percent of kindergarten and first-grade students miss a month or more of school every year. And at that age, illness is the leading cause – not truancy. A recent study found that these chronically absent students are less likely than their peers to master reading by the end of third grade. That’s not surprising. It’s harder to learn when you’re not in the classroom.

Advocates across the state have already formed the Arkansas Campaign for Grade-Level Reading to work toward ensuring more students read proficiently by the end of third grade. Right now, about a third of our students hit that mark.

With support from Governor Hutchinson, Arkansas is poised to make real progress on improving this important indicator of school success. We can’t let federal health policy undermine our efforts.  Our leaders in Washington should protect Arkansas’s future by ensuring that our families continue to have access to the health care they need.

Marquita Little is the Health Policy Director of Arkansas Advocates for Children and Families.