Medicaid Expansion: Two Issues Legislators Should Consider

This week the Governor put the question of expanding the traditional Medicaid program squarely on the table for our legislators to debate next month. He is asking for a special session of the legislature to focus on this one issue. I applaud the heart behind his proposal, but as we apply our heads to it, I’d like to suggest we debate some things beyond just the elements of the proposal itself.

The proposal, as I understand it, is an attempt to provide health insurance coverage to what we might call the “working poor.” While we can debate the difference between absolute and relative poverty, at least we are not talking about something that’s purely a “hand out.”

Those who would be covered would be earning some income, so they are in the workforce. And the proposal would try to put those to whom it would apply into the private sector insurance market and require some element of co-pays for services. Those elements are commendable.

It is also commendable that Gov. Haslam has a heart for those who are economically challenged and may struggle with affording some basic level of health care. It is “morally right,” to use an expression the Governor used, to care about the well-being of our fellow citizens.

But if all the legislature debates is whether it is “morally right” to care for our fellow citizens and the “mechanics” of the proposal, it will miss the opportunity to have a much-needed debate at a much deeper level than we’ve had in our state and nation in a long time. Let me suggest just two fundamental matters that should be debated.

The first major issue we’ve ignored since the New Deal, if not before, is to whom the moral duty to care for our neighbor falls in a civil society made up of individuals, families, private associations, and civil government. Historically, we have said it was the moral responsibility of individuals, families, and private associations.

For instance, years ago, in my hometown of Chattanooga, individuals and their families who saw a need to care for those with physical and mental challenges came together and out of their own resources established two wonderful institutions that still exist, Siskin Hospital and Orange Grove. You may know of such organizations in your own community.

If we stop to think about it, care for the poor is essentially an act of either mercy or grace. Civil government is an instrument of law. Are we willing to debate whether an instrument of law can be an effective instrument of mercy or grace without eventually destroying both law and mercy and grace?

Under the guise of grace and mercy, law can become an instrument of injustice by taking from some to give to others. Respect for the law is lost and then law becomes an instrument of plunder, not protection. Of course, taking from some to give to others might help the other person in the short run, but it will not make the person from whom money is taken gracious or merciful. In fact, it might just make them resentful and more callous toward the poor, hurting them in the long run.

Lastly, even if we are not willing to reopen debate on this issue, there is the issue of debt. If we’re going to talk about what is morally right, then we must talk about the fact that our federal government is printing and borrowing money it doesn’t really have to pay for this expansion.

So the question for debate is whether it is morally right for our state to be part of expanding a federal debt. In asking this question, I’m thinking of two things Solomon said. First, that a good man leaves an inheritance to his children’s children (Proverbs 13:22), and second that the borrower is the slave of the lender (Proverbs 22:7).

We will leave an inheritance to our children’s children; the only question in this regard is whether it is morally right to leave them an inheritance of even greater debt with its corresponding loss of freedom.

There are other issues that come to mind, but if our legislators will take up just these two issues, we will be better served. It might even make a special session really special.

Related Video:

David Fowler Explains the Future of Medicaid Expansion


David Fowler served in the Tennessee state Senate for 12 years before joining FACT as President in 2006. Read David’s complete bio.

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