As Governor Gary Herbert unveiled the Healthy Utah Plan to extend Medicaid eligibility to more of our neighbors in need he stated how “complex” this issue has become in the age of Obamacare.
These complexities now fall equally upon the good judgment of state legislators to discern. The ball is in their court.
How does a conservative state legislator wrap his mind around extending Medicaid eligibility even further? Perhaps I can help. I’m a conservative and I’m well familiar with policymaking. Conservatives must face some realities. As we did with state-based immigration reform, we need to get very practical. In that debate we first had to consider the rule of law. We needed to get the rule right before we could get the law right. A similar standard of analysis applies to the Healthy Utah Plan in extending Medicaid eligibility beyond current levels, especially inside the crazy world of Obamacare. We need to correctly understand the context of the governor’s proposal to correctly discern its sound application.
First, a free society requires a safety net for its neighbors in need to maintain social, political and economic order. There is no space in which this safety net cannot be provided and society still function freely.
In the Road to Serfdom, noted libertarian F.A. Hayek wrote,
There is no reason why, in a society which has reached the general level of wealth which ours has attained, the first kind of security should not be guaranteed to all without endangering general freedom. There are difficult questions about the precise standard which should thus be assured…but there can be no doubt that some minimum food, shelter, and clothing, sufficient to preserve the health and the capacity to work, can be assured to everybody.
In principle, this safety net is created and provided privately. In reality, if not provided privately, this safety net will be provided publicly. We have a moral obligation to care for our poor and needy and this obligation will be met rightfully one way or another. Conservatives might not like when government steps in to fill this gap but our philosophical dislikes do not trump nor diminish real human needs and our moral obligation (to both the needy and to freedom) to provide reasonable solutions.
Second, Medicaid is inherently a system of standards of eligibility. Given that a person in need is either eligible or not, where do we draw the line of eligibility? If Medicaid eligibility stops at 100 percent of the official poverty level, does this mean that a single mother making one dollar over that level is any less impoverished, less needy or unworthy of assistance? Of course, we have fiscal limitations. But conservatives who get hung up philosophically on the politics of “Medicaid expansion” as the sole reason to deny extending eligibility beyond the current standard must first come to grips with the calculus of eligibility. Setting eligibility at 100 percent or 133 percent is not a point of gospel doctrine or even a point of principle. It’s a standard that can adapt with needs and circumstances. It’s a policy decided largely by what the state can afford not to do as much as what it can afford to do.
The governor and the state Legislature are rightly concerned about fiscal costs and priorities – and these concerns will be thoroughly debated. But to oppose any recommendation that might extend Medicaid eligibility, to any degree, just because it “expands” the pool of recipients, an opponent must first explain why he then would support Medicaid for anyone. In other words, there is no freedom principle that explains why a person making one dollar less than the approved eligibility is worthy to receive Medicaid but a person making one dollar more is not.
Third, doing nothing would be irresponsible when Obamacare is doing so much damage. Doing nothing would be as irresponsible as a victim of theft denying any level of restitution because it was not complete restitution – or worse, pridefully claiming that seeking restitution somehow makes us complicit in the theft. Every responsible person would seek restitution of any kind and no responsible person would deny any level of restitution while staring into the eyes of anyone in need that could reasonably benefit from it. Obamacare is sucking tax dollars from Utah. It is reasonable to seek maximum restitution as long as it is the law.
By the way, doing nothing includes even wonderful alternatives that do not effectively meet all needs. For over a decade I have championed authentic charity care and have worked to make this sound idea more popular among lawmakers. Providing an effective level of charity care – insinuated throughout Utah culture – should be the gold standard of poverty relief for a truly free society. Whatever Medicaid solution agreed upon by the governor and state Legislature, charity care needs to become a more integral component in providing future medical care to Utahns in need. That said, current levels of charity care do not meet today’s needs, let alone serve as a policy alternative to recoup Obamacare’s taxes. As difficult as it is for me to admit, resting my entire argument on the value of charity care is the equivalent of doing nothing in this instance.
Lastly, the Healthy Utah Plan is not Obamacare. Obamacare is an ideological concoction to achieve socialized medicine in this country, imposed by Congress and the president. The governor and most state legislators wisely and aggressively oppose it. Unfortunately, it is the law of the land. Agree or disagree with how Utah should strive to cope under this law, no reasonable person would deny that coping is necessary. What the governor has proposed in the Healthy Utah Plan, and what state legislators must now thoughtfully consider, is a prudent way to cope with the imposition of Obamacare until it is repealed, if that day ever comes.
For all of these reasons I support the Healthy Utah Plan pilot program and every attempt by the governor’s team and the Legislature to perfect it, if needed. The goal with which everyone can agree is plain and simple: Mitigate the impact of Obamacare. At the federal level, the goal should be to repeal it. At the state level, the goal is to lessen its impact. The Healthy Utah Plan does that.
I support Governor Herbert’s sensible leadership in this matter just as I encourage every state legislator to rise to the occasion. As a conservative thought leader, my bearings are correct: 1) a free society requires a safety net, 2) if the private sector cannot or will not fully meet the need, the use of government to meet neeeds is hardly an unjustifiable surprise, 3) the simple act of extending Medicaid to others is not some nefarious “expansion” because of the functional nature of eligibility standards, 4) doing nothing to mitigate the negative impacts of Obamacare would be irresponsible, and 5) the Healthy Utah Plan is a reasonable Utah solution to Obamacare.
Paul Mero lives in Sandy and can be reached at [email protected].
