"Now, when you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer."
Republican John Kasich said that. He’s Matt Mead’s GOP colleague, governor of Ohio. Kasich supports Medicaid expansion. Kasich’s conservative, small government credentials are as good as any GOP governor. His sense of morality is better than many.
Asked how a conservative, small government Republican could support this part of Obamacare, Kasich made it spiritual.
Kasich is right. This is a deeply spiritual issue. Politicians try to cast it as a political issue. They can run from the spiritual implications but they can’t hide. Half a century ago, the nation debated whether Congress should enact Medicare and Medicaid. Martin Luther King framed the issue then, as it must now be understood. "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
Recently Missouri governor Jay Nixon invoked the Hebrew prophet Isaiah in support of Medicaid expansion. “If you pour yourself out for the hungry and satisfy the needs of the afflicted, then your light shall rise in the darkness and your gloom be as the noonday.” (Isaiah 58:10)
Carl Carmichael, chairman of the Wyoming Association of Churches says, “Opposition to expanding Medicaid in our state is a debacle worthy of nothing but shame for those who refuse to help the 17,000 uninsured Wyoming citizens who would benefit from that expansion. Not only is it morally wrong, it is fiscally irresponsible.”
The Affordable Card Act obligates Washington to pay 100% of the costs of expansion initially, declining to 90%. Searching for a pretext to justify rejecting the money, the governor and legislators say, “We don’t trust the federal government to pay their share.” The governor makes this specious argument while relying on the federal government to balance the state budget by contributing 1.5 billion dollars. The pretentious argument is seconded state senator Eli Bebout, chair of the Appropriations Committee even as he ushers through a budget that trusts the feds that much.
These politicians have always exhibited trust that the feds would pay up as year after year the legislature has balanced its budget on the federal promise to pay.
The governor and Bebout claim the feds reneged on their promise to pay Abandoned Mine Lands funds to the state. But they know those funds were withheld because Wyoming misused the money, spending them on roads and capital improvements at the University rather than on restoring abandoned mines, as the law intended. (Note the irony next time they say someone should be impeached for misuse of federal funds.)
Others argue that the federal share has declined over the years is proof they might not pay that 90%, ignoring provisions of the law that include a formula for non-ACA Medicaid costs. The fluctuation, which doesn’t apply to expansion, takes into account changes in a state’s per capita income and has been modified only three times in the last 35 years. Two times it was raised to provide fiscal relief in response to economic downturns. It was reduced only once, in 1981, when President Reagan requested a temporary reduction. Rates returned to previous levels in 1985.
Jennifer Butler, Faith in Public Life, wrote about the impact of the decision in Republican-governed states to not expand Medicaid. She cited findings that “that as many as 17,000 Americans will die as a result of states refusing to expand Medicaid under the Affordable Care Act.” Her essay was titled “Medicaid and Mortality” and could have just as well been named “Medicaid and Morality.”
When issues have the spiritual dimensions of this one, politicians might want to sidestep deceptive political arguments and focus on the truth. As scripture says, “The truth will set you free,” making the face-to-face meeting with St. Peter that Governor Kasich warned about a lot more pleasant.