Governing Insanity: Medicaid and Farm Aid

Two articles on the front page of this morning’s Washington Post show what is wrong with American politics today. The first details the fights in several states where Republican legislatures are voting not to expand Medicaid as permitted, and encouraged, under the Affordable Care Act (ACA). The second looks at a $5 billion farm aid program that sends checks to a lot of people who do not farm.

The ACA adopted two primary vehicles for expanding coverage to the uninsured. It sets up exchanges where individuals and small businesses can choose from a variety of plans, and it also expands Medicaid to the poorest Americans. When the Supreme Court upheld the ACA last year, it struck down the provision that the federal government could withhold all Medicaid payments to states that declined to participate in the expansion. So, it was left to each state to decide if they wanted to participate.

This is not a tough call. Medicaid helps give the poor access to health care, not to great health care, but to basic health care. To be eligible, under the original terms of the ACA, a person needed to make less than 138 percent of the federal poverty level, which comes to $15,856. Think about that number for a minute and imagine if you could live on that amount of money. How would you carve out of a family budget of less than $20,000 the costs of health insurance, or the cost of a visit to the emergency room? Would you give up paying rent and face eviction? Would you stop eating? And, when will we hear from our bishops about how morally wrong this denial of Medicaid expansion is? Not just from the USCCB, but from individual bishops in the states where this debate is on-going?

But, Republicans have been so hostile to the ACA since its inception, they are refusing to join the Medicaid expansion. Not all Republicans. Such conservative darlings as Arizona Gov. Jan Brewer is in a stalemate with her legislature over her desire to expand the program. Michigan Gov. Rick Snyder and Ohio Gov. John Kasich are likewise engaged in an effort to persuade their reluctant fellow Republicans to support expanding the program. Alas, the poor have no powerful lobby and the opponents of the dreaded Obamacare have been told for five years now that it will end our liberties, set up :death panels,” and other foolishness that, alas, some people, including may Republican constituents who vote in off-year elections, believe.  

The farm aid program was originally intended as a temporary program designed to help small farmers, giving them direct cash payments with very lax rules for eligibility. Sadly, and it is not an isolated case, the program has lived on beyond its expected shelf life. Here is an example of government run amok. It does not mean anyone’s liberties are threatened, but it evidences the kind of fiscal indiscipline that has resulted in a bloated federal government and an enormous federal debt.

One of my biggest disappointments in President Obama is that at no time has he mounted an effort to search out these kinds of programs that cost a great deal of money – the farm aid program has cost taxpayers $46 billion more than anticipated – but which are outdated, no longer necessary, or both. Temporary programs that help people transition as the economy changes may be a good thing, but only if there is a sunset provision that is firm. Just as it took a Nixon to go to China, only a Democrat can really attack these kinds of government programs in a way that can be trusted. President Clinton had his vice president, Al Gore, undertake a “Reinventing Government” program that saved the country billions of dollars. Obama has mounted no such effort. I suspect that Obama would reap a political windfall for exercising a bit of budgetary stringency too, especially among independent voters.

What is missing from both the Medicaid and the Farm Aid that never dies is a sense of the common good. Pope Francis has repeatedly encouraged public officials to remember their responsibility to act in behalf of the common good. That plea seems to fall on deaf ears in Washington and in the various state capitals. The Republicans are enamored of an ideological vision that is hostile to all government. The Democrats tend to ignore issues of fiscal discipline. And, between the two, the common good vanishes. Our president has failed, utterly, to create a narrative that articulates his understand of the common good and government’s role in promoting it, dashing from issue to issue with now over-arching theme: this week, gun control, next week, Guantanamo, the following week, jobs.

And so, absent a focus on the common good, and what we Catholics consider a preferential option for the poor, our politics becomes increasingly vicious, increasingly expensive, increasingly foolish. This should especially concern Democrats who believe in the power of government to improve people’s lives: Every article about huge sums of money being spent on wasteful projects turns one more Independent voter to his right. And, Catholics, for whom the pursuit of the common good is at the center of our social teaching, should be more vocal in calling out these legislators who are backing the Medicaid expansion and more comprehensive in voicing our concerns about the long-term effect of the federal debt. We are not being good stewards of our nation’s riches when anyone goes without health care or when our children are saddled with unnecessary debt.