By Cameron Smith
Alabama Policy Institute
Over the last several months, liberal politicians, members of the media, hospitals and even the head of Alabama’s retirement system have renewed their calls for Alabama to expand Medicaid under the Patient Protection and Affordable Care Act.
The left and right have quibbled over economic projections, job creation, state costs, and political motivations. Every special interest, crony business or power hungry politician with a shot at either controlling or benefitting from a short-term federal cash infusion acts as if rejecting federal money is irresponsible and harmful to the most vulnerable in our state.
First, let’s get one thing straight: Any Medicaid expansion would result in more dollars entering Alabama and jobs created in the short term. When the federal government spends, new money enters the state’s economy. This is not a point of debate; it is a simple fact.
Proponents of the expansion reason that this short-term economic stimulus absolutely demands that state leaders expand the government program. We have heard these arguments time and again. At this point, they should sound quite familiar.
These are the same talking points of big government, one-size-fits-all policies that have failed for decades and created staggering generational debt. Our bipartisan acceptance of tax, borrow, spend, and “stimulate” has created a federal government that accounts for nearly 25 percent of the American economy and a national debt greater than America’s annual GDP.
Rejecting the Medicaid expansion is a sobering and necessary step towards ending the relentless political culture of grabbing any short-term benefits with a blind eye towards the future.
Many studies touting the positive impacts of federal spending and federal programs in Alabama act as if the federal dollars simply appear without any other macroeconomic impact on the state. If we are willing to simply ignore the national economic consequences of federal regulation and the taxes or borrowing that fuel federal spending, then virtually all federal money in Alabama appears to be beneficial.
Even so, the greatest reason to reject Medicaid’s expansion has precious little to do with economics. The Affordable Care Act and its programs are the latest instance of a tragic narrative that offers only two choices: We either accept a massive, inefficient, impersonal federal solution to our problems or we simply do not care about the problem at all.
This thinking is both false and destructive. Yet we, as a nation, have acted as if it were the only path set before us.
The integrity and ultimate success of our Republic depends on the concept that each state is best situated to address most of its own challenges, even those common to a number of states, in a manner suitable to its citizens. The relative success of each solution gives other states the opportunity to adopt or reject them as their own. Each state has a unique identity comprised of different people, perspectives, and communities. Why must all answers be the same for more than 300 million Americans? Such tactics defy the very nature of who we are as free people.
As the federal government gains more leverage by increasing the states’ financial dependency, the benefits that come from exploring multiple solutions to shared problems are lost. Medicaid is no exception to that reality.
Think about what the Medicaid expansion means: Our best answer for those with limited access to healthcare is a government system with glaring liabilities for the states, rampant abuse, and suspect overall results for beneficiaries. How many advocates of the Medicaid expansion would exchange even the “worst” of their private plans for Medicaid coverage? If a giant government program is not good enough for those with health care options, why must it be the only option for lower income Americans?
The Medicaid expansion personifies the failure of big government. Our leaders stop looking for better ways to solve the problem, eliminate a wide field of ideas in favor of one expansive response, and then have the audacity to claim that they have met the needs of the most vulnerable with a program that most of the same politicians would not want for themselves or their families.
States like Florida and Wisconsin are looking for patient-focused solutions that improve Medicaid beneficiary outcomes and save money. They are not flawless, but the moral imperative of caring for the most vulnerable in society begs us to try. We need to explore innovative ideas like permitting health insurance companies to compete with free-market sales across state lines. Doing so may have a pronounced impact on the cost of insurance and consequently the ability of many uninsured to obtain needed coverage.
We must not ignore the challenges facing our fellow Alabamians who have limited access to health care, but neither should we accept that expanding a bloated, fraud-ridden, one-size-fits-all government health care behemoth is our best or only option. Not only must we reject the Medicaid expansion, but we should undertake the difficult challenge of developing health care solutions, government related or otherwise, that we can be proud to support and which help those who need it most.
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Cameron Smith is Vice President and General Counsel for the Alabama Policy Institute, an independent non-partisan, non-profit research and education organization dedicated to the preservation of free markets, limited government and strong families, which are indispensable to a prosperous society.
