Scoppe: The moral argument for Medicaid expansion

Associate EditorMarch 17, 2013 

Scoppe

— OUTSIDE the brief, and fruitless, effort this past week by House Democrats, the debate over expanding Medicaid to cover more of the working poor has been waged largely on economic terms, and understandably so: This decision has profound economic consequences — both in terms of the cost to state government of doing it and the much larger cost to all of us of not doing it.

But for many people, this is first and foremost a moral question, a question of our obligation to the least of these. It is in that context that the leader of the state’s 200,000 Roman Catholics, the Most Rev. Robert E. Guglielmone, has engaged this ongoing political battle, framing the question in terms that any Christian would have to see as profoundly powerful.

In his Lenten pastoral message, the bishop leaves no question about what he considers the state’s moral obligation to provide medical care to 350,000 poor South Carolinians who aren’t covered and can’t afford health insurance.

“The State of South Carolina would be required to pay for ten percent of the total cost of this expansion after three years of full funding by the Federal Government,” he writes. “This will require us as a state to find the revenue to pay for this expansion. It will cost us.

“Bearing a cost for the sake of something greater is the heart of our faith; it brought us salvation.”

You might want to read that again. Maybe a couple of times.

Critics like to say that expanding Medicaid to cover childless adults who make up to 138 percent of poverty will cost the state as much as $1.9 billion by 2020, but our Legislature doesn’t write multi-year budgets. The expansion would cost $43 million in 2017, increasing to $166 million by 2020. By way of comparison, the Legislature passed $97 million in new tax cuts last year, and the general fund budget that the House passed Wednesday, which pays our share of Medicaid and most other programs, is $6.3 billion.

Although Democrats fought Wednesday to add the Medicaid expansion to the 2013-14 state budget, supporters know they have to spend this year making their case, and then mount an all-out effort next year.

Bishop Guglielmone begins his letter by reminding Catholics that “To be Christian means that we are concerned about the wellbeing and health of all people,” recalling that the church’s position on health care traces its roots to Jesus’ healing ministry.

He acknowledges that “determining how to implement such access is open to prudential judgments,” notes that “we can and must make this expansion and our whole healthcare system more effective and economically viable” and says we “are not powerless as a society to refine and make it more effective even as we implement it.”

But he gives no ground on the idea — controversial in the larger society but dogma in the Roman church — that health care is a “basic human right.”

“The Patient Protection and Affordable Care Act (PPACA) now being legally enacted in our country is an attempt to bring health care access to a broader range of citizenry in the United States,” he writes. “It is not perfect. In fact, the U.S. Catholic Church is deeply concerned about mandates associated with aspects of the law that would require religious institutions to provide contraception coverage, asking us to violate a consistent position by the Church on this. There are also many concerns about how to rein in the costs of health care so that its expansion is affordable to our country. However, providing access to health care is consonant with Catholic social teaching. Indeed, it is more than consonant — it is called for by Catholic social teaching.”

He calls on Catholics to make their own “prudential judgment” on the expansion. “However,” he writes, “I ask that you start that evaluation with a presumption in favor of what the Church says is a good to be pursued in society, namely, the flourishing of all people through access to health care. Hold as well our faith conviction that shared sacrifice for a greater good and concern for the poor make us more like Christ. Make your views known to your legislators. For my part, I believe Medicaid expansion offers a step forward for South Carolina.”

There is plenty to criticize about the Roman church. But when it comes to theology, it is far more consistently faithful to two millennia of Christian teaching than most churches — certainly more than my own.

And if the U.S. church ever was too closely affiliated with one political party — and it probably was — it hasn’t been a consistent voice for either in recent years. That has been particularly clear in the bishops’ opposition to Obamacare; few entities outside the Republican Party have been more vocal critics of the law’s birth-control mandate, which for many Catholics has overshadowed everything else about the law.

So when the church speaks out on that law — or on any matter of public policy — those of us who call ourselves Christians have an obligation to listen. Not necessarily to fall in lock step behind it — I certainly don’t agree with Bishop Guglielmone’s enthusiastic support of paying parents to abandon the public schools — but to consider whether its position is in fact based on the teachings of Christ. And if it is, we need to examine how our own position measures up to that standard.

Ms. Scoppe can be reached at cscoppe@thestate.com.

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