Preserving Freedom with Medicaid Expansion

by Joseph Jerome

After declaring that Texas would not be expanding Medicaid to include millions of uninsured Texans, Gov. Rick Perry insisted that “the real issue here is about freedom.” South Carolina Gov. Nikki Haley argued that the Affordable Care Act reveals a federal government that “simply [doesn’t] believe states should be trusted to govern themselves.” Speaking on the Meet the Press, Louisiana Gov. Bobby Jindal invoked the principles of federalism when he suggested universal health care was akin to having Mardi Gras in Vermont.

This rhetoric reveals a profoundly state-centric view on what freedom means, and while the Tenth Amendment certainly speaks to the rights of states vis-à-vis the federal government, it also talks about the rights of individual citizens. “If anything, the Tenth Amendment recognizes potentially expansive federal power,” Professor Steven Schwinn wrote on SCOTUSblog, rebutting “states’ rights” arguments against the Affordable Care Act.

The problem is that “we are all hypocrites” when it comes to power struggles between the state and federal governments, Professor Garrett Epps explains. “The basic view of ‘states' rights’ is that they extend to any policy that the speaker thinks will go his or her way at the state level,” he writes.

Though Gov. Perry (pictured) has long been a “states’ right stalwart,” he too falls into Epps’s trap. The governor supports federal efforts to restrict marriage equality and ban abortions, and the real issue was not freedom when $17 billion in federal stimulus money was used to balance Texas’ budget. When it comes to the Medicaid expansion, however, millions of Americans in these states must find comfort in being told they will go without health insurance as a matter of principle.

This freedom will come at a terrible cost. Texas already has the worst health care system in the country and the largest percentage of uninsured.  South Carolina and Louisiana are not far behind. The numbers alone suggest that even if these states should be trusted to govern themselves, they should not be trusted to take care of their citizens. 

According to these states, the Affordable Care Act is not the solution. In Texas, “common sense laws and the spirit of innovation” will solve what ails the Lone Star State instead. Yet Texan health care providers are still waiting for Perry to provide those alternatives.

If rhetoric alone is anything to go by, any eventual alternative will use “freedom” as a justification for lawmakers simply to do nothing.  Previously the governor’s spokeswoman has explained that Texans are passionately individualistic and value their freedoms and responsibilities. "Individual responsibility is about making healthy choices and taking ownership of your lifestyle – not just about buying health insurance," she reiterated. 

This mindset makes it too easy to merely blame the poor for their impoverished lifestyles. In a free country, after all, any able-bodied individual can always just “get a job,” as Maine Gov. Paul LePage recently argued.  Inside Texas emergency rooms, however, 70 percent of the people seeking health care are employed. “They’re hourly wage earners, nannies . . . or people working two part-time jobs and neither will pay for health care,” one ER chief reported. “Many are small business owners who are well-educated and well-dressed.”

During oral arguments in March, Solicitor General Donald Verrilli explained that freedom really is at the heart of the Medicaid expansion. “Millions of people with chronic conditions,” he argued, “will be unshackled from the disabilities that those diseases put on them and have the opportunity to enjoy the blessings of liberty.”

[image Talk Radio News Service]