Mississippi lawmakers say they’ll spend part of the summer studying the state’s Medicaid program to see if there’s a way to save taxpayer money. But if recent history is any indication, the effort will not yield significant fruit.
Lawmakers in other states have, for years, picked through the federal-state medical welfare partnership, and so far, the best they’ve been able to do is slightly lower the annual increases.
Knowing the outcome of the inquiry is obvious, perhaps lawmakers would be better served in examining the questions that, so far, no state has dared to address:
- Has Medicaid quietly replaced our human capacity for compassion with something cold and rigid?
- Has Medicaid calcified the propensity to show our neighbors love and kindness – the qualities that defined Mississippi and Mississippians for generations?
- Is the six-decades-long experiment in government-administered aid an appropriate substitute for the neighborly concern our grandparents and their parents and grandparents prioritized in their communities?
This is not to say that state officials should not bother spending their time looking at the financial ledger of the state’s Medicaid program, overturning all the accounting rocks in search of waste, fraud, abuse, and potential for savings. But this leaves untouched the matter of what happens to society when compassion becomes a line item, when caring for the vulnerable is outsourced to a bureaucracy, and when neighbors are quietly absolved of any felt obligation to one another.
The Legislature already knows that real reforms — and therefore, real savings — require doing the things no one seems willing to do, such as wholesale elimination of the program’s federally unrequired elements, including prescription drugs and prosthetics.
Indeed, most states including Mississippi have found eliminating program components politically undesirable, and so they avoid raising the question. The reason is not simple electoral cowardice. It is that decades of Medicaid have conditioned Americans to regard government-provided care as so natural that imagining its absence feels monstrous — even though government is filling the role once held by the private charitable networks, church benevolence funds, and community mutual-aid societies.
When the government guarantees a service, the moral urgency to provide it privately fades. The obligation migrates, and with it, something irreplaceable about how a community understands its own members.
Of course, the most optional part of Medicaid is the decision of a state to offer the program at all. No state is required to participate in the Great Society program that Congress passed and President Lyndon B. Johnson signed into law in 1965. States have, one by one, agreed to participate. Mississippi joined in following a contentious special session of the Legislature in 1969. And to date, not a single state has seriously weighed the prospect of dropping from the program, even as costs skyrocket.
Across the country, Medicaid is now the largest program that states administer, far surpassing education as the government’s chief responsibility by cost. Mississippi is expected to spend roughly $8.5 billion on government-run healthcare in the budget year that starts July 1. The state’s portion of the tab will cross $1 billion for the first time, an increase of roughly 16%.
Meanwhile, the loudest debate in Mississippi Medicaid circles is whether the state should expand coverage under the Affordable Care Act to able-bodied, childless adults. Expansion proponents argue that the federal government would cover 90 percent of the cost, that hundreds of thousands of working-age Mississippians fall into a coverage gap, and that rural hospitals struggle with uncompensated care.
Opponents argue the long-run costs are uncertain, federal promises are unreliable, and expansion would add 200,000 or more people to a program already straining the budget.
Both sides are, again, counting money. Neither is exploring the tougher, more challenging matter.
Mississippi has a tradition — rooted in its churches and towns, its extended families and its history of community survival under genuine hardship — of people caring for one another without being instructed to by statute. That tradition has not been destroyed by Medicaid, but it has been crowded out.
When the government guarantees a service, the neighbor who once organized the collection plate for a sick family now assumes there’s a government program somewhere to handle it. He doesn’t need to know about the struggles occurring on his block, across town, or on the other side of the state.
People who are sick need care, and the mere existence of a program is not care. “Care” requires active awareness of the plight of others. Such knowledge can seemingly challenge the capacity of voluntarism alone. But “challenging” doesn’t mean impossible. And it’s important to remember that Medicaid, as large as it is, still has a tough time meeting the needs of the people, in part because it is so large — and because bureaucratic rules often displace personal judgment and local knowledge.
The question is not whether the sick receive help but through what means, and at what cost to our common life and our moral character as a people.
Mississippi has spent decades and tens of billions of dollars discovering that you can administer a program for hundreds of thousands of people; you can budget it and audit it and let contracts for it, but you cannot manufacture compassion or replace what is lost when the community stops being its own first answer.
If Mississippi lawmakers really want to understand Medicaid and its consequences, these are the questions they should spend their time considering this summer.
— Wayne Hoffman is President of the public policy education and advocacy organization, Level Up Humanity, and is a research fellow of the Mississippi Center for Public Policy.
