Let’s make the Medicaid “gap population” bigger

Wayne Hoffman Articles

This month marks the 20th anniversary of federal welfare reform. Such was a bipartisan public policy achievement made possible by the belief that government should not trap people forever in its programs and inhibit human flourishing. Welfare reform freed Americans from that snare. The 1996 welfare reforms were hailed as an effort to move people from government dependence to self-reliance.  

What a difference 20 years makes. Today, more people than ever are dependent on one government program or another, directly or indirectly, thanks in large part to the expansion of government-run health care and various state and federal business subsidies. And in the case of health care, a number of politicians decry the notion that there exists people who do not qualify for government programs or handouts.

That’s the case in Idaho as some legislators lament that fact that an estimated 78,000 people do not qualify for either Medicaid or government insurance subsidies. These people are collectively referred to as the “gap population.” The lamenting legislators want to “close the gap” by enrolling more people in government programs. The public servants have it backwards. Really, the gap should be bigger. There should be more people who don’t qualify for government help, not fewer.

An interim legislative committee met Thursday to discuss the gap population, and the committee will meet again later this month. Its members are charged with finding a way to help those people who make too much money for Medicaid and too little for government insurance assistance. Several legislators, mostly in the Senate, appear determined to add people to Medicaid by expanding it — even though the existing Medicaid program is a fiscally-broken, costly mess. Last legislative session, the state Senate made a run at Medicaid expansion, but House members blocked the effort.

Understand that, in the history of government involvement in medicine, there has never been a single instance in which state, federal or local intervention in the health care marketplace has reduced costs. To the contrary, government is to blame for making health care less affordable, less accessible and has reduced quality. Government is the reason you can’t shop for insurance across state lines. Government is the reason your doctor’s office has as many paper pushers as medical practitioners. Government is the reason independent doctors are disappearing, their practices having been swallowed by large hospitals.

If legislators really care about people in the gap, they should examine what they’re doing to prevent people from buying insurance, what they’re doing to limit access to health care, medications and insurance. They should look at ways in which government programs compete against the free market and crowd out charities, churches and other community programs that have a track record of helping people because they work directly with them, care about them and want to provide them with the tools they need to thrive. Legislators should examine current programs, including Medicaid, and find ways to get people off programs, instead of adding to them. They should listen to experts, like Drs. John Livingston and Jim Brook, who are telling Idaho lawmakers that a free market is the medicine Idaho needs.

Consider the 78,000 people in the gap as a benchmark. If that number shrinks because more people are signed up for government programs, we will have failed to truly help people who really need it. We will have doomed them, just as the people who were trapped in welfare 20 years ago were. As with welfare reform, our mark of success should be the number of people who are no longer dependent on government.