| July 27, 2012

Report: Maintaining Medicaid could require states to cut school funding or levy tax increases

Even if state legislators across the country choose not to expand Medicaid under Obamacare, they might still have to cut school funding or levy tax increases just to maintain the beleaguered program, according to a recent report by the State Budget Crisis Task Force. The nonpartisan Task Force asserts:

Medicaid costs have been growing faster than the economy since the program's inception and generally have grown faster than state revenue, as well. When the program was only a small part of state spending, states were able to fund this imbalance in growth. But Medicaid is now such a large part of state spending -- 24 percent of total funds and 16 percent of state general funds -- that the imbalance (or structural budget gap) can no longer be absorbed without significant cuts to other essential state programs like education or unpopular tax increases or both.

In the throes of the recent recession, for example, states cut education aid, but Medicaid spending continued to grow.

The report, which is worth perusing at length, attributes Medicaid cost growth primarily to growth in enrollment. "The Obamacare expansion" of Medicaid is nothing more than intentional enrollment growth, an attempt to cover more of the currently uninsured. While we want every Oklahoman to have access to affordable health insurance, we acknowledge the unfortunate reality: Neither the federal government nor state governments can afford to cover the cost of Medicaid expansion.

A budget -- whether of a family or a government -- is essentially a statement of priorities. While some of the currently uninsured might truly have no money to purchase anything beyond the bare necessities and so must rely on a limited social safety net, others have indicated by their purchase of luxury items (TVs, cars, additional household appliances) that health insurance is simply not a priority for them. When legislators cut education aid but grow Medicaid, they essentially say that government-funded health care is a higher priority than government-funded education. It's important that we at least be clear about that, so we can begin to have a truly honest discussion about the role of government and our priorities as a people.

We want Oklahomans to be well-educated and healthy -- but throwing government funding at education and health programs does not equate with the provision of well-rounded education or the preservation of sound health. First and foremost, Oklahomans must take responsibility for their own education and for their own health. Consider the unrivaled education Abraham Lincoln provided himself within the walls of his log cabin. Consider the tip-top shape of a regular jogger whose greatest expense is the cost of a pair of running shoes. Maintaining freedom requires maintaining discipline.

Public policy should serve to facilitate the efforts of the private sector, not to frustrate them. Unfortunately, legislators far too often adopt policies that fall in the latter category.

Consider just one example. The Daily Oklahoman editorial board writes this week:

FUNDED by tobacco tax revenue, Insure Oklahoma was created several years ago to provide matching funds to the state's small businesses to help them offer private health insurance to employees. Yet lawmakers have since voted to shift millions from Insure Oklahoma to shore up Medicaid, the government health care program for the poor. ...

Addressing the Medicaid problem will be a significant challenge for the Republican lawmakers who control Oklahoma government. It would be a step in the right direction if they stopped raiding programs that encourage private insurance coverage.

The more the state assumes responsibility for us, the less we assume responsibility for ourselves. The solution, then, is to take more responsibility as individuals. After all, as even kindergarteners used to learn, freedom and responsibility go hand in hand.

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