Jesus and Medicaid

Several governors say they'll reject federal money to insure health care for low-income families. Since many of them are very public about their Christian faith, it's appropriate to ask how their decision stacks up to to the morals of Jesus.

The earliest stories about Jesus focus on free healing, free food and an earthly order ("the kingdom of God") where vulnerable people are safe and secure.

These ideas are rooted in Jewish tradition, emphasized in Christian scriptures: "If a brother or sister is naked and lacks daily food, and you say, 'Go in peace, stay warm and eat your fill,' but you don't meet their bodily needs, what good is that? Faith without works is dead" (James 3:15-17; see also Matthew 25:31-46; Acts 2:44-47; 4:32-35; etc.).

God makes a covenant with Israel built on economic justice and care for the vulnerable (Exodus 22:21-27; Deuteronomy 14:28-29; 26:12-15; etc.). God keeps sending prophets to "capital hill" to pressure the government to help the poor and build a just economy (Isaiah 1:10-17; Isaiah 58; Amos 5:21-24; Micah 6:6-8). God shows particular concern for people trapped in debt (Deuteronomy 15).

One biblical tradition says that God's name is first revealed to the world when God "redeems" (pays the debt of) Israelites who are debt slaves in Egypt (Exodus 3:13-17; 6:2-8). Rescuing the vulnerable, liberating the oppressed, freeing people who are slaves to debt is not just what God does. It's who God is.

In Luke 4, Jesus reads Isaiah 61 when he preaches the sermon that launches his career, a scripture that announces "good news to the poor" and proclaims deror, "liberty" -- a royal decree abolishing debt and debt slavery. Jesus says this decree is now in effect -- a radical and dangerous claim that nearly gets him killed on the spot and probably contributes to his eventual execution by Rome.

When Jesus teaches his disciples how to pray, he tells them to ask for the kingdom of God on the earth, for everyone to have enough to eat every day, for canceled debts and for rescue from trying times (Matthew 6:9-13; Luke 11:2-4). Jesus expects his disciples to share his concern for the physical, mental and spiritual health and liberation of everyone, especially the most vulnerable.

How does this moral vision of Jesus play out in health care today?

A Federal Reserve study a few years back estimated that more than half of all collection actions by creditors and collection agencies are related to health care debts. Many families are drowning in medical debt.

What would Jesus say about this?

Health care inflation is due in part to "cost shifting." Hospitals and doctors raise prices on insured people to cover losses for treating people who can't pay. The more people don't have insurance, the higher the overall cost of health care. The higher the cost, the higher the premiums and the more likely small businesses are priced out of the insurance market. Their employees lose coverage, join the ranks of the uninsured, and drive up health costs. It's an economic death spiral, a perpetual motion machine that keeps raising health costs and increasing public debt. We can break the destructive cycle if we provide insurance for everyone.

What would Jesus say about the spiral of rising costs and public debt we're passing on to our children?

We currently encourage the uninsured to put off going to the doctor until an illness or injury becomes a crisis, and then send them to the emergency room for the most expensive care there is. It's cheaper and more humane to give them insurance.

A recent study in the New England Journal of Medicine found that deaths dropped 6.1 percent in states that have already expanded Medicaid, but rose in comparable states that have not. The study finds that 2,840 deaths were prevented each year for every 500,000 adults newly covered by Medicaid. Cost-related delays in getting care dropped by 21 percent. Insured people get care in a more timely fashion, so they are healthier and less likely to die.

The Affordable Care Act (ACA) will insure an additional 33 million people by expanding Medicaid and providing subsidies for private insurance.

A few days ago, the Congressional Budget Office (CBO) estimated that 3 million fewer people will be insured than that because several states will refuse to take federal dollars to expand Medicaid. That's more than 17,000 premature deaths each year and who knows how much preventable illness to score a political point.

What would Jesus say about this easily avoided death and suffering? Why would political leaders who say they follow Jesus choose to block health insurance for the poor?

Though the federal government will pay 100 percent of the cost the first three years, then gradually reduce the federal share to 90 percent, some governors say their states can't afford to pick up the 10 percent they'll eventually have to pay.

But their math doesn't add up. A 2009 editorial in USA Today explains why. The author says the federal government should follow what his own state did because it saves money:

"First, we established incentives for those who were uninsured to buy insurance. Using tax penalties [individual mandate], as we did, or tax credits, as others have proposed, encourages 'free riders' to take responsibility for themselves rather than pass their medical costs on to others. This doesn't cost the government a single dollar. Second, we helped pay for our new program by ending an old one -- something government should do more often. The federal government sends an estimated $42 billion to hospitals that care for the poor: Use those funds instead to help the poor buy private insurance, as we did."

Mitt Romney was right.

An Urban Institute study projects that state budgets will save between $92 and $129 billion by 2019 under the health care law. CBO estimates the Medicaid expansion will cost states $73 billion by 2022. States will save money overall.

Romney's editorial promised that Republicans would join President Obama in health care reform if he abandoned the "public option" (allowing people to buy into Medicare or a similar public program) and presented a plan that wouldn't add to the long-term debt. The bill the president signed abandoned the public option. And according to a recent CBO letter to Speaker John Boehner, the Republican bill to "repeal Obamacare" would increase the federal deficit by $109 billion over the next 10 years!

ACA reduces the federal deficit and saves states money. Tens of millions of uninsured people will get health care in a timely fashion. This law saves lives and taxpayers' money.

These governors are playing politics with the lives of our most vulnerable families and increasing the debt burden of taxpayers. Their behavior is callous, foolish and fails the moral test of the Bible. I'm praying for them.