I am a retired pediatrician. I practiced for 35 years in Salt Lake City, and loved it. But some of the saddest times were visits spent caring for children with Medicaid or CHIP insurance coverage, for whom I could give care, and refer for needed medical services, but whose parents had no insurance and couldn’t afford medical care for themselves. These folks often were taking time off from one or two jobs, frequently with an acute or chronic illness. These visits, while great for the kids, were sad and frustrating for me and for the parents.
Rep. Mia Love recently wrote of being “buoyed up by the resilience, determination and courage” of those “affected by chronic disease, serious injury or unexpected illness.” She advanced community health centers as a solution for the uninsured. Unfortunately, the number of centers will never be able to cope with the numbers of uninsured, in Utah or across the nation, unless huge amounts of federal and state money were invested in building more centers, an unlikely possibility.
State Rep. Paul Ray recently authored an op-ed as chairman of the Social Services Committee of the Legislature. He wrote that Healthy Utah would have cost the state at least $90 million, that the state carries a “heavy burden by providing Medicaid to 300,000 of our very most vulnerable residents,” but that funding to expand Medicaid would have cost nearly $100 million, simply not available in the Social Services budget.
We on the outside must certainly allow for the great stress under which our legislators work, as they try to fund all the programs that need funding and still stay within the constitutionally mandated state budget balance. Nevertheless, I do know from 30 years on the hill as a child advocate that the distribution of state moneys is a matter of priorities: money flows to and fro among the committee budgets at the behest of leadership and the Executive Appropriations Committee. Examples include the $53 million funding for the coal terminal in California; the millions already spent, and more proposed, to wrest Utah’s public lands from the federal government.
Additional money could be found for Medicaid expansion by closing the tax loophole for families with more than three children, by taxing internet sales, by taxing e-cigarettes and by addressing taxpayer-funded economic windfalls for businesses coming into Utah. Even by raising the income tax — admittedly ideological anathema.
Many in the community say that Medicaid expansion “is going nowhere” this coming session, while the leadership waits for the national GOP to repeal Obamacare. That is no excuse to wait, given the Supreme Court’s decision to leave Medicaid expansion up to the states and while our uninsured neighbors get sicker and not infrequently die without insurance for medical care. Ideology should not stand in the way.
Even as our governor and Legislature balance the state budget each year, they have a great deal of flexibility and they should be able to look inside and outside current boxes in setting priorities. As our country recovered from the Great Depression, threatening to leave many Americans behind, FDR said in 1937, “The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have little.” The passage of Medicaid expansion is just such a test of our progress. Is our Legislature, as a representative of our people, compassionate or cruel?
Tom Metcalf is a retired pediatrician living in Salt Lake City.