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Medicaid safety net should catch poor single men

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Unlike most Democrats, this GOP supporter of Medicaid expansion doesn't deem fellow conservatives that oppose this aspect of Obamacare as proof they don't care about the poor. After all, compassion for the poor prompted this former Dem to switch parties 13 years ago to advocate the continuance of Reagan economic policies that shrunk poverty and grew the middle class to historic levels. And given other aspects of the quite un-Affordable Care Act, it is perfectly acceptable to oppose all of it and insist upon its complete or partial repeal before reforming federal government interventions in the health care and insurance markets.

But it is also acceptable to maintain one's Reaganite conservative bona fides by supporting what The Gipper himself dubbed a federal "safety net for the truly needy" with interim compromise reforms of the possible before more perfect freer markets that lower costs becomes achievable. In that regard, we applaud Georgia State Senator Charles Hufstetler (R-Rome), the only elected Republican to publicly support the expansion of Medicaid in the Peach State before the General Assembly declared sine die and adjourned last week until 2015:

One of the year’s grandest acts of political rebellion in the state Capitol took place last Tuesday, deep into the 39th day of a 40-day session of the Legislature.

“I am concerned that my party is going to lose thousands of health care workers and independent voters over this,” said state Sen. Chuck Hufstetler, R-Rome. “The majority of Georgians do oppose Obamacare, but six out of 10 believe we ought to expand Medicaid. There is a difference between the two.”

Hufstetler is a first-termer and a back-bencher. Literally. His seat is on the final row. But he is the sleepy, quiet type. No bomb-thrower. In fact, by trade he is an anesthetist at Redmond Regional Medical Center, the smaller of two hospitals in his district. The occasion of Hufstetler’s outburst was the Senate debate over HB 990. The bill was the lesser of two anti-Obamacare measures in circulation, a greased piece of legislation that would take the decision of whether to expand Medicaid, as recommended by the ACA, out of the hands of the governor. Legislative approval would be required.

Gov. Nathan Deal had endorsed the whittling of his own authority, so the Senate vote and the words that went with it were mere formalities. Until Hufstetler took the well.

First, the former member of the Floyd County Commission presented his credentials. He had opposed the 2009 passage of the Affordable Care Act, he said, primarily because of its mandate that individuals purchase insurance or be fined. But President Barack Obama has issued so many waivers for the requirement that it is almost meaningless, Hufstetler said.

What worried the Rome senator was Gov. Nathan Deal’s decision – which will soon be in the hands of the GOP-controlled Legislature – to refuse to expand the federal-state health care program for low-income Georgians. Hufstetler cited a list of Republican governors in Arizona, Pennsylvania, Michigan, Ohio and Utah who have made their peace with the Affordable Care Act, expanding health care coverage to poorer residents in their state.

In Georgia, Medicaid expansion would wrap in an estimated 650,000 more low-income earners. The program currently covers about 1.7 million children, pregnant women, plus elderly and disabled residents. The federal government would cover the entire cost of Medicaid expansion for the first three years, with its share gradually dropping to no less than 90 percent thereafter – a promise that most Republicans treat with high skepticism.

But Hufstetler sees something else. He sees his state giving up billions upon billions of dollars at the cost of thousands of health care jobs. With no impact on the federal deficit. Money will be flowing out of Georgia into states that have accepted Obamacare.

“I believe this transfer of wealth is going to hurt Georgia as numerous studies by Kaiser [Permanente], the University of Georgia, and Georgia State have pointed out,” Hufstetler said.

Huftsetler was the only Republican to cast a vote against HB 990. He also voted against a measure sent to the governor that will eventually force the University of Georgia to drop a federally funded program to train the “navigators” that point consumers to health insurance exchanges.

“I don’t know why we as Republicans would vote to not allow the University of Georgia to help enroll people at no cost to the state, to help enroll people in private insurance,” he later said.

At the very least, Hufstetler’s speech, which startled even Democrats, was inconvenient to the chief resident of the state Capitol’s second floor. The next day, the governor would tell a gathering of rural legislators that he would back a plan allow rural hospitals in south Georgia – which are gasping for cash that could come their way under an expansion of Medicaid – to reduce the services they offer as a way of cutting expenses. For many health care centers, the only other alternative is to shut down.

Hufstetler voted against HB 990, which passed the Senate on a vote of 35-19. Had the bill been defeated Governor Deal would have retained the power to reverse his decision not to expand Medicaid in Georgia.

In addition to Hufstetler's concerns, we would contend that it has always been wrong, even before Obamacare, that those deemed "truly needy" has not included poor single men (and women) not eligible for disability benefits and without custody of a minor child. Must they wait until their diabetic condition requires the chopping off of their left foot before having the privilege of seeing non-emergency room doctors? They shouldn't have to in our humble opinion.

We support repeal of Obamacare, but we also supported reforms in Medicaid to cover poor adults (and Medicare for that matter) before Obamacare became "law" (or a vehicle for presidential executive fiats operating as law). Sadly, a needed expansion of Medicare to cover Rx drugs under President George W. Bush didn't also end state health insurance monopolies and draconian mandates that push up health care costs and cause the ongoing doctor shortage. That mistake is shared by Democrats and the GOP, but we think a credible federal safety net should include drug treatment.

Republicans can't make the perfect the enemy of the good, even as we work for GOP victories in 2014 and 2016 that would make ACA repeal and reform possible; because truly needy single adults in America, many of whom do and have paid taxes to support others in all states, are dying slow deaths due to a lack of medical insurance and care that emergency room visits won't arrest.

Yes, Georgia has many charitable programs, including Grady Cards for those who can figure out that maze which would often have to include hitchhiking to Fulton and DeKalb counties and having fare for MARTA, in addition to compiling a poverty portfolio that must prove a sometimes impossible-to-prove negative, i.e. that one is truly needy.

This debate is not about who cares most about the poor. Democrats that always support more, more and more government funding think that settles the matter of the compassionate condition of one's heart, even as they support policies that kill an economy that makes any government welfare for the poor possible. Also lost in the debate is the simple fact that Republicans have never actually cut any existing welfare program when they have had the power to do so since the New Deal and Great Society programs were passed.

But it should also be acceptable for conservatives to favor interim measures that save lives, especially in an anemic economy kept so for five years by a Democratic Party that seems to prefer economic victim voters supposedly dependent upon them for life. Conservative economic policies are the best program for the poor and middle class. And the GOP can walk with those policies while chewing the gum of health care reform on the road to a post-Obamacare America, at the same time.

"One man with courage makes a majority." - Andrew Jackson

Mike DeVine is a former op-ed columnist at the Charlotte Observer and legal editor of The (Decatur) Champion (legal organ of DeKalb County, Georgia). He is currently with the Ruf Law Firm in Atlanta Metro and conservative voice of the Atlanta Times News.

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