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John Livingston

Medicaid is the Ticking Economic Time Bomb

In light of the Idaho Republican House of Representatives “kicking the can down the road” regarding our State’s ever-increasing Medicaid budget and recognizing that when the Federal match for the expansion program will most likely drop from 90/10 to 80/20 and the regular Medicaid match will drop even more when the Republicans in Washington regain control of both houses of congress, I believe a siren call for adult responsibility is appropriate. The people who will be harmed the most will be the people who Medicaid was designed to originally help—the poor and those living on the margins. The people who will be hurt the least will be those who expansion has helped the most—large hospital systems and their suppliers—medical supply companies and big pharma—the two groups that benefited the most from Medicaid reimbursement policies under Covid.

Remember there was never an Idaho CEO of a hospital who made $18million/2yrs until Medicaid expansion and those numbers under the Emergency Order being paid to large hospital systems and everyone down the supply chain have only gotten bigger. Thanks in large part in my opinion to a lack of legislative oversite and a lack of curiosity for examining the issue by a less than curious press and disengaged hospital Boards of Directors.

Let’s for a moment review the history of the “social justice movement” and how it differs from Traditional BIBLICAL JUSTICE, which thousands of years ago defined how we should tend to those who are unable to care for themselves. Medicaid is neither of these.

The Hebrew prophets Isaiah and Amos said that charitable justice means helping the weakest members of society—specifically “the poor, the aged, the sick, the handicapped, the orphaned and the widowed”. In Proverbs, we are told that “whosoever gives to the poor lends to the Lord”

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We are informed in the New Testament that “whatsoever you do unto the least of my brethren you do unto Me”, and “to love thy neighbor (whoever he may be—the good Samaritan in Luke”) informs us in this regard…..”

The great Jewish figure of the Middle Ages Maimonides defined social justice in a more practical and less spiritual sense.

Social justice was described as a series of activities designed to help others. He described these activities as rungs on a ladder. The lowest rung was for giving handouts, the middle rung was for loans or covenants to be paid back (indenture hood would be an example), and the top rung was to help people get jobs. Government programs should focus on the upper rungs of the ladder.

The father of Catholic Social Justice was Fr. Luigi Taparelli the teacher and Confessor for Pope Pius IX who wrote the first Biblical justice encyclical Rerum Novarum. Using Thomistic Philosophy and marrying it to Natural Law Theory Fr. Taparelli introduced the concept of “subsidiarity” “the principle that a central authority should have a subsidiary function, performing only those tasks which cannot be performed at a more local level”. When Nancy Pelosi told Wolfe Blitzer that “we feed them” she was referring to politicians transferring citizens’ tax payments to the poor. That is not her money nor is it her charity nor is it charity of any kind. It absolutely violates the idea of “subsidiarity”.

Charity is what a church—The LDS, Catholic or any Church does when it provides for those in need with the labor or fruits of the labors of its members. When Catholic Charities that receives over 50% of their revenues from government sources provides services to those in need, it is not providing “charity”. Charity is a covenant relationship between the giver and the receiver to which God is a party. The government is Not God—unless you kneel to a secular sovereign as many progressive liberals seem to do today.

A responsible legislator in my most humble opinion would look to the estimated 35 % of people who are fraudulently enrolled in Medicaid. Then she would look to the practice of fraudulent “upcoding” for services that is a ubiquitous practice amongst many providers. Finally, he would codify in State Statute today (this session) the priorities that will be applied to the neediest recipients in the future should the Federal matching formula change. This should be done as a condition for approving the budget as presented by the Governor and The Department of Health and Welfare. Continuing the tradition of passing on a blank check will only make the future more problematic for those who may find themselves ‘living on the margins” tomorrow.

In my opinion, determining these priorities would be facilitated by an independent signed partner’s audit of the Department of Health and Welfare that would be presented to the people of Idaho ( the supposed givers of charity) via their legislature. Any recipient of over $100 million of transfer (supposed charitable payments) would likewise be required to submit such an audit. Maybe we could find out just how “fungible” Medicaid revenues to large hospital systems are that pay their CEOs $18million/2yrs.

Significant reforms in Medicaid and our State Department of Health and Welfare will never reach fruition without leaders who are willing to put their own political capital at risk, who are willing to put the interests of their constituents above the pressure of lobbyist special interests like the Idaho Medical and Hospital Associations (IMA-IHA)—are they not one and the same, and resistant bureaucrats and political opponents.

To my fellow Republicans in leadership positions in the Idaho legislature, I say this: “If not now when? If not you who?”

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