Democrat Gov. John Bel Edwards finds himself needing to escape some unfavorable public scrutiny catalyzed efforts to find help for over a thousand Louisiana families with children with disabilities.
Without fanfare, close to the end of the Louisiana Legislature’s 2019 regular session, Edwards signed HB 199 by Republican state Rep. Dodie Horton into law. Act 421 requires the state to follow the “TEFRA option,” first made available in 1982 that permits Medicaid assistance to families with a child with disability regardless of family income and assets. As long as the cost of care for the client at home comes out less than if institutionalized, the state must provide similar services as in institutions.
By way of example, Horton recently visited with a new program recipient as part of a media story. Until the law went into effect recently, that family paid $74,000 a year out of pocket for care, putting it under a severe financial strain. This highlights the perversity of existing Medicaid policy, where families with lower incomes receive these services for free, but those middle-class and above have to divest themselves of assets they earned, often by spending themselves into poverty because of bad fortune in order to qualify for Medicaid services.
This also puts an uncomfortable spotlight onto the liberal political ideology of Edwards that drove his choice to expand Medicaid and the perversity behind that. The left ignores any distinction between the deserving poor – such as many people with disabilities whose afflictions prevent them from contributing to society economically more than trivially, if at all – and those who choose to behave in ways that make it difficult to leave poverty behind. Conservatism recognizes that those born with mental and physical disadvantages may need a safety net to help them live meaningful lives, but policy should address differently those who are in poverty because of inferior choices rather than bad luck, in a manner that asks for recipients of government largesse to contribute to their own cause and to take increased personal responsibility for their lives.
Edwards’ Medicaid expansion didn’t do that. It simply affirmed that any able-bodied working adult household below a certain level of income (it also can include children, but existing medical programs already covered the vast majority who live in families below the specified income level) got free health insurance – even though at least a third who thus qualified already paid for their own insurance.
Increasingly, this has created a public relations problem for Edwards. He made great show during his first day in office of expanding Medicaid that has grown to include around 460,000 new clients. Starting next year, that will cost state taxpayers over $300 million a year, while tax revenues from that activity won’t even cover a third of that amount – and as much as $150 million of that will go to around 200,000 people who can afford their own health insurance.
On that day, Edwards chose to give government freebies to all these people, but ignored the 1,600 or so families who, ironically, had the character and ability to contribute significantly to society that disqualified them from any assistance, which would cost state taxpayers only about $9 million annually. And he continued to ignore them through the first three years of his term.
All the TEFRA option required was the state to tell the federal government it wanted to pursue it. As a practical matter, then all the state had to do was fund it and collect the federal government match; it didn’t require separate legislation. But Edwards never proposed that spending in any of his first three budgets – even though the Louisiana Development Disabilities Council supported it and his own Governor’s Advisory Council on Disability Affairs recommended it in 2017 – even as he fought for other items of greater expense, among these expanding the state’s earned income tax credit by $21 million that discourages work and productivity, or making the state pay to administer food aid to able-bodied adults without dependents without requiring them to make any serious effort to work or to engage in work-related activities.
This left him with some bad optics as he jostled for reelection this year. He doesn’t lift a finger to spend $9 million to help families with children born with disabilities whose only crime was to have parents be more productive citizens, yet he’ll give away $150 million to able-bodied adults already paying for their own health insurance. Into this environment Horton offered her bill that won unanimous approval and his signature. (Meanwhile, Edwards had his chief of staff disparage Horton and vetoed a line item for her district in this year’s capital outlay bill.)
None of this came naturally to the politician Edwards, who spends the people’s money to encourage more people to vote for him, and in this case 200,000>2,000. It’s great that he finally supported the idea behind Horton’s bill, but until this year he was missing from action, showing by the policy priorities he chose he puts politics over people, even those most in need.