What Would the Founders Do about Medicaid Expansion?



Earlier this month, the Policy Council issued our annual guide to the year’s legislative session, The Best & Worst of the General Assembly. In the introduction to this year’s booklet (which we comment to your attention), we reminded readers that, in our view, the proper goal of legislation “isn’t to make government more efficient or to make South Carolina more attractive to investors; those are happy consequences, not the goal itself. The goal, rather, is to make South Carolina the freest state in the nation.”

We think that the Founding Fathers, concerned as they were with preserving the freedoms of a newly formed nation, would agree with that assessment. And so we’ve taken another look at some of the bills we analyzed in Best & Worst and asked the question: What would the Founders think of it? If they were South Carolina lawmakers, would they vote “aye” or “no”? In short: What Would the Founders Do?

We take a look first at the euphemistically titled “Truth in Health Financing and Responsible Consumer Health Care Act” – otherwise known as Medicaid expansion, H.4095. It  would opt South Carolina in to expanding Medicaid under the Affordable Care Act (ObamaCare) and use the new money to fund a “Responsible Consumer Health Care Program.” This program would fund a state-run managed care program for those with income 138 percent of the federal poverty level or less. These individuals would receive up to $500 in qualifying preventative care services each year, and would be required to contribute to a medical savings account (a fuller analysis of the bill is here).

It would, of course, be almost impossible for the American Founders to fathom federal entitlement programs like Medicaid, Medicare, and Social Security. The U.S. Constitution sets clear limits on the role of the federal government, and nowhere in the document is the federal government given the authority to regulate medical care. In order to allow federal activity in the field of medical care (and a large number of other activities), constitutional phrases such as “commerce among the several states” and “the general welfare of the United States” have had to be stretched to the point of meaninglessness.

Even if the Founders could be convinced that the regulation of medical care is actually a federal prerogative, however – and even if we were able to hide from them the nation’s $16 trillion debt and the utter irresponsibility of adding to that burden with new entitlement spending – the Founders wouldn’t condone the transfer of state sovereignty to the federal government through the acceptance of accepting mounds of new federal tax dollars ($17 billion over the next 10 years) in exchange for regulating our state’s healthcare system in any way the federal government wants.

The expansion would put South Carolina on the hook for $1.5 billion in new state spending over the next ten years, and, since actual cuts to government almost never happen, that additional state spending would have to be paid for with additional taxes. An expansion certainly wouldn’t make us freer, then: on the contrary, it would make us more dependent on and beholden to government. And inasmuch as the Founders broke with Great Britain chiefly over the issue of burdensome taxation, one has to assume they would vote “no” on H.4095.

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