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Web letter by David Kolhoff: Refusal of Medicaid expansion a choice of politics over lives

What would be said of a businessperson who refused to engage in a transaction where an expenditure of each $2.60 would safely return between $14.30 and $26.40? I think most trying to be kind would say that businessperson is missing a great opportunity. Many would conclude that person is a fool.

I all the time hear conservative Republican politicians saying that government should be run more like a business. Yet in Indiana, the chief conservative Republican, Gov. Mike Pence, has refused to engage in just such a transaction as described above. But I’m not talking about several dollars; I’m talking about several billions.

The Indiana state government in a slide presentation prepared last September by Indiana Republican officials and the state’s actuary point to Pence’s horrible mistake. Slide 9 shows the estimated cost to Indiana taxpayers of expanding Medicaid under the Affordable Care Act (what most conservatives love to spew out as “Obamacare”) and it shows the estimate of how much in federal tax dollars Indiana doctors, nurses, hospitals, etc. would receive if there were such an expansion. Pence, of course, says he won’t agree to such an expansion and the Indiana legislature completely punted its responsibility to the citizens of Indiana and simply turned the entire matter over to the governor.

Based on Indiana’s own numbers, we would get between $14.3 billion and $26.4 billion in federal tax money for an expenditure of $1.7 billion to $2.6 billion in Indiana tax money. That’s a great deal, and the only possible reason it’s being refused is because the conservative Republicans running Indiana into the ground won’t say yes because President Obama wants it. It is conservative nonsense and nothing more.

Pence says he’s concerned that the federal government won’t actually pay 100 percent of the cost of expansion for the first three years and then never less than 90 percent thereafter (note that the federal taxpayer only pays 75 percent of Indiana Medicaid currently). If that’s a real concern, which it isn’t, then why wouldn’t he and his conservative Republican allies in the legislature expand Medicaid under the Affordable Care Act so long as the federal government pays what it promises? The reason, of course, is because the Republican base includes so many ideologues who would punish those Republicans in future elections for embracing “Obamacare.”

I for one don’t think that a government should be run like a business, since it isn’t. It’s a government that should be run in a cost-efficient manner to provide necessary services to its citizens. I think that health care is necessary. The discussion above doesn’t even consider the estimated 400,000 Hoosiers who would be covered under the Affordable Care Act’s expansion of Medicaid if Pence would simply agree to the more than 1000 percent return being offered. Among those 400,000 people, there will be many who will needlessly suffer and die without health care. That’s what government should try to correct, even if it’s not a good business deal.


Fort Wayne