Medicaid Expansion is Catholic Justice

In January of this year, John Bel Edwards assumed office as the 56th governor of Louisiana. Within 48 hours, he had signed an executive order expanding Medicaid as part of the Affordable Care Act—something his predecessor, Bobby Jindal, refused to do. Flash forward 7 months later to the present, over 200,000 people who didn’t have health insurance under the previous administration are now covered.

Medicaid expansion remains a provocative topic throughout the country, despite the fact that it seems to be both a social and fiscal winner. In the 31 states that have expanded their programs, there has been a huge jump in coverage, as well as large savings, job growth, and increased revenue. In states like Ohio, Medicaid spending has actually dropped—a sharp contrast to the 19 states that haven’t expanded their programs where Medicaid spending has, ironically, increased by 6.9%. In Kansas, for example, non-expansion has cost the state over $1 billion since 2014.

Obviously, for the expansion states, these numbers are great and should be celebrated. But for me as a Catholic, neither the fiscal benefits nor my political leanings are the main reason why I support Medicaid expansion (and single payer, for that matter)—I do so because of Catholic Social Justice.

The Catechism makes it clear that healthcare is vital part of life and a right for all.

Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good.
Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance. – The Catechism of the Catholic Church, 2288

Additionally, the USCCB reiterated this notion in a 2009 letter to congress about healthcare:

All people need and should have access to comprehensive, quality health care that they can afford, and it should not depend on their stage of life, where or whether they or their parents work, how much they earn, where they live, or where they were born. The Bishops’ Conference believes health care reform should be truly universal and it should be genuinely affordable.

Now, it’s true while the Church sees healthcare as a right, they’re not making a sweeping endorsement of government sponsored, single payer healthcare. In fact, the Church is very explicit about its dedication to subsidarity:

Excessive intervention by the state can threaten personal freedom and initiative. The teaching of the Church has elaborated the principle of subsidiarity, according to which ‘a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to coordinate its activity with the rest of society, always with a view to the common good.– The Catechism of the Catholic Church, 1883

 That said, the Church has, on multiple occasions, stated that the public authority has an obligation to ensure the protection of rights.

It is vital that government leaders and financial leaders take heed and broaden their horizons, working to ensure that all citizens have dignified work, education and healthcare”. – Pope Francis, Evangelii Gaudium

For “to safeguard the inviolable rights of the human person, and to facilitate the performance of his duties, is the principal duty of every public authority. – Pope John XXIII, Pacem In Terris

Political authorities are obliged to respect the fundamental rights of the human person. They will dispense justice humanely by respecting the rights of everyone, especially of families and the disadvantaged. Catechism of the Catholic Church, 2237

So when it comes to something a complex and necessary as healthcare, you need more than the charity of others to ensure that all people have access. The public authority needs to act. Say what you will about the Affordable Care Act, but in the years before it became law, upwards of 18% of Americans (approx. 12 million people) were living without health insurance. Now, that number has dropped to 11%, with over 12 million people covered under the Medicaid expansion.

Yet there are still nearly 3 million people between the 19 non expansion states who live in the coverage gap, meaning they don’t qualify for Medicaid under current laws, but also don’t make enough to qualify for the insurance exchange. And neither charities, nor the market, nor anyone else is addressing this issue. Barring a dramatic, immediate change in their job or income level, the only way many of these people can expect to find coverage is through the Medicaid expansion.

As both Christians and Americans, we have to stop thinking about healthcare as something to be “earned”, and start looking at it as something that all people—regardless of status, class, or income—are entitled to. And if you’re a Catholic living in one of the 19 expansion states, I encourage you to petition your governor to expand your state’s Medicaid program. Not because it’s fiscally beneficial, but because it’s morally right.