That’s a bold statement, and it’s inaccurate in the sense that if you read our Constitution you won’t find the word “Medicaid” in it. Medicaid is a federal program created in 1965 as part of a series of amendments to the Social Security Act of 1935. Here’s a quick, neutral definition of Medicaid from Wikipedia:
“Under the program, the federal government provides matching funds to states to enable them to provide medical assistance to residents who meet certain eligibility requirements. The objective is to help states provide medical assistance to residents whose incomes and resources are insufficient to meet the costs of necessary medical services. Medicaid serves as the nation’s primary source of health insurance coverage for low-income populations.
States are not required to participate. Those that do must comply with federal Medicaid laws under which each participating state administers its own Medicaid program, establishes eligibility standards, determines the scope and types of services it will cover, and sets the rate of payment. Benefits vary from state to state, and because someone qualifies for Medicaid in one state, it does not mean they will qualify in another.”
Millions of Americans rely on Medicaid (and the related Medicare) for medical care. All of them are poor–officially living below the poverty threshold as defined by the federal government. In 2017, for instance, the poverty threshold for a household of four people is $32,300. Most Americans who receive Medicaid are elderly. Many are disabled, many are veterans, many are children.
Medicaid, then, is a federal safety net like Social Security that is meant to maintain a basic standard of living for the poorest, oldest, and youngest Americans.
When the Affordable Healthcare Act (Obamacare) was passed, it required Americans to have health insurance. If someone lives below the poverty line, Medicaid pays for that insurance. To make this happen, the federal government offered all states more money for Medicaid.
18 states, all but two with Republican governors or legislatures, refused to take this extra funding for Medicaid. Some representatives of these states claimed they wanted to draft their own Medicaid “reform” legislation; others, like Maine’s governor LePage, claimed it was just an attempt by the Democratic party to create a “massive increase in welfare expansion.”
That word—“welfare”—has become a charged word in the U.S. Like “liberal”, which means “generous”, welfare is a positive word that has been given a negative meaning by its opponents. “Welfare” means “
But conservatives who oppose any government spending on social safety nets turned our federal welfare system into a whipping boy in the 1980s, under President Reagan. The infamous “welfare queen” Reagan wowed audiences with—a woman who supposedly bilked the federal system to the tune of $150,000 a year—was used by conservatives to damn the program. They said people on welfare were lazy (code word for “black”), and that all hard-working, middle-class Americans (code words for “white”) were paying to support these people who laid around eating candy and watching TV all day. Why should they go get jobs? They were living the good life on our dime. If we got rid of welfare (shorthand for all federal safety net programs, from food stamps to subsidized school lunches to Head Start), the conservatives said, all of those people would have to go out and get jobs, and we’d all be better off.
To help make this happen, Reagan’s administrations cut funding to the programs, and subsequent Republican lawmakers and presidents continued this trend. They also began cutting taxes sharply under George W. Bush. With less money coming into the federal government, less money could go to states to support programs like Medicaid and SNAP (food stamps). States began to cut services, often by making the poverty threshold lower and lower.
These cuts in funding exacerbated the problems of the poor who depended on them. They also coincided with stagnating incomes, a stubbornly low minimum wage, and a forced shift of workers to part-time employment by companies that did not want to pay full-time wages or offer full-time benefits to make the traditionally poor even poorer, and to move working people who used to make enough money to live on into the poverty range, where they need federal assistance.
Despite the fact that “the poor” includes white people, people who are working, children, veterans, and elderly people who worked all their lives, conservatives today continue to slam “welfare” as a trap set by devious immigrants, blacks, and criminals to trick honorable working white people into giving away their money.
Welfare. Despite all of this recent effort to make it a bad word and an even worse idea, welfare actually is in the Constitution. Let’s revisit that famous Preamble (and sing it in our heads to the Schoolhouse Rock melody):
We, the People of the United States, in Order to form a more perfect Union, establish Justice, ensure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity do ordain and establish this Constitution for the United States of America.
“Promote the general Welfare”: that’s written into the fabric of our national identity, the purpose of our nation. One of our fundamental reasons for being is to ensure that every American has the full opportunity to experience the Blessings of Liberty. This is an idea that was first expressed by English settlers in 1630, when Puritan John Winthrop said, in what we call the “City on a Hill” speech,
…we must be knit together in this work as one man, we must entertain each other in brotherly Affection, we must be willing to abridge our selves of our superfluities, for the supply of others necessities, we must uphold a familiar Commerce together in all meekness, gentleness, patience and liberality, we must delight in each other, make others Conditions our own, rejoice together, mourn together, labour, and suffer together, always having before our eyes our Commission and Community in the work, our Community as members of the same body, so shall we keep the unity of the spirit in the bond of peace, the Lord will be our God and delight to dwell among us, as his own people and will command a blessing upon us in all our ways…
As we note in our original post, this is a beautiful passage, reminiscent of the Sermon on the Mount in its focus on mercy, kindness, sharing, and other selfless qualities. The Puritans will not succeed by harrying out the sinner or otherwise smiting evil, but by loving each other, caring for each other, and “abridging our selves of our superfluities, for the supply of others necessities” (that is, there will be equality of wealth, with no one living in luxury while others starve). They will delight in each other, making others’ conditions their own, and they will do all this to create a natural community of faith.
That’s what America was still dedicated to in 1787 when the Constitution was written and ratified by popular vote. We dedicated ourselves to giving some of our own wealth to provide for others. We dedicated ourselves to “liberality”, meaning generosity. We dedicated ourselves to Community, to seeing ourselves as members of the same body, living in a unity of spirit.
In short, we committed ourselves to the “general Welfare”, as the Constitution says. Americans must remember this in an age where we are urged to believe that “rugged individualism” is our true creed, and urged to say “no one helped me so why should I help anyone else?” and “I take care of my own.” Medicaid, food stamps, subsidized school breakfasts and lunches, Social Security, and everything else slighted now as “welfare” are really avenues toward establishing and maintaining the general Welfare our Founders envisioned. No nation is rich if it refuses to create equality of opportunity for all its citizens. No nation ends poverty claiming it is a trick played on the nation by the poor. No nation but the United States made generosity a cornerstone of its political outlook and purpose. Let’s remember that, and live up to our own creed.