Commentary: Freeloading on health care isn't freedom of choice

Barbara Shelly is a columnist for the Kansas City Star. (Kansas City Star/MCT)
Barbara Shelly is a columnist for the Kansas City Star. (Kansas City Star/MCT) MCT

The Missouri Hospital Association is nothing if not persistent. It keeps pushing this crazy idea that people should have health insurance.

Last year the member hospitals went so far as to volunteer to pay the state millions of dollars to gather more low-income citizens under its Medicaid umbrella. Republicans in the legislature called the plan a welfare trap and told their would-be benefactors to keep their money.

This year, the hospital association is financing opposition to Proposition C. That's the measure on Tuesday's statewide ballot that seeks to tell the federal government that it can't require Missourians to purchase health insurance if they don't want to.

Missouri hospitals don't want this measure to pass. They prefer that people be insured when they seek treatment.

No doubt this strikes some as self-serving. After all, supporters are calling Proposition C the "Health Care Freedom Act." Who would begrudge Missourians their freedom?

Here's the short answer: Freeloading isn't freedom.

Hospitals have to treat everyone who walks in their door. So let's say a Missourian — we'll call him Joe Defiant — decides he's not going to purchase health insurance, no matter what Uncle Sam says. He's young, he's healthy, and he'd rather buy an iPad than pay into an insurance policy.

But then Joe wrecks his car and lands in the nearest hospital emergency room. The staff will patch him up. They'll keep him a couple of days for observation if necessary.

Chances are Joe doesn't have enough money to pay a hospital bill that could easily climb into the tens of thousands of dollars. So the hospital will bear the cost, and recoup some of it from the federal government, and from charging insurance firms higher rates — which they, of course, pass on to policyholders.

"Proposition C would only reinforce a broken system," Herb B. Kuhn, president and chief executive of the Missouri Hospital Association, wrote in an opinion piece. "More than 700,000 Missourians don't have health insurance and the state's hospitals spent more than $830 million in 2008 providing care for these individuals. Under Proposition C, this system of cost shifts will continue."

Well, perhaps. Many legal experts give the ballot measure little chance of being upheld in the courts. But in theory, Kuhn is exactly right.

Supporters of the ballot question are tickled pink that Missouri will be the first state to take on "Obamacare."

But is it really a point of pride to encourage people to go without health insurance? You wouldn't have thought so if you'd listened to the Missouri House debate the subject in 2009.

That year, Missouri hospitals offered to collectively pay the state an additional $52.5 million a year if the legislature would expand Medicaid eligibility.

Currently, a family of four can earn no more than $4,410 a year — or 20 percent of the federal poverty level — to qualify for state assistance with health care. The hospitals and Gov. Jay Nixon proposed expanding the limit to $11,500.

When combined with matching federal funds, the extra money the hospitals were willing to pay would have expanded health coverage to 35,000 additional persons.

Republicans in the House were hard on the uninsured then. One lawmaker called them "plunderers." Another asked why folks couldn't work two or three low-wage jobs if they needed health insurance.

But the legislators who were most offended by the idea of state-subsidized health insurance for the poor are the very lawmakers who this year were most keen to opt out of the federal insurance mandate.

In other words, people who can't afford health insurance are lazy and irresponsible. People who can afford it and chose not to are exercising their freedom.

Go figure.

Better yet, go vote. Don't be fooled by the hype or phony titles. Proposition C is not a referendum on federal health reform, and it's not a ticket to freedom. It's a license to freeload. Just say No.