Medical Assistance

I’ve worked with the county office of Family Services several times during the three decades of my pastoral ministry. But yesterday was the first time I’ve ever walked into their office with my own case number. I visited to inquire about a puzzling packet which had arrived from them in Wednesday’s mail. The metered postage was $7.35.

To my shock and horror, the social worker informed me the state had placed my wife and me on Medical Assistance (Medicaid). I had no idea. They did it even though we still have an active private health insurance policy. There had been no notice, except that I had been unable to renew my current health insurance policy on the public exchange. She said I could drop the Medical Assistance in January if I wished. Then I would be left to find my own insurance. She gave me two choices regarding Medical Assistance: take it or leave it. The financial cost of leaving Medical Assistance is enormous. But the cost of taking it might be even more.

Over the years I’ve heard people talk about how welfare strips people of their dignity. I’ve listened to lectures about how helping can actually hurt. I’ve read and embraced When Helping Hurts as one who gives help, not one who receives it. I’ve had a vague, theoretical appreciation of that catastrophic side effect of a system which is intended to help the poor.

It’s no longer theoretical. I felt something very strange in that county office yesterday. I felt demeaned, although that wasn’t their purpose. It felt like my dignity had been stripped away. I felt powerless. Buying health insurance on my own would be very hard, if not impossible. But free health insurance felt like an insult. It hurt. I had to suppress frustration.

In hindsight, some of my reaction was self-righteous pride. The anger I could barely suppress was my responsibility. Maybe I should be willing to receive help. Social workers are doing their best in an impossible situation created by an imperfect system. It’s not their fault. The welfare system is broken. It’s really hard to help those who hurt.

People talk about a “welfare trap.” Today I can feel it. The trap isn’t about receiving help. We all need help, especially help from God. The welfare trap is about becoming dependent on others in an unhealthy way when we should provide for ourselves. The trap is entitlement. It’s dangerous. The Apostle Paul was blunt about this in one of his letters. He wrote, “When we were with you, we gave you this rule: ‘The one who is unwilling to work shall not eat.'” (1 Thessalonians 3:10). He means eating is a privilege which we earn, not a right to which we are entitled. The key word is “unwilling.” This principle requiring work obliterates entitlement. If food isn’t an entitlement to the Apostle Paul, certainly health care isn’t one, either. This is sticky stuff, and I don’t mean peanut butter!

The cost of choosing Medical Assistance is more than wrestling with human dignity and pride. All of a sudden, obscure legal terms like capitation, property liens, and estate recovery have personal significance. Philosophical issues, moral issues, emotional issues, spiritual issues, legal issues, financial issues. All converging at a single point.

It’s decision time.