Are KidCare and FamilyCare Welfare? Let's Have a Real Debate on Important Questions

Those who opposed the KidCare and FamilyCare expansions have begun to criticize them as “welfare” programs, effectively killing debate on the merits of expanding health care coverage in the state. Illinois has expanded the FamilyCare and KidCare health insurance programs to over 300,000 additional working families in the past three state budgets. The supporters of these changes assert that they are excellent examples of government doing important work and doing it well. This is so because the children and adults in these programs will be healthier, better students, more employable and more productive; the families will have less medical debt; and health care providers will have less uncompensated care. This is wise policy that probably also saves the state money in the long run. But, to sweeten it further, the federal government pays for two-thirds of the program costs with money that Illinois would lose to other states if we did not use it for this purpose.

Both KidCare and FamilyCare started under Republican administrations and experienced significant expansion under Democratic ones. The ongoing support for the programs comes from both parties. So thankfully they have not usually been partisan issues.

The current opponents of KidCare and FamilyCare appear to realize a central fact about the programs: most of the general public of all political stripes strongly support the programs and other expansions of health coverage. So, instead of criticizing the expansion of “health coverage,” they have taken to criticizing the expansion of “welfare.” When pressed, they admit that they are talking about FamilyCare and KidCare (which overwhelmingly serve working families). When asked to explain how those programs constitute “welfare,” the opponents state that it is because the programs are funded by the “government” and thus promote “dependence.” End of conversation?

If there is opposition to government funding of health care or anything else, there is an important conversation to be had about it. Is it a good use of tax dollars? Can the government do it well enough? What is the appropriate role of the private sector? Can it be done better or more efficiently? Is it appropriate for government ever to have a role in health care? Is health care a high-enough priority to demand its current budget share given the state’s budget crisis? Is “dependence” the right way to characterize people’s use of government services, and, if so, is that always necessarily a bad thing? Is avoidance of this kind of “dependence” more important than providing access to health care to hundreds of thousands of working families and children?

Apparently the opponents of FamilyCare and KidCare do not want that conversation. Instead, this appears to be an attempt to use a hot political code word—“welfare”—to gain a perceived political advantage. It is not meant to provoke conversation or debate. It is meant to close off conversation and debate, to criticize policies of a political opponent without actually having to talk about the policies on the merits.

That is too bad because access to health care is one of the most important conversations of our times, a prime subject to hear about from our potential next governors. Perhaps more important, the candidates’ general attitudes about the role of government need discussion—not just the role but also the whole notion of whether government does any good at all. There is a strong and destructive current in American public discourse that anything involving government is automatically bad, inefficient, and ineffective and therefore presumptively to be opposed. This dismissive attitude fosters a near perfect disconnect in the public’s mind between taxes and the government services that they fund. In this current of public discourse, taxes are “bad” because they fund “government,” and that is just about all that needs to be said. But there is a glaring contradiction: strong majorities of voters want government (or somebody) to provide important services such as health care and agree that many of the services provided by government are necessary or desirable for quality of life.

A debate about the proper government role in health care is needed right now, as is a debate about the proper role of government, period. Government does itself no favors when there are stories of corruption or bureaucratic failures. But it is nevertheless important to maintain respect for the important things that government does well, or is best positioned to do. Debate about how government should do things better or more efficiently or whether government should stop doing certain things altogether is part of this discussion. A candidate is not engaged in good faith in important public discourse by just calling things by highly charged or coded names. To call something “welfare,” or to call it “government,” is just to call it a name. And so what? Neither concept is inherently good or bad. And so let’s have real conversation and debate among our potential governors regarding KidCare, FamilyCare, and the role of government in health care. Indeed, let’s talk openly about the role of government in anything at all. How much of a particular service (such as health care) is needed, how much does it cost and how do we pay for it, is it efficient, can it be done better inside or outside of government, is it a priority, and what are the candidate’s intentions for acting (or not) on these issues?