I’m a health policy wonk, with the academic and professional credentials to prove it. I’m used to writing opinion pieces that take policy positions based on research and data analysis about what works and what doesn’t, with careful attention to costs and benefits.
When I began writing this piece about the impact on Texans of the American Health Care Act, passed by the U.S. House of Representatives on May 4, I reviewed the language of the bill and dozens of analyses from diverse sources. I outlined the major provisions and noted the differences between this bill and the Affordable Care Act. When the Congressional Budget Office released its estimate of the impact of the bill, showing an increase of 23 million in the number of people who would be uninsured in 2026, due to reduced support for lower income families to obtain coverage combined with tax cuts for monied interests, I dived into the details.
I planned to explain how this bill could return Texas to its past where people with preexisting conditions struggled to find affordable insurance coverage. I was going to show the risk to Texas children, pregnant women and aged and disabled people, and to the state budget, because of billions of dollars in cuts to the federal contribution to our Medicaid program. Surely a reasoned, fiscally sound analysis would make the point that this bill takes us backward.
But the tone and content of social welfare discussions, including health policy, have changed in the last 20 years. Left and right always had different approaches to solving thorny societal problems, especially those involving poor people. In the 1990s, we debated the efficacy of welfare programs, and there was serious disagreement about the best ways to alleviate poverty. President Clinton signed the Personal Responsibility and Work Opportunity Act of 1996 to “end welfare as we know it” amid this debate. In 1996, we didn’t doubt that government had a role to play in poverty reduction; we argued about the best way to do it.
That consensus no longer holds. The American Health Care Act, followed by the release of the White House’s proposed budget, represent a radical departure from a core belief that held this country together for the last century – the belief that we’re all in this together. I still hold this belief, and it shapes the way I examine policy proposals. I’m also the president of a faith-based philanthropy, called to serve our neighbors, especially those in greatest need. We are our brother’s keeper.
There’s a lot of talk about who is worthy of compassion, and therefore help, and who is not; the deserving poor versus the undeserving poor. Too many people seem to have confused merit with grace.
The federal government has an important role to play, on behalf of all of us, in solving social welfare issues like health policy. Health doesn’t have to be a zero-sum game. We have more than enough resources invested in health care in this country – $3.2 trillion annually – to improve the health of our entire population. Now we need political leaders with the courage to do the right thing for all Americans.