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This critical view should be taken about the newly passed UPSKILL program, which is expected to cover tuition and fees associated with getting a certificate or degree at a Mississippi public community or junior college. The program, in House Bill 562, passed with unanimous support from lawmakers and the governor signed it into law.

Initially, the program will be exclusively for Mississippians overcoming opioid addiction, hence the funding source of the program starts with money from $50 billion opioid settlement to state, local, and tribal governments. Republican Sen. Nicole Boyd told her colleagues that the program will be good for people in recovery.

“It is the program where we encourage those that are over age 24 to up-skill and get into high priority work sectors,” she said, according to the Magnolia Tribune.

The Design Problem: Labor Market First, Person Second

But UPSKILL’s eligible programs will be determined annually by the state’s review of employer demand and workforce shortages — essentially, what the labor market needs. That sounds sensible, but in practice those designations are heavily influenced by major employers who want a trained workforce pipeline at public expense. The program could function as a publicly-subsidized labor supply program for specific private employers without those employers contributing to its cost.

Crucially such an approach underemphasizes, and even ignores, the fact that each person is born with unique gifts and talents. Asking what the labor market needs and then pushing people into state-sanctioned boxes is the reverse of what should be happening.

A person with a gift for artistry, writing, craftsmanship, early childhood education, or caregiving work might find little room in a program built around HVAC, welding, and construction certifications. The program, therefore, treats people as inputs to an economic system rather than as individuals who deserve respect for escaping addiction and now have distinct contributions to make.

The state might (and probably will) eventually justify the program’s existence and call for its expansion as students apply for funding to gain a certificate or degree in an approved field and shortages in some areas are ameliorated. But in such an analysis, there’s no accounting for quality of life, e.g., if a person finds himself in a job he never wanted just because money was available to meet the need.

The Community Problem: What the State Crowds Out

It’s also worth noting that the program creates a transactional connection between a person and an employer-defined credential, but it severs and discourages the community connections important to the growth and wellbeing of a person, especially one in recovery. The state stipend is $500, which would be a manageable dollar amount for local charities, churches, civic organizations to offer, if they were so inclined.

UPSKILL’s enabling legislation intends participants to tap into other government assistance programs, including Temporary Assistance for Needy Families (TANF) to provide up to $250 for “emergency aid, childcare stipends or transportation assistance (bus vouchers or gas cards).”

That leaves no room for local charities and organizations to engage. If they were invited to, they could offer things the state is not offering: mentorship, peer cohorts, community check-ins, drug rehab integration circles, stuff that goes beyond a program and several hundred dollars. Recovery communities know that sustainable reintegration requires more than a job; it requires belonging.

The state program also has the deleterious effect of creating an expectation that the state will step in to offer money and support services, because that’s what the state does, as proven by this program. One could reasonably ask, “where does the state’s role stop and the community effort begin?”

A person who has spent ten years in a low-wage job, never touched drugs, but lacks the credential to move up — isn’t he or she equally deserving of support? The program’s initial gatekeeping, driven by the funding source, creates a hierarchy of deservingness that puts former addicts ahead of people who also struggle.

None of this is to say the problem UPSKILL is trying to solve isn’t real. Mississippi has thousands of job openings and communities hollowed out by addiction. The state stepped in precisely because communities, churches, and civic organizations hadn’t filled the gap at scale. That’s worth acknowledging honestly. It’s also worth understanding why. Is it possible that the state government’s broad list of programs played some part in the lack of persistence of non-governmental organizations to meet local needs?

The critique isn’t that the need doesn’t exist — it’s that the state’s instinct to solve it by building a pipeline for employers, rather than building up people, reflects a persistent confusion about what investment in human beings actually looks like. It also avoids the bigger questions about systemic problems that Mississippi, and many other states, must begin to understand.

— Wayne Hoffman is President of the public policy education and advocacy organization, Level Up Humanity, and is a research fellow of the Mississippi Center for Public Policy.

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Lawmakers in other states have picked through the federal-state medical welfare partnership, and so far, the best they’ve been able to do is slightly lower the annual increases.

But knowing the outcome of the inquiry is obvious, perhaps lawmakers would be better served in examining the questions that, so far, no state has dared to address:

· Has Medicaid quietly replaced our human capacity for compassion with something cold and rigid?
· Has Medicaid calcified the propensity to show our neighbors love and kindness – the qualities that defined Mississippi and Mississippians for generations?
· Is the six-decades-long experiment in government-administered aid an appropriate substitute for the neighborly concern our grandparents and their parents and grandparents prioritized in their communities?

This is not to say that state officials should not bother spending their time looking at the financial ledger of the state’s Medicaid program, overturning all the accounting rocks in search of waste, fraud, abuse, and potential for savings. But this leaves untouched the matter of what happens to society when compassion becomes a line item, when caring for the vulnerable is outsourced to a bureaucracy, and when neighbors are quietly absolved of any felt obligation to one another.

The Legislature already knows that real reforms — and therefore, real savings — require doing the things no one seems willing to do, such as wholesale elimination of the program’s federally unrequired elements, including prescription drugs and prosthetics.

Indeed, most states including Mississippi have found eliminating program components politically undesirable, and so they avoid raising the question. The reason is not simple electoral cowardice. It is that decades of Medicaid have conditioned Americans to regard government-provided care as so natural that imagining its absence feels monstrous — even though government is filling the role once held by the private charitable networks, church benevolence funds, and community mutual-aid societies.

When the government guarantees a service, the moral urgency to provide it privately fades. The obligation migrates, and with it, something irreplaceable about how a community understands its own members.

Of course, the most optional part of Medicaid is the decision of a state to offer the program at all. No state is required to participate in the Great Society program that Congress passed and President Lyndon B. Johnson signed into law in 1965. States have, one by one, agreed to participate. Mississippi joined in following a contentious special session of the Legislature in 1969. And to date, not a single state has seriously weighed the prospect of dropping from the program, even as costs skyrocket.

Across the country, Medicaid is now the largest program that states administer, far surpassing education as the government’s chief responsibility by cost. Mississippi is expected to spend roughly $8.5 billion on government-run healthcare in the budget year that starts July 1. The state’s portion of the tab will cross $1 billion for the first time, an increase of roughly 16%.

Meanwhile, the loudest debate in Mississippi Medicaid circles is whether the state should expand coverage under the Affordable Care Act to able-bodied, childless adults. Expansion proponents argue that the federal government would cover 90 percent of the cost, that hundreds of thousands of working-age Mississippians fall into a coverage gap, and that rural hospitals struggle with uncompensated care.

Opponents argue the long-run costs are uncertain, federal promises are unreliable, and expansion would add 200,000 or more people to a program already straining the budget.

Both sides are, again, counting money. Neither is exploring the tougher, more challenging matter.

Mississippi has a tradition — rooted in its churches and towns, its extended families and its history of community survival under genuine hardship — of people caring for one another without being instructed to by statute. That tradition has not been destroyed by Medicaid, but it has been crowded out.

When the government guarantees a service, the neighbor who once organized the collection plate for a sick family now assumes there’s a government program somewhere to handle it. He doesn’t need to know about the struggles occurring on his block, across town, or on the other side of the state.

People who are sick need care, and the mere existence of a program is not care. “Care” requires active awareness of the plight of others. Such knowledge can seemingly challenge the capacity of voluntarism alone. But “challenging” doesn’t mean impossible. And it’s important to remember that Medicaid, as large as it is, still has a tough time meeting the needs of the people, in part because it is so large — and because bureaucratic rules often displace personal judgment and local knowledge.

The question is not whether the sick receive help but through what means, and at what cost to our common life and our moral character as a people.

Mississippi has spent decades and tens of billions of dollars discovering that you can administer a program for hundreds of thousands of people; you can budget it and audit it and let contracts for it, but you cannot manufacture compassion or replace what is lost when the community stops being its own first answer.

If Mississippi lawmakers really want to understand Medicaid and its consequences, these are the questions they should spend their time considering this summer.