The enlistment of roughly half the Republican legislative delegation in implementation of Obamacare’s Medicaid expansion is remarkable. Republicans tend to fall by faith in opposition to bigger government investments in the well-being of poor people.

But some of the faithful hold firm. I was drawn to Rep. Josh Miller, a Republican legislator from Heber Springs, who orated against the private option Medicaid expansion last week. He invoked FDR’s New Deal — a “hand up,” he said, not a “handout.”

Miller is of interest because he’s a well-known beneficiary of federal government support himself.

Miller, 33, was on an alcohol-fueled drive with a friend about 11 years ago (he can’t remember who was driving) when their pickup plunged off a ravine near Choctaw. He was rescued, but suffered a broken neck and was paralyzed. Miller was uninsured. What young, fit man needs health insurance, he thought then. (He had some reason to know better. Not long before, he’d broken his hand in a fight and had to refuse the recommended surgery to fix the injuries properly because he was uninsured.)


Months of hospitalization and rehabilitation followed, including a long stretch in intensive care at St. Vincent Infirmary. There was a $1 million bill. Medicaid paid most of it. Miller was placed on disability and checks began. In time, between Medicaid and Medicare, all his health costs were covered by the federal government. For that reason, he need not be among the 82 Arkansas legislators (61 percent of the body) who enjoy heavily subsidized and comprehensive state employee health insurance.

Health insurance isn’t Miller’s only government benefit. Another federal Medicaid program for which he qualifies provides daily personal care assistance.


Between the government-paid trauma care, ongoing Medicare and Medicaid coverage, government-provided personal assistant and his own grit, Miller has made a full life. He manages a rental property business (some government-subsidized renters are among his tenants) and serves as a legislator.

My question: How could someone who’s received — and continues to receive — significant public assistance oppose health insurance for the working poor? Isn’t Miller himself a shining example of how government help can encourage productive citizens?

Miller sees it differently. He said some who qualify for the private option aren’t working hard enough. He claims many want health insurance just so they can get prescription drugs to abuse. He draws distinctions with government help for catastrophic occurrences such as he suffered. He falls back, too, on a developing defense from private option holdouts that they prefer an alternative that wouldn’t end coverage for the 100,000 people currently signed up, at least until next year. This is disingenuous. He and other opponents have made clear that they want to strip Obamacare from government root and branch. Here’s how Miller boiled his opposition down:

“My problem is two things,” Miller said. “One, we are giving it to able-bodied folks who can work … and two, how do we pay for it?”


Lucky for Josh Miller, such thinking didn’t prevail when Congress — over Republican opposition — created the programs that sustain him.

A coldly rational person might say a cook in a fast-food restaurant, working long hours at low pay to feed a family, looks more deserving than an uninsured person injured on a drunken joy ride. I would not. No one should be pre-judged on a subjective merit test for health care. We are all God’s children — all residents of a country Republicans like to call exceptional, despite its lack of universal health care.

Apart from the core philosophical difference — Miller opposes an expansion of government expenditures; I don’t — Miller’s position seems to boil down to the belief that some needy people are more deserving than others.