What would Jacob Marley do with Medicaid?

In 2011, 377,700 Utahns, including 100,000 children, had no health insurance. Should the state Legislature expand Medicaid eligibility to cover an additional 42,500 parents and 10,400 childless adults?

Under the Affordable Care Act, the feds would reimburse Utah, over 10 years, $3.6 billion — for a corresponding state investment of $239 million.

Federal law requires hospitals to treat ER patients regardless of ability to pay. That's an advantage to those without insurance, but the costs are ultimately passed along to everyone else in the form of higher medical bills. ER services are the least efficient way to provide health care because they discourage earlier and less expensive interventions.

February marks Charles Dickens's 201st birthday. Last May, NPR's Diane Rehm interviewed British author Ruth Richardson, who had just published her book, Dickens and the Workhouse: Oliver Twist and the London Poor. A caller asked an odd question: "Has the government ever considered paying reparations to the families of workhouse boys?"

"Oh, certainly," Richardson responded. "We call it the National Health Service."

Winston Churchill was born in 1874, four years after Dickens died. The arc of Churchill's life ran to 1965, and we are not so far from the London of his youth.

William Manchester's biography of Churchill describes the tenuousness of life then: "Except for the thriftiest of savers, no class was immune to the catastrophe that followed the passing of a head of household. If a man had been a successful physician or a respectable barrister, his family might have belonged to the upper middle class as long as he was alive, living in Wordsworthian tranquility. All that vanished with his last breath. The family was evicted from the house; the son took a job as a clerk; his mother made what she could as a seamstress, or, in that bitterest refuge of shabby gentility, as a governess in a bourgeois home."

Today, it doesn't take the death of a breadwinner to cast a family into penury; it only takes a catastrophic medical emergency.

The American Journal of Medicine cites to a 2007 study showing that 62 percent of all bankruptcies that year were related to medical bills, and 92 percent of those debtors had medical debt of more than $5,000.

Congress has offered Utah a return of 1,500 percent on an investment of $239 million spread over a decade. The raw economic benefit to Utah from investing in Medicaid expansion would seem to be unarguable, especially when factored with even a conservative multiplier that economists use to measure the ripple effect of consumer and government spending.

Other states and programs will gladly claim any money Utah might leave on the table, should a notion of "principle" triumph over practicality and humanity.

What stands in the way? Well, some legislators' resolute determination to thwart anything that would aid the successful implementation of the Affordable Care Act.

Based on history, two-thirds of the newly enrolled will be children. This "family-friendly" Legislature thus would use the well-being of more than 33,000 children to thumb its nose at a president that legislators despise.

We staunchly defend right to life, but is it really a Utah value to insist that once you're here, no matter your tender age, "You're on your own, kid!"

It won't be pitched that starkly. We'll hear: "Federal funding won't last, and when it goes we can't afford to replace it." There will always be "good" reasons why we shouldn't do the right thing, but if we keep shunting the right thing aside, who are we — or, rather, who are our legislators?

They can give away millions of dollars every year in tax incentives and exemptions to corporations that come asking. They can spend millions on lost-cause message litigation. They can praise their own good management skills. But what does it say about us if they're unable to figure out how to ensure that children who need to see a doctor will actually get there?

David R. Irvine is a Salt Lake City attorney and a former Republican legislator who lives on a professional football player's borrowed heart.