In response to the Supreme Court’s recent decision to allow states to opt out of the Medicaid expansion under the Affordable Care Act, at least 15 governors have voiced their opposition. Gov. Nikki Haley logged on Facebook to make known her stance against the expansion.
She wrote: “South Carolina will NOT expand Medicaid, or participate in any health exchanges. We will not support Pres. Obama's tax increase or job killing agenda. I WILL do everything I can to get Mitt Romney elected and work to strengthen our Senate so that we can repeal this unAmerican policy aimed at moving our country in the wrong direction.”
South Carolina Democrats and industry professionals are concerned — but not surprised.
“If George Bush hated black people, then Nikki Haley hates poor people,” said outgoing S.C. Rep. Boyd Brown, D-Fairfield. “It makes me sick.”
Brown said that the politicians that often cite Christian morals and principles are the ones cutting funding to the poor people who need it most.
"I can't think of anything further unChristian than cutting funding to the people who need it," he added.
“It’d do her some good to see exactly what Medicaid does. It baffles me that she’s against it, but no, I’m not surprised."
Dick Harpootlian, chairman of the S.C. Democratic Party, said: “This is a preening politician’s publicity stunt and is typical with Nikki Haley. This is petty and foolish and is about Haley trying to get a job in D.C.”
Harpootlian said he thinks the governor is putting politics before the people of South Carolina.
“She’s using the misery of the people of South Carolina as a springboard to get to Romney,” he said.
Health care economist consultant Lynn Bailey of local firm Lynn Bailey Associates said she, too, anticipated Haley’s reaction.
“Are we surprised that our governor would throw the poorest of the poor under the bus?” she asked. “Not at all.”
Bailey said that if the legislature follows through with opting out of the program, the people who will hurt the most are poor people who do not currently fall into one of the Medicaid categories.
“Is that the kind of state we want? No, but it’s the kind we get.”
The combination federal-state program expansion extends Medicaid enrollment eligibility to those under 65 at or below 133 percent of the federal poverty line. Coverage would include those adults making about $15,000 or less per year, or about $31,000 or less for a family of four, according to federal poverty guidelines.
Federal law requires state Medicaid programs cover low-income mothers, children and pregnant woman as defined by federal guidelines. States may choose to extend service to the low income elderly or people with disabilities.
The first three years of the expansion, beginning 2014, would be fully funded by federal dollars with at least 90 percent covered federally each year thereafter. This would insure anywhere from 335,000 to more than 500,000 South Carolina residents and provide a 56 percent reduction in the total number of uninsured adults.
Tony Keck, S.C. director of Medicaid, said an expansion of coverage is not what the state needs. Keck is also the director of the S.C. Department of Health and Human Services, as chosen by Haley in January 2011.
“What we’re saying is as long as the Medicaid system is as broken as it is, it doesn’t make sense to expand to coverage,” he said. “The governor and I work on those policies together, so you know, that’s how we feel about it.”
Keck said that instead of taking on new beneficiaries, S.C. Medicaid should work to enroll those eligible under current state program requirements.
“We share the goal of getting everyone healthy, but you gotta pay for it. We wanna make sure that we fix the [current] healthcare system before we dive in and try to fix a system that hasn’t produced great results,” he said. “The money has to come from somewhere.”
According to a detailed report by the Kaiser Family Foundation, the Medicaid expansion would require a 3.6 to 4.7 percent increase, or an extra $470 million to $615 million, in Medicaid spending from 2014 to 2019. In 2010, federal and state spending on Medicaid totaled more than $5.1 billion. South Carolina paid about 20% of that bill, or about $1.1 billion.
Graph and statistical information in this article were provided, with permission, by the Kaiser Family Foundation, a non-profit foundation dedicated to health care information and analysis.