Gov. Nikki Haley’s office has spent a considerable amount of time publicly bashing the Affordable Care Act, more time than she has spent articulating just what the governor would do to make health care more accessible and affordable in South Carolina.

Months ago she wasted taxpayer dollars and the time of serious health officials by giving them the task of determining if South Carolina should establish a health insurance exchange mandated under the health reform law or allow the federal government to do it.

She created the non-partisan “South Carolina Health Planning Committee” in March of 2011 but behind the scenes wrote that “the whole point of this commission should be to figure out how to opt out and how to avoid a federal takeover, NOT create a state exchange.”

Since the Supreme Court upheld health care reform, she became one of at least five governors to say she would not accept the Medicaid expansion available under the law, an expansion that would be fully paid for by the federal government the first three years and at least 90 percent every year thereafter.

And Haley and Tony Keck, the director of S.C. Department of Health and Human Services, recently penned a joint opinion piece once again lambasting the Affordable Care Act while speaking only in generalities on what they plan to do about reform.

Keck on Thursday morning filled me on some of the Haley administration’s health reform plans and thinking.

He said they oppose the Affordable Care Act because they believe it is bad policy and said the Medicaid provisions are too inflexible to make work in South Carolina.

“Medicaid is not producing the types of results that we hope for all the spending,” he said. “We spend $6 billion a year. The question is, are we getting our money’s worth, and the answer is no, we are not getting our money’s worth.”

He went on to cite the state’s dismal ratings on a variety of health measures.

The state is trying to locate roughly 70,000 children who are hard to reach but eligible for Medicaid, working with physician’s groups, hospitals and others to identify health care priorities and problems, improve in-home care for seniors and may put in place a plan that will eventually reduce the number of uninsured residents from about 19 percent to 5 percent over the next 15 years or so.

Bringing down health care costs is a priority, as well as squeezing out potentially hundreds of millions of dollars of waste out of the system, Keck said. In a couple of weeks, the public will be able to comment on some of the ideas, and sometime within the next 12 months to 18 months, a fuller plan should emerge, he said.

“We are working at these problems, problem by problem,” he said. “We don’t necessarily want to do these huge expansions. We want to deal with the hot spots, trying to lower the costs of health care and hopefully jobs will start to increase. We have to do it within a South Carolina strategy.”

That all sounds reasonable. But what Keck failed to mention are the recent findings based on an unprecedented study in Oregon. It showed that Medicaid improves health care outcomes for the poor dramatically as well increase their economic stability. The study found that those on Medicaid were 40 percent less likely to borrow money or miss paying other bills because of medical expenses.

The Affordable Care Act’s Medicaid expansion could mean health care coverage for an additional estimated 247,478 South Carolinians, according to a 2010 survey by the Kaiser foundation. And the state exchanges South Carolina is also turning down are designed to increase competition in the market to slow run-away health care costs.

Keck said Haley does not mind the accountability that would come with all those federal dollars, just that she believes there’s a better way to improve the system.

The governor shouldn’t worry about having to face federal accountability.

She’s taken the bold step of refusing to implement programs that are almost fully paid for that could lower health care costs while bringing insurance to almost a quarter of a million residents. Keck said her “South Carolina strategy” will do those things, only better.

If Haley fails on those two counts, it’s the accountability the state’s residents will dole out that she should worry about.

Contact ISSAC J. BAILEY at 626-0357, ibailey@thesunnews.com or at Twitter at @TSN_IssacBailey or @ijbailey.