House members were offered two choices on Medicaid, the federal program that provides health care to the poor. They could choose between a three-year expansion of the program, insuring hundreds of thousands of previously uninsured South Carolinians, with the federal government picking up the whole tab. Or they could vote to let S.C. residents continue to pay the billions in federal taxes earmarked for the expansion, but refuse to actually allow the expansion to go through, saving no money and insuring no new patients.
Despite hours of pleading by expansion proponents, the vote ended up the way observers had been expecting for months: 73 Republicans voted against it, and 45 Democrats voted for it. Next it’s the state Senate’s turn to weigh in.
Was the vote’s outcome because that was the best decision for the state? Did it make good financial sense? No.
“It was more political than it was financial reality,” said Rep. Tracy Edge of North Myrtle Beach, who voted against the expansion with all of his GOP colleagues.
The background is a bit more complicated, of course.
The growth of Medicaid was designed in phases. The federal budget pledged to pick up the entire bill for the first three years of expansion, and then states would slowly take on more responsibility for funding until 2020, when they would be expected to pay for 10 percent of the cost of the new enrollees. The program begins in 2014, but states can opt in or out at any time. S.C. expansion proponents – most health care providers among them – proposed taking advantage of at least those first three years, when the federal government was paying the whole bill, then reassessing whether the program worked and whether South Carolina could afford to continue before dedicating any state dollars to the expansion.
That compromise approach appeals in two ways: It lets the state test the expansion to see how many people really sign up and take advantage of services, giving us a better estimate of what the cost to the state would be later. It also allows us to take advantage of a federal program that taxpayers will be funding anyway, whether South Carolina joins in or not. In other words, it would bring more taxes paid by S.C. residents back to the state. The alternative is not paying less; it’s handing our money to our neighbors.
But when the U.S. Supreme Court ruled last year that expanding Medicaid could not be mandated as part of the Affordable Care Act – better known as Obamacare – Republicans across the nation jumped on it as a concrete way to show their opposition to the health care program and the president.
Gov. Nikki Haley vowed last year not to allow an expansion and has stood firm behind her veto threat, even as other Republican governors – Florida’s Rick Scott and New Jersey’s Chris Christie, for example – have softened their stances.
Whatever your views on Obamacare – and there are certainly plenty of issues to address within the massive government program – the defeat this week was folly. Refusing to allow better health care for the least of our S.C. brethren not because of the cost, which would be picked up by the federal government, but simply because of qualms about who proposed the idea is a particularly craven brand of politics.
Yes, there is a valid concern that our leaders won’t have the will if necessary to remove hundreds of thousands of people from the rolls if they determine in three years that the state can’t afford to pay its share. Nobody will want to be tagged as the politician who kept poor Johnny from getting his needed operation three years from now. But that reality could be avoided by including an automatic sunset provision that would kick in unless overridden, at least partly shielding politicians from political fallout.
The Senate, which takes up the state budget in the next few weeks, is expected to have a better chance of passing the expansion, and we hope they do, at least for the next three years. If they can manage to, there are signs that some Republican House members would be willing to change their own stances.
Edge, a former chairman of the health care subcommittee that oversaw the state’s Medicaid spending, said this week that he doesn’t necessarily oppose the expansion and in fact thinks it would probably be better than the $83 million alternative that Republicans offered – money that would insure no new patients but would pay hospitals to encourage poor residents to get more care at free health care clinics rather than emergency rooms. Both parties agree that that money would be well spent on worthy programs, but that wasn’t really the point, Edge said. Those voting for the money are “spending $83 million just so you can say you’re not doing Obamacare.”
Other GOP House members have also expressed doubts about turning down the expansion.
Rep. Kris Crawford, a doctor from Florence, has voiced support for the expansion, and said that opposition can be traced only to politics. And Rep. B.R. Skelton told The State newspaper last week that “There are some people in the Republican Caucus who believe we should take the money.”
The big issue of course continues to be Gov. Haley and her veto threat.
“We were handcuffed early on by Nikki Haley,” said Edge.
If the governor does not change her mind, finding the two-thirds majority needed to overcome any veto may prove impossible. But we fervently hope there still remain enough politicians with the courage to do what’s right for our state rather than what’s right for their own re-election campaigns.
Otherwise, sorry, uninsured poor. Your health care has been held hostage for political reasons. Better luck next time.