Three of South Carolina's Republican leaders blasted the new federal health care overhaul Wednesday for requiring the state to come up with hundreds of millions of dollars more for Medicaid.
U.S. Sens. Lindsey Graham and Jim DeMint joined with state House Speaker Bobby Harrell in charging that the new law will saddle states with massive new costs on an already expensive government program - a prediction the third-ranking Democrat in Congress says is overblown.
The law is expected to add 480,000 people to Medicaid rolls - a 61 percent increase - and cost the state an additional $914 million over the next decade, according to a report updated last week for the state's Medicaid agency. The extra costs would start in 2014, when the mandated expansion starts. By 2019, the law is expected to annually add more than $300 million to state Medicaid costs - or 12 percent more than the state would spend otherwise, the report says.
"It grew government at every turn," Graham said about the law, arguing the better option would have been to help everyone buy private insurance. "This is a tremendous expansion of Medicaid."
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The senators said they hope legislators across the nation joined them in speaking out about the costs to states, to build momentum against the law.
"If they want to do a program like this, fund it. Don't tell the state we have to come up with a billion on top of what's already a strapped budget," said Harrell, R-Charleston. "It's going to be crippling."
But U.S. House Majority Whip Jim Clyburn predicted the law will change before it kicks in, and the extra costs won't occur. He also argued that providing care to people whose only option now is the emergency room - where the public ends up paying their bills - will save the state money in the long run.
Clyburn encouraged his colleagues to work with him to get a better deal from the federal government on Medicaid. But he added the law's 90 percent federal funding for the expansion - when fully implemented in 2020 - is unprecedented, considering states now pay 30 percent of Medicaid costs.
"We're going to revisit this four or five times before now and 2018," said the South Carolina Democrat. "If the economy starts to grow, and we can fix a lot in this system, that may not ever come to pass. ... None of that's going to happen."
Graham countered, "I wish I could rely on that being true." Besides, he said, it doesn't matter whether it's the state or federal government paying because neither can afford it.
"It doesn't matter which form of government is taking money out of your wallet," he said.
The report assumes that everyone who's eligible for the government program for poor and disabled residents will sign up, though that's not currently the case. Under the law, the federal government will initially pay the full tab of people newly eligible. But the report predicts the state will still incur additional costs starting in 2014 as people already eligible sign up for the first time in response to the mandate that people have health coverage or pay fines.
Over the next decade, South Carolina is projected to spend nearly $22 billion on Medicaid, or about 4.5 percent more than it would spend without the new law.
An advocate for the poor said state GOP leaders are being political, rather than pragmatic about the benefits of bringing health care to hundreds of thousands of residents. The state investment is small compared to the federal money that will be spent here on health care, said Sue Berkowitz, director of the Appleseed Legal Justice Center.
"It is sad we are such a poor state that so many people would fall into Medicaid, but we shouldn't blame those folks who could never afford health care on their own to deny them coverage," she said.
The senators praised an effort by attorneys general in South Carolina and more than a dozen other states to sue the federal government - whether it's successful or not.
Clyburn called it a waste of money.