Issac J. Bailey | Haley now owns the state’s health care system

Gov. Nikki Haley should be judged harshly if access to South Carolina’s health care system does not improve for the state’s most-needy residents, and if her administration fails to stem the tide against increased costs and bad health outcomes.

S.C. Health and Human Services Director tony Keck has made it all but official that the state plans to buck the Affordable Care Act as much as possible.

That means refusing to set up the insurance exchanges designed to help people use the power of competition to bring down costs. That move is particularly perplexing because the exchanges will be set up any way, by the federal government.

For an administration supposedly concerned about state control, it makes little sense.

Keck testified before a state Senate Medical Affairs Committee that the state won’t expand Medicaid under the Affordable Care Act, either. That came just days after the Kaiser Foundation said such an expansion would cut the number of uninsured in the state by about 57 percent while increasing Medicaid costs only modestly, or not at all if you include the billions of dollars of health care spending that would generate extra economic activity and defray what we are now losing while dealing with the uninsured in haphazard ways.

Keck and Haley believe they have good reasons for making such a decision. Sens. Lindsey Graham and Jim DeMint have praised their actions.

Critics claim they are thumbing their noses at the health reform law primarily out of political spite and gamesmanship.

But it no longer matters whether the Haley administration’s motivation is pure or political.

All that matters is that the state has decided to forgo billions of dollars of federal help from a program that is designed to get more people covered and slow the rate of health cost increases. There are numerous independent studies which suggest that flawed piece of legislation has a good shot at doing just that.

The Haley decision is critical because about a fifth of the state’s residents don’t have health insurance. Keck says that providing more coverage isn’t the same as improving health outcomes.

That’s a distinction without a difference.

Those who have health insurance are generally healthier than those who don’t, as well as more financially secure. They worry less about a single, unexpected major health event pushing them into the ranks of personal bankruptcy – whose No. 1 cause is just such a health event that is not covered by insurance.

The Haley administration will continue to ignore studies that undercut its arguments. Political opponents will continue to hammer on them.

That’s just theater, though.

Getting a handle on runaway health care costs and an unhealthy populace are more important.

Haley has forgone the country’s first real, comprehensive attempt to tackle the long-standing health care problem.

That’s her right as governor.

She was elected to lead. Voters were not unaware of her opposition to health reform.

All the cards are on the table.

If in a few years the state of health care in South Carolina has improved, Haley will own that success.

But if it doesn’t, she will own that failure.

And she should.