It is Time to Expand Medicaid Coverage in South Carolina
When it validated the constitutionality of The Patient Protection and Affordable Care Act in 2012, the United States Supreme Court also ruled that states could decide for themselves whether or not to expand their Medicaid programs (Sonfield, 2012). Predictably, South Carolina said no. The Palmetto State’s decision not to expand Medicaid in concert with the Affordable Care Act was wrong, and it is time to correct that mistake.
The leadership’s decision not to expand Medicaid leaves between 300,000 and 400,000 South Carolinians without health insurance (South Carolina Medical Association, 2012). The stated intent of the Affordable Care Act, pejoratively dubbed “Obamacare” by its critics, was to put affordable health care within reach of more of the 40 million Americans who lacked health insurance. The law’s grand design included an assumption that states would expand their Medicaid programs, since the federal government would pay 100 percent of the expansion costs through 2016, and 90 percent thereafter. But in demonstrating its traditional mistrust of Washington’s promises, Columbia declined the offer and, in the process, left thousands of low-income workers without the means to obtain health coverage, either because they cannot afford the premiums or because their employers do not provide it. (Advisory Committee, 2013). Ironically, in a state where the median annual income is $44,600, South Carolina’s working poor earn too much money to qualify for Medicaid; however, they would be covered under the ACA model (Hailsmaier and Blasé, 2010).
While voluntary, non-compliance with Obamacare’s strategy will cost the state. South Carolina’s share of the nation’s ACA-engineered Medicaid expansion through 2020 will be $1.1 billion (Zaleski, 2014). At the same time, had the Palmetto State chosen to grow its Medicaid ranks, the federal government would be injecting $13.34 billion into the state’s economy. According to the South Carolina Medical Association, “for every $7.50 South Carolina puts into [Medicaid] between 2014 and 2020 to cover new beneficiaries, the federal government will pay $92.75” (South Carolina Medical Association, 2012). But unless the state reverses course and expands Medicaid coverage, South Carolina’s $1.1 billion share of the national program will be distributed to other states while its citizens get nothing in return. In other words, the state’s taxpayers will be on the hook for $1 billion, with the number of uninsured exceeding the combined populations of Greenville, Charleston and Columbia. (Populations of South Carolina Cities, 2010)
So far Gov. Nikki Haley is unmoved. Haley and the state’s conservative legislature have refused to accept the $13.3 billion in federal funds, arguing that the state will be unable to pay the state’s Medicaid bill once full federal subsidies end in 2020 (Haley, 2014). Their working assumption is that Washington will renege on its 90-percent...