Columbia, SC — I KEEP GETTING these offers in the mail: Let us send you this cookbook for free, and then well send you another one every year, which you have to pay for, unless you cancel. I throw them in the trash because so far I havent been offered any cookbooks that I want, and its silly to accept something for free that you dont need or want. But if it was something I needed or wanted, itd be even sillier to say no.
You know, like medical insurance, if I didnt have that and couldnt afford it.
Just like our state is silly and thats a kind word to turn down three years of free Medicaid for the working poor, as long as we can opt out before the federal government starts sending us a bill.
But that, in a nutshell, is what South Carolina has decided to do: Democrats want free Medicaid for the working poor for the next three years; Republicans dont want it, and since Republicans are in complete control in our state, we wont get it, at least not the first year of it.
Advocates have recognized for months that convincing the Legislature to expand Medicaid would be a multi-year effort. Most of that effort involves helping legislators and the public understand what the issues really are. To wit:
Republicans are genuinely concerned about the long-term cost of expanding Medicaid, even if their concerns are over-hyped and their claims devoid of context: Expanding Medicaid would cost South Carolina $43 million in 2017, and the cost is projected to increase to $166 million by 2020; by comparison, the Legislature handed out $97 million in tax cuts last year. Which is to say that expanding Medicaid eventually could make it more difficult for our legislators to feed their tax-cut addiction.
But opposition to the three-year freebie expansion has nothing to do with whether we can afford it or not. After all, its free. (The administrative costs that a few legislators like to harp on dont even amount to a rounding error in the Medicaid budget.)
The opposition has nothing to do with fantasies about how accepting the expansion would make it impossible for us to make Medicaid more efficient; all of those cool reforms that Medicaid director Tony Keck brags about and hes right to brag about them have been implemented under the same Medicaid rules that he argues will stymie reform.
Nor does it have anything to do with the insulting claim that people are no better off with health insurance a claim thats championed by Mr. Keck and Gov. Nikki Haley and legislators who arent about to give up their own government-provided health insurance.
No, when you listen closely to what opponents say, you realize that the opposition stems from their fear that our state couldnt accept just the three-year expansion and then return to the status quo before the federal government started sending us a bill.
The key word there was fear, because Republicans dont suggest that federal law would prevent us from taking the money for just three years. Theres not a legal problem with the three-year-and-out expansion. Its a political problem a political problem that Republican legislators and the governor have decided to throw away nearly $1 billion next year in order to avoid.
Theyre worried that they wont be able to muster the political support to cut off the Medicaid spigot once its turned on. That the public, having seen how cool those free cookbooks are, will say: We like these well enough that were willing to start buying them. Particularly since the federal government is only making us pick up 10 percent of the cost.
Talk about not having much confidence in the strength of your own ideas.
Republicans take issue with calling the expansion free. They argue that our nation cant afford to expand Medicaid and pay for everything else its doing, and they are correct about that. Clearly, South Carolinians and everybody else in the country are paying for the Medicaid expansion, through our federal income taxes.
But heres the thing: Were buying Medicaid expansion, for ourselves and for the rest of the country, whether we accept the benefits or not. If we reject them, our cost that is, our federal taxes wont go down. The best that could happen is that the nation would go a little less deeply into debt. And if you really believe thatll happen, then Ive got a bridge to nowhere Id be happy to sell you if the Congress doesnt buy it first.
Ms. Scoppe can be reached at firstname.lastname@example.org or at (803) 771-8571. Follow her on Twitter @CindiScoppe.