Scoppe: Medicaid madness

Associate EditorMay 12, 2013 


— I KEEP GETTING these offers in the mail: Let us send you this cookbook for free, and then we’ll 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 haven’t been offered any cookbooks that I want, and it’s silly to accept something for free that you don’t need or want. But if it was something I needed or wanted, it’d be even sillier to say no.

You know, like medical insurance, if I didn’t have that and couldn’t afford it.

Just like our state is silly — and that’s 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 don’t want it, and since Republicans are in complete control in our state, we won’t 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, it’s free. (The administrative costs that a few legislators like to harp on don’t 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 he’s 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 that’s championed by Mr. Keck and Gov. Nikki Haley and legislators who aren’t 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 couldn’t 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 don’t suggest that federal law would prevent us from taking the money for just three years. There’s not a legal problem with the three-year-and-out expansion. It’s 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.

They’re worried that they won’t be able to muster the political support to cut off the Medicaid spigot once it’s turned on. That the public, having seen how cool those free cookbooks are, will say: We like these well enough that we’re 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 can’t afford to expand Medicaid and pay for everything else it’s 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 here’s the thing: We’re 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 — won’t go down. The best that could happen is that the nation would go a little less deeply into debt. And if you really believe that’ll happen, then I’ve got a bridge to nowhere I’d be happy to sell you — if the Congress doesn’t buy it first.

Ms. Scoppe can be reached at or at (803) 771-8571. Follow her on Twitter @CindiScoppe.

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