Medicaid expansion advocates in SC ask foes to at least consider options

Discussion about Medicaid expansion in South Carolina too often has boiled down to party politics rather than true examination of how to improve health care in the state, according to the bi-partisan sponsors of a bid to provide health insurance for more poor South Carolinians.

Republicans Sens. Ray Cleary of Georgetown and Paul Campbell of Berkeley joined Democratic Sen. Joel Lourie of Columbia and John Matthews of Orangeburg on Tuesday in pushing for a budget amendment that would bring federal Medicaid dollars to the state to pay for private health insurance for nearly 194,000 South Carolinians.

Those people, most of them working poor, aren’t eligible for subsidized health insurance under the Affordable Care Act. They are caught in a coverage gap because South Carolina’s leaders turned down the law’s option to expand Medicaid to everyone making about $15,000 or less annually. Twenty-eight states and the District of Columbia have accepted some form of Medicaid expansion. The proposed budget amendment announced Tuesday would follow frameworks being used in Arkansas and Kentucky.

Many Republicans, including Gov. Nikki Haley, have refused to consider any expansion of the Affordable Care Act, also known as Obamacare. Cleary noted that reluctance in his statement Tuesday.

“We’re up here, we’re elected, to study the issues before we make a decision,” Cleary said. “Unfortunately, we have people who are willing to make a decision before they even know the issues. Is it something to do or not do? I don’t know. But we have some facts, and it seems Arkansas and Kentucky are able to diminish the roles of Medicaid by providing this. So I think this is well worth studying.”

Two major obstacles stand in the way of the proposal. Haley has made it clear she will not approve it, meaning it would have to have enough support to override a veto. And at the federal level, a U.S. Supreme Court ruling this summer declaring the setup of the federal insurance marketplace illegal in many state would doom this South Carolina proposal, if not the Affordable Care Act as a whole.

The budget amendment would require the S.C. Department of Health and Human Services to develop a plan and submit it to the federal government for approval. The goal is to authorize payment of federal Medicaid dollars to private insurance companies to cover South Carolinians caught in the coverage gap. The policies would be similar to those now available on the federal health insurance marketplace but with extremely low co-payments typical in Medicaid coverage.

Under the Affordable Care Act, the federal government will pay 100 percent of the cost of such a program for the next two years. Beginning in 2017, the state begins to pick up a slightly larger portion of the cost each year, up to 10 percent in 2021. The cost estimates to the state in 2017 would be $57 million, rising to $153 million in 2021. Federal dollars coming to the state would rise from about $846 million in 2015 to $1.4 billion in 2021.

Lourie noted that South Carolina was one of the last states to accept original Medicaid benefits in the late 1960s and early 1970s. He doesn’t want the state to be last this time, and certainly not without a full discussion of the alternatives.

“If people want to shoot this down, don’t shoot it down with political rhetoric,” Lourie said. “Shoot it down with a viable opportunity to help the people we are supposed to help.”

This story was originally published April 14, 2015 at 2:18 PM with the headline "Medicaid expansion advocates in SC ask foes to at least consider options."