South Carolina should give health insurance to more poor people -- at least as long as the federal government is willing to pay for it, state Sen. Vincent Sheheen said Thursday.
The announcement, made on the campus of the Medical University of South Carolina, focused mostly on Gov. Nikki Haley’s refusal to expand the program under the federal Affordable Care Act, adding to the growing evidence that the Democratic lawmaker plans to challenge the Republican governor to a rematch in 2014.
And it highlighted the tightrope often walked by Palmetto State Democrats who are pushing for an expansion of the state’s Medicaid program in a Republican state often openly hostile to Obamacare.
The Affordable Care Act, or Obamacare, promises to give South Carolina billions of dollars to expand Medicaid, the state’s health insurance program for the poor and disabled. For the first three years -- beginning in 2014 -- the federal government would pay the entire cost of that expansion. It would add an estimated 500,000 South Carolinians to Medicaid who make below 138 percent of the federal poverty level -- about $15,000 a year for a single person and $32,000 per year for a family of four.
However, after three years South Carolina taxpayers would have to cover 10 percent of the cost of the expansion -- a cost state health officials estimate would reach $1.7 billion by 2020.
South Carolina can opt into -- or out of -- the expansion at anytime. That’s why Sheheen said he wants to expand Medicaid for at least the next three years because it would not cost South Carolina anything. Beyond that, he said the state would have to decide whether it could afford to continue the expansion.
He argued that expanding Medicaid would “generate more revenue into the state of South Carolina than it would cost (to expand),” a reference to a University of South Carolina study estimating the expansion would pump $11.2 billion in federal dollars into the state’s economy and create 44,000 jobs by 2020.
“If that is true in the future maybe we would continue with the expansion. But if it’s not true we would have to pull back from the expansion,” he said. “But we would have three years to figure that out.”
Sheheen called on Haley to join “reasonable governors across this country” -- including Republican governors Jan Brewer of Arizona, Rick Scott of Florida, John Kasich of Ohio and Chris Christie of New Jersey -- in supporting the Medicaid expansion.
“On this issue Gov. Haley and any Republican or Democrat who simply says ‘no’ in a knee jerk reaction is not acting in the best interests of South Carolina,” Sheheen said. “This is just plain ideological politics again.”
But Tony Keck, the Haley-appointed director of the state’s Medicaid program, told state Senators Thursday morning he was frustrated with those governors “who just sort of throw up their hands and just say, ‘Well we can’t fix this so we might as well take the money.’”
“I think that’s a sad comment on where we are in terms of our ability to get things done in this country,” he said.
Instead Keck -- in a $75 million proposal embraced by Haley and S.C. House Republicans -- argues the state should pay hospitals incentives to cut their costs. Keck says one of the biggest costs to Medicaid is paying for the uninsured who use hospital emergency rooms as a doctor’s office. Keck’s proposal -- which the S.C. House is scheduled to debate next week -- would pay hospitals to steer those patients to free or subsidized health clinics.
While Sheheen said he likes some parts of the idea -- which he dubbed “Haleycare” -- he said it should not take the place of expanding Medicaid.
“It makes no sense to spend more of our taxpayer dollars which could be used for road construction and improvement or education when we are turning away money we’ve already spent for this very purpose,” he said.
Sheheen said his announcement does not mean he is running for governor, saying it means he is trying to use his role as a state Senator “ to advocate on behalf of the people of South Carolina.” But Sheheen represents Kershaw County in the state Senate, and his decision to announce on MUSC’s campus in Charleston suggests he had other motives.
Haley often refers to herself as the “jobs governor,” touting the number of companies that have decided to locate in South Carolina since she took office. But Sheheen referenced MUSC President Ray Greenberg’s testimony before a state Senate subcommittee last week, where he said the hospital is trying to cut 10 percent of its budget “just to survive.”
“It is very hard to take 10 percent out of your operating budget without reducing your personnel expenses,” Greenberg said.
Sheheen argued that 10 percent cut could translate to about 1,200 “good paying South Carolina jobs” out of the 12,000 people MUSC employs. An MUSC spokesman could not confirm Sheheen’s numbers, saying the university has not studied how opting out of the Medicaid expansion would affect the hospital’s employment levels
“South Carolina continues to have one of the highest unemployment rates in the nation and yet our leaders are purposefully ignoring the fact that over 40,000 jobs could be created right here in local doctors offices and in local hospitals if our tax dollars were kept in South Carolina,” Sheheen said.
A Haley spokesman said “After years of ducking and dodging, it's at least good that Vince has finally taken a position. Unfortunately, his position in support of Obamacare would bust the South Carolina budget and do nothing to reduce health care costs."
And the Haley camp was quick to respond to Sheheen’s comments, forwarding a news release from Sen. Lindsey Graham -- a fellow Republican also up for reelection in 2014 -- saying “We should all be thankful for Gov. Haley's courageous stand against Obamacare.”