CONTRARY TO the short-hand version in some national reports and even in-state conversations, South Carolina has not refused to expand medical care for the working poor now that the U.S. Supreme Court has said the Congress can’t force states to do that as part of the president’s health-care law. Gov. Nikki Haley has said she opposes expanding the federal-state Medicaid program.
But while her veto pen gives her a bigger vote than anybody else, the governor doesn’t get to decide that. Two-thirds of the Legislature can reject her rejection. And while there are a lot of numbers to be crunched and debates to be had and alternative approaches to be pursued, all indications are that if it came down to such a simple choice, it would be a mistake for the Legislature to follow the governor’s lead.
The governor says Medicaid’s rules are inflexible and sometimes wasteful, and we agree, and hope she and other officials will continue to press Washington for more flexibility, as they have done in recent years, to some success. She says the states should not have to pick up part of the bill for a congressional program — and we agree with that as well, although not because we think a federal health law is a bad idea but because it has never made sense for the states to have to help pay for medical care for poor, sick, young people while the federal government picks up the entire cost for wealthy, healthy, old people.
The governor makes it sound as though our choice is between providing over-priced, substandard care through Medicaid or opting out of the Medicaid expansion and providing better and more efficient care under our own rules. And we might be able to do that if we could spend as much money doing it our way as we could doing it Washington’s way. It’s theoretically possible that we could pull that off if we could spend, say, half as much — i.e., that our way would be twice as efficient as Washington’s way.
But those aren’t our options. At the moment, our choice is to expand Medicaid or else do it our way with 10 percent of the money we’d have if we expanded Medicaid and accepted Washington’s 9-to-1 match; less than 10 percent, actually, since one of Gov. Haley’s objections is that we can’t afford even 10 percent. And even if we were willing to adopt every conceivable nanny-state idea for driving down medical costs — ideas that the governor would never condone and that would go too far even for our taste — it’s simply not conceivable that our program would be nine times more efficient than Medicaid.
No matter how discounted something is, it’s always a bad buy if you don’t need it. And if you do need it but can’t afford it, then you can’t have it. But if it’s something you need and it’s discounted by 90 percent, then even if the original price was ridiculously high, it’s foolhardy not to buy it. Particularly when, as a federal taxpayer, you’re going to be picking up part of that 90 percent whether you accept it or not.