Health care reform is helping South Carolinians, but the state’s decision not to expand Medicaid leaves those most in need without health insurance while costs continue to rise, according to local lawmakers.
Rep. Bakari Sellers, D-Denmark, called the decision not to expand Medicaid, “a $200 million concern.”
“It is going to cost the taxpayers. We just have to write another check instead of letting the federal government pay for it. It is redundant,” he said.
When President Barack Obama signed the Affordable Care Act in March 2010, a piece of the law left it up to the individual states to decide whether to opt into an expansion of the Medicaid program. While the federal government promised to shoulder the initial cost of the expansion, the state would gradually pick up a larger share.
Gov. Nikki Haley and most of the state’s Republican legislative leadership opposed the expansion, saying it was too costly in light of existing budget challenges.
The S.C. Department of Health and Human Services Office of Planning and Budget reports the state would have to spend $745.9 million extra for Medicaid over the next six years if it accepted the expansion. That’s if only 67 percent of the people eligible participated.
If all those eligible signed up for Medicaid, the expansion would cost the state $1.1 billion over the next six years, according to Health and Human Services.
“The enrollment in Medicaid is about 1 million, so an increase of 400,000 persons because of expansion is relatively large. Presently, not everyone that is eligible for Medicaid signs up,” said Tim Rogers, staffer on the S.C. House Ways and Means Health Care Subcommittee.
Rogers said the totals take into consideration that federal government will pay 100 percent of the expansion costs through 2016. The state would then be responsible for 5 percent in 2017, 6 percent in 2018, 7 percent in 2019 and 10 percent from 2020 on.
Even without the expansion, the state’s Medicaid budget has grown from about $5.8 billion in 2011 to $6.5 billion in 2013, Health and Human Services reports.
According to the Health and Human Services expectations, the budget will continue to grow to about $7 billion by 2015 without the expansion of Medicaid.
Officials expect the growth because more people are aware now that they qualify for Medicaid.
Health and Human Services Director Tony Keck said the state has brought more than 100,000 South Carolina children into the Medicaid program since 2011.
“When we came into office in 2011, we had 450,000 people eligible for the program and not enrolled,” Keck said.
The state Legislature made a promise to help people who had not been helped, he said. “We saw that we needed to bring them into the program.”
Keck said the governor has been clear about the need to help those who need help.
“These promises have been around a long time,” he said.
Keck said there has also been a growing list of poor people needing disability services. They are also being helped.
“The governor says we need to help people in need through lots of different ways,” Keck said. “It does not have to be Obamacare.”
Keck said the Medicaid expansion offered through the Affordable Care Act would end up being another “government entitlement program.”
Rep. Russell Ott, D-St. Matthews, says Medicaid expansion is not “some kind of government entitlement program.”
“These are working South Carolinians,” he said. “This is money that South Carolina taxpayers paid into the federal government that we won’t reap the benefits from.”
Rep. Gilda Cobb-Hunter, D-Orangeburg, said there are 200,000 people in the state who have “fallen in the coverage gap” since they do not qualify for subsidies and could have been covered under Medicaid expansion.
“I fail to see how 100 percent federal funding is costing South Carolina and is too expensive,” she said. “Even in 2020, when the state would have to pick up 10 percent of the Medicaid expansion tab, it’s much cheaper than employers and the privately insured picking up 100 percent of the uncompensated care cost shift tab.”
Cobb-Hunter is optimistic state leaders will have a change of heart.
“The elections will be behind us and I fully expect the General Assembly to figure out a way next year to expand Medicaid without calling it that,” Cobb-Hunter said.
Rep. Jerry Govan, D-Orangeburg, said the issue is all about politics.
“This is not about President Obama,” he said. “This is about the physical well-being and health of citizens in this state.”
“We realize there are thousands of people in South Carolina who unfortunately do not have health insurance,” Govan said. “Of course, there are those who know how important health insurance is to not only the physical well-being but also to the financial well-being of families.”
Govan said from all indications, the state’s leadership does not look like it will change its mind about accepting federal dollars for the expansion of the program.
“The different sides are pretty well entrenched,” Govan said. There was a renewed effort to deal with Medicaid expansion a few weeks ago, but it failed.
“I think it is pretty evident that this issue … is one you will see rear its ugly head throughout until the general election,” he said.
Sen. John Matthews, D-Bowman, is confident state legislators and leaders will eventually come around to see the benefits and importance of Medicaid expansion.
In three to five years, the General Assembly will have a change of heart and accept Medicaid expansion, he said.
“This state’s leadership is always lagging behind on changes,” he said. “The more people learn about it, the more people will go online, the more I think they will sign up. You will see less resistance and more support.”
Haley spokesperson Doug Mayer said the governor continues to stand by her opposition to the Affordable Care Act.
“As we’ve seen over the past six months, the president’s health care plan is an unmitigated disaster and Gov. Haley, without qualifications, stands by her decision to reject it and its centerpiece: the expansion of an already broken Medicaid program,” Mayer said in a prepared statement. “Obamacare is wrong for South Carolina and the governor will continue fighting against it while pushing for the state-based reforms that will actually improve the health of our citizens.”
Matthews said most of the people he has talked with are pleased with the Affordable Care Act.
“The roll-out was bad, but the product is good,” he said.
Matthews said he personally has talked to an Orangeburg businessperson who had a pre-existing condition.
“He was paying $1,250 a month on his bill and now it is less than $600,” Matthews said. “There are some good features. In some cases there will be some (costs) going up, but the number going down will outweigh those going up.”
Sellers said he has heard stories of people who did not have insurance being able to be seen by a primary-care doctor for the first time ever. He has also heard from those who were denied coverage in the past because of pre-existing medical conditions being able to benefit from health care.
“It is an exciting time and we are looking forward to greater stories,” Sellers said.