|Position||All||Registered S.C. voters||Republicans and GOP-leaning registered voters||Democrats and Democratic-leaning registered voters|
|Don’t know or not sure||11.3%||9.7%||8.9%||11.1%|
A slim majority of South Carolinians – 50.8 percent – support expanding Medicaid, the government-run health-insurance program for the poor.
But don’t expect those Winthrop poll results – the first time that South Carolinians have been asked what they think on the issue – to change any minds at the State House.
For months, South Carolina’s Republican-dominated state government has vowed not to expand Medicaid, an expansion that supporters say is critical to improving the state’s heath and economy.
According to the Winthrop poll question, asked exclusively for The State, 36 percent of South Carolinians oppose expanding Medicaid. Eleven percent of those surveyed said they did not know enough to have an opinion. Another 2 percent declined to answer the question.
The poll results are not expected to affect the State House debate. The solidly Republican S.C. House already has rejected expanding Medicaid, an issue the Republican-majority state Senate is expected to take up this week.
The 50.8 percent of South Carolinians who favor expanding Medicaid also is not a decisive majority. The poll’s margin of error is plus or minus 3 percentage points, meaning support could be as low as just under 48 percent or as high as almost 54 percent.
The issue of expanding Medicaid polarizes South Carolinians along party lines, the Winthrop poll found.
A solid majority of Republican or Republican-leaning voters polled, 65.5 percent, said they opposed expansion. Meanwhile, 77 percent of Democratic or Democratic-leaning voters said they supported expansion.
State Senate President Pro Tempore John Courson, R-Richland, compared the Medicaid debate to the filibuster vote in the U.S. Senate last week that killed a gun-control bill despite some national polls showing 86 percent of Americans favored some form of new gun-control laws.
“The political reality right now is that it is not going to pass this year,” Courson said of Medicaid expansion. “It could in subsequent years, but it is going to take a lot of work.”
Moral or fiscal imperative?
Supporters have framed Medicaid expansion as a moral issue that also would benefit the state’s economy.
Expanding Medicaid in South Carolina would make up to 500,000 more people eligible for health insurance. During their budget debate last month, House Democrats quoted Scripture and told about their constituents having to choose between buying groceries or medication.
On Tuesday, the same day the state Senate Finance Committee holds a hearing on Medicaid expansion, the S.C. Christian Action Council – representing 4,500 congregations across the state – plans to hold a rally at the State House to push for Medicaid expansion as an issue of social justice.
Opponents paint the issue as one of financial responsibility, citing the budget deficit in Washington, the lingering effects of the national recession and the state’s budget concerns.
Health care already consumes the largest portion of state spending, they say. Even without the expansion, the state’s Medicaid program needs an extra $154 million in next year’s state budget, which takes effect July 1, to keep up with the rising cost of health care for the poor and disabled.
The state Department of Health and Human Services – which reports to Republican Gov. Nikki Haley, who opposes expanding Medicaid – estimates the expansion could cost the state between $691 million and $1.9 billion by 2020. The conservative Heritage Foundation, run by former U.S. Sen. Jim DeMint, R-Greenville, estimates expansion would cost South Carolina $612 million by 2022.
Hospital finances debated
Hospitals and other medical-care providers counter by saying expanding Medicaid is key to keeping them solvent under the federal Affordable Care Act, commonly known as Obamacare.
Everything else in Obamacare – billions in cuts to Medicare reimbursements and a reduction in federal payments for uninsured payments – will cut into hospitals’ budgets unless Medicaid is expanded. Ray Greenberg – president of the Medical University of South Carolina, one of the state’s largest Medicaid providers – says he will have to cut 10 percent from his institution’s budget “just to survive.”
Tony Keck, director of the state Medicaid agency and a Haley appointee, disputes some of those claims.
Last week, Keck released a report showing S.C. hospitals made a combined profit of $2.6 billion from 2008 to 2011. Instead of expanding Medicaid, Keck is pushing a plan – accepted by House Republicans – that would take existing money and use it to pay hospitals to steer uninsured patients away from costly emergency rooms and into free or subsidized health clinics.
That plan, Keck said, would free up millions of dollars for the state to use on other things – like education or creating jobs. Statistics show that those things help keep people healthier more than simply having health insurance, he says.
“I hope people understand I’m not making this decision just based on the dollars. You could pay for anything you want,” Keck said. “What is primarily driving this decision is what is going to improve health in South Carolina.”
‘People are being educated’
Hospitals also say expanding Medicaid would help the state’s economy.
They point to a University of South Carolina study that says the $11 billion in federal money that would pour into the state from Medicaid expansion would create 44,000 jobs.
Republicans generally dismiss that study because it was paid for by the S.C. Hospital Association, which supports the expansion.
However, those that favor expanding Medicaid include at least eight business groups across the state that normally are supportive of Republican interests. Those groups include chambers of commerce and other business associations in Charleston, Anderson, Florence, North Myrtle Beach, Orangeburg, Dillon, Darlington and the Midlands.
“Support has grown because people are being educated on all of the facts about expansion,” said Rozalynn Goodwin, director of policy research at the S.C. Hospital Association. “They are learning and they are reading about how the uninsured cost all of us money and particularly those who are employers.”
Democrats, too, say the Winthrop poll shows South Carolinians are paying attention and understand the issue.
“It’s disappointing to know that so many people support the idea and it got no traction in the House,” House Minority Leader Todd Rutherford, D-Richland, said, referring to last month’s House vote that rejected expansion. “It is purely political, and I think it is a clear indication that the House does not care what the majority of South Carolinians think.”
‘More complicated issue’
State Reps. Brian White, R-Anderson, the House budget chairman, and Murrell Smith, R-Sumter, the chairman of the House health-care subcommittee, counter that Medicaid expansion is a complicated issue – probably too complicated to ask about in a poll.
For example, House Democrats put forward a plan to expand Medicaid for three years, when the federal government would pay 100 percent of the cost. But Smith says the state would have to pay at least $25 million in administrative costs during those three years.
“I talk to people all the time who contact me saying, ‘Why aren’t you supporting Medicaid expansion?’ And, when I spend five, 10, 15 minutes on the phone with them, then they say, ‘I didn’t know that, and I understand your point,’” Smith said. “People have to be informed on the issue from both sides, and it’s a much more complicated issue than what you’re told.”