COLUMBIA — The state Senate killed Medicaid expansion on Tuesday, the last hope for supporters who wanted to extend health insurance benefits to South Carolina’s working poor.
The vote was 23-19, with two Republicans – Ray Cleary of Georgetown and Paul Campbell of Berkeley County – joining all of the Senate’s 17 Democrats present in voting for the expansion. Four senators, one Democrat and three Republicans, were absent.
The proposal would have accepted $795.8 million in federal money to pay for health insurance for about 320,000 South Carolinians beginning Jan. 1. There would have been no direct cost to the state. Because the proposed Medicaid expansion was an amendment to the state budget, it would have expired after one year. Lawmakers would have had to vote to expand coverage again next year.
S.C. taxpayers would not have to pay for the expansion until 2017. By 2020, the federal government would have sent $11 billion to South Carolina while state taxpayers would have had to pay for 10 percent of the expansion’s costs – between $619 million and $1.9 billion, according to estimates.
Republicans, including Gov. Nikki Haley, said South Carolina could not afford the expansion, saying the state already struggles to pay for its share of the current Medicaid program. Health care is the largest single expense in the state’s $22.7 billion budget.
Instead of expanding Medicaid, the state budget includes paying $9 million to free and subsidized health clinics that serve low-income South Carolinians who would have been covered by the Medicaid expansion. The plan also set asides $10 million to pay hospitals as an incentive to keep uninsured patients out of expensive emergency rooms and send them to those cheaper clinics.
Senate Democrats urged expanding Medicaid on moral grounds, arguing the state has a responsibility to take care of “the least of these.”
Senate Minority Leader Nikki Setzler, D-Lexington, talked about his bout with prostate cancer two years ago, saying he was thankful he had insurance. Setzler also said that of the 320,000 people eligible for the Medicaid expansion, 40 percent are employed but still have no health insurance.
“To me, it’s about (320,000) South Carolinians and I, for one, refuse to turn my back on them and to say to them that, ‘I am standing too tall to reach down and give you a hand when you need a hand to lift you up,’” he said
State Sen. Tom Davis, R-Beaufort, said he does not trust the federal government to continue paying for its 90 percent share of the expansion, given the ballooning federal debt.
Davis also said he refused to “cede the moral high ground,” adding he volunteers in his community to help those in need.
“Where is it written that to be compassionate I have to pay higher taxes for the state to take care of that?” he said. “This isn’t just free money. At some point in time, we have a responsibility as adults to say, ‘This can’t go on.’”
South Carolina is one of 15 states that will not expand Medicaid, according to the Advisory Board Co., a consulting firm. Twenty-six states will expand Medicaid. Five others are leaning toward not participating, one is leading toward participating and three are pursuing other options.
Slightly more than half of South Carolinians say they support Medicaid expansion, according to a recent poll conducted by Winthrop University.
About 40 percent opposed expanding the joint federal-state insurance program for the poor and disabled, while 11.3 percent said they were not sure.
That same poll found 65.5 percent of Republicans opposed expanding Medicaid, while 77 percent of Democrats supported expansion – demonstrating the deep political divisions that have come to define the debate over Obamacare.
“Polling shows that South Carolinians want their elected officials to find a way to reclaim our dollars, and we’ll continue to explore options with bipartisan support to do just that,” said Rozalyn Goodwin, director of policy research for the S.C. Hospital Association, which pushed to expand Medicaid.
Ellen Weaver, president of the conservative Palmetto Policy Forum think tank, said the expansion debate is about “a fundamental restructuring of Medicaid as we know it.”
“It’s intended function was to be a safety net for children, the disabled and the elderly, and instead it is being transformed into a government-run insurance program for able-bodied adults,” Weaver said at a Statehouse news conference last week.
“There are many problems with this approach, not the least of which those who are currently in the program will begin to experience longer and longer wait times to see the physicians they currently are seeing because there simply aren’t enough providers to work under the expansion as it has been proposed.”