State should expand Medicaid program

South Carolina lawmakers might finally be figuring out that refusing to expand Medicaid in the state under the 2010 health care law was a costly mistake.

When 23 states with Republican governors, most of them in the South, rejected the Medicaid expansion that was part of the Affordable Care Act, they regarded it as an act of principle, a refusal to cooperate in the rollout of “Obamacare.” Gov. Nikki Haley swore at the time that she would never expand Medicaid in the state.

But not all Republican-run states made the same decision. Arkansas and Kentucky were two that decided to expand the program and accept the federal money that came with it.

And since then, a number of other states that originally rejected expansion apparently have redone the math and decided that it would be in their best interests to accept the federal largess, including Pennsylvania, Indiana and Utah. And Republican North Carolina Gov. Pat McCrory also has called on lawmakers in his state to join the expansion movement.

Recently, some state lawmakers in South Carolina also have begun beating the drum to expand Medicaid in the state. On Tuesday, Republican Sens. Ray Cleary of Georgetown and Paul Campbell of Berkeley joined Democratic Sens. Joel Lourie of Columbia and John Matthews of Orangeburg in calling for a budget amendment that would bring federal Medicaid dollars to the state.

While the math hasn’t changed, perhaps it has become more compelling in light of all the state’s other pressing needs. Federal money could be used to pay for private health insurance for nearly 194,000 South Carolinians at minimal cost to the state.

Those people, most of them working poor, aren’t eligible for subsidized health insurance under the Affordable Care Act. While they would have qualified for Medicaid coverage under the expanded plan, which would have covered everyone making about $15,000 or less annually, many of them make too much to qualify under the current state program.

If the state chose to expand the Medicaid program, federal money would cover 100 percent of medical costs for the newly eligible enrollees through 2016, and no less than 90 percent of their costs thereafter. And, if the state is not satisfied with the program, it could opt out at any time.

As it stands, taxpayers in South Carolina and the other states that have not expanded still must pay billions in federal taxes to cover the cost of Medicaid. But that money migrates to other states that agreed to expand the program, helping them pay for medical care for the poor in their states.

In all, if the states that have rejected expanding Medicaid continue to do so for the next eight years, according to a McClatchy analysis, they’ll pay $152 billion to cover the costs of programs in other states – while receiving nothing in return. If those states agreed to expand Medicaid, they could split nearly $396 billion in federal Medicaid funding over the next seven years.

If South Carolina expanded its Medicaid program under the Affordable Care Act, the federal government would cover the entire cost until 2017. Beginning in 2017, the state would pay $57 million a year, rising to $153 million in 2021.

But federal dollars coming to the state would rise from about $846 million in 2015 to $1.4 billion in 2021.

Haley still threatens to veto any effort to expand Medicaid. We hope, however, that enough lawmakers will realize that this blind opposition to any participation in the Affordable Care Act is both costing the state hundreds of millions of dollars and denying access to health care to tens of thousands of poor South Carolinians.

In summary

State could benefit from millions of dollars in federal money to help provide access to medical care to the poor.