SC finds itself among dwindling number of red states refusing Medicaid expansion

Post and Courier
November 8, 2018

By Lauren Sausser

Voters in three historically red states — Idaho, Nebraska and Utah — opted to expand eligibility for the low-income Medicaid program. This leaves fewer than 15 states, including South Carolina, that continue to refuse federal money made available under the Affordable Care Act for Medicaid expansion.

Experts here don’t think things will change anytime soon, even if Republicans elsewhere are warming to the idea.

“It would be surprising to see a dramatic shift in Columbia over the course of the next legislative session,” said Christian Soura, a vice president at the S.C. Hospital Association and the state’s former Medicaid director under both former Gov. Nikki Haley and Gov. Henry McMaster.

That doesn’t mean South Carolina leaders won’t eventually change their minds, he said.

When Medicaid was first established nationally more than 50 years ago, states drifted into the program gradually. South Carolina waited for two years after the program was created, opting to participate in 1968. Arizona, the last state to offer Medicaid coverage, didn’t do so until the 1982.

“We’re seeing something similar to that,” Soura said.

An estimated 170,000 adults in South Carolina would qualify for Medicaid if the state expanded eligibility, according to the nonprofit Kaiser Family Foundation. The 2010 Affordable Care Act laid out that the federal government would always cover at least 90 percent of the expansion’s cost, but a U.S. Supreme Court ruling made Medicaid expansion an optional provision of Obamacare in 2012. Since then, states have been able to choose to adopt the expansion or not.

While most states have, South Carolina has not. Unlike Medicare, Medicaid is paid for with a combination of state and federal money, which allows some state-level flexibility to craft eligibility rules. In South Carolina, for example, adults without children rarely qualify for Medicaid coverage, no matter their income level.

McMaster has staunchly opposed expanding eligibility for the program, a stance his spokesman reaffirmed after McMaster won re-election Tuesday.

“The governor’s position absolutely has not changed,” Brian Symmes said.

Frank Knapp, president of the S.C. Small Business Chamber of Commerce, has long supported Medicaid expansion and said this week that it’s time for South Carolina conservatives to reconsider.

“We have a lot of our population that does not have access to health care. That doesn’t mean that they’re not getting health care. It simply means that … the cost is being shifted to those of us who have health insurance, driving up our premiums,” Knapp said. “The argument is resonating in more red states. They’re being pragmatic. It is time for South Carolina to have that discussion again.”

Soura, who formerly opposed Medicaid expansion as a gubernatorial cabinet member, now supports it. He is hopeful that McMaster’s administration will work with the federal government to expand health insurance coverage of some kind to more people in South Carolina.

“Health care was the No. 1 issue that brought people to the polls. There was no close second place,” Soura said. “It’s clear that health care is mobilizing the electorate.”

Meanwhile, in Montana, voters rejected a measure on Tuesday that would have extended their own Medicaid expansion. The ballot question was paired with proposal to raise cigarette taxes by $2 per pack, Soura said. “That drew a lot of tobacco money.”


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