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House rejects Medicaid expansion

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Curt Olson

COLUMBIA – After a day-long budget debate Tuesday, March 11, on a state House Democratic amendment to expand Medicaid in South Carolina, the House Republican majority rejected it and adopted their own plan.

In a 73-45 vote along party lines, the House tabled the amendment – effectively killing it – then voted 73-41 shortly after to adopt the section of provisos in the S.C. Department of Health and Human Services’ proposed fiscal 2014 budget that would establish the GOP health-care alternative.

Debate continued Friday, March 15, on the House Ways and Means Committee’s $22.7 billion state spending plan for next fiscal year, which begins July 1.

Under the federal Patient Protection and Affordable Care Act, known as “Obamacare,” states can expand Medicaid rolls by obtaining more federal money to pay health-care bills for the poor. Several GOP governors have opposed Medicaid expansion, including Gov. Nikki Haley.

If the Palmetto State approved the expansion, which would cover working adults with incomes of 138 percent or less of the federal poverty level – about $15,000 – the federal government said it would pay 100 percent of the costs in the first three years of the expansion, and would cover 90 percent of the costs in the initial ensuing years.

A University of South Carolina study projected that an additional $11.2 billion in federal spending in the state with the expansion would create 44,000 jobs by 2020.

Critics contend, however, the expansion would likely cost the state millions in administrative and other costs even in the first three years. The state’s cost of the expansion afterward could rise to as much as $1.9 billion by 2020, under an estimate by Health and Human Services (HHS).

House Republicans put forward a plan some would consider Obamacare on a smaller scale. It would tap $63 million in reserves at HHS, which manages the state’s Medicaid program, and add about $20 million in federal dollars to pay for uncompensated care at hospitals and steer uninsured patients from emergency rooms to free or low-cost health clinics, The Nerve reported recently.

Democrats believe the GOP plan does not do enough to help those who have no health insurance. On Monday, the first day of the House budget debate, a group of House Democrats announced they would file a budget amendment requiring South Carolina to accept the additional federal Medicaid dollars for the first three years only.

Their proposal was fashioned after a plan that Florida Gov. Rick Scott sought passage in the Sunshine State.

However, both houses of the Florida Legislature have rejected Medicaid expansion, according to media reports.

S.C. Democrats argue that expanding Medicaid for the first three years would allow South Carolina to accept $4.1 billion in federal funds. They also contend that 500,000 poor South Carolinians would be eligible for Medicaid under the expansion.

An HHS report reveals a couple of key state Medicaid statistics, including that Medicaid represents about 18 percent of state funds and 25 percent of total funds in fiscal year 2013 and that 22.4 percent of South Carolinians are currently enrolled in Medicaid.

Democrats during Tuesday’s debate lined up to support the amendment with a talking point to “put policy over politics.” Some quoted Scripture in trying to convince their GOP colleagues.

“Think about the people who are trying to figure out which bill they are going to pay,” said Rep. Todd Rutherford, (D-74, Richland) and the House minority leader. “It is our moral obligation. It is our duty because we are Christians, and God tells us how to treat the least of these. “

Rutherford said Democrats agree that money spent on Medicaid must be spent more efficiently to have better outcomes for recipients, but Republicans need to compromise with Democrats on Medicaid expansion.

Democrats made arguments that the additional federal dollars would be “free money.” Rep. Harry Ott, (D-93, Calhoun) and the immediate past House minority leader, said South Carolina would be a “donor state” if it did not accept the federal money for Medicaid expansion.

GOP House members didn’t match the lengthy Democratic speeches Tuesday, though the S.C. House GOP Caucus responded to the floor debate on Twitter, arguing that South Carolina receives $1.35 for every $1 sent to the federal government in federal taxes paid.

Some Democrats noted that given South Carolina’s reliance on taxpayer-funded giveaways to businesses, Republicans should be willing to expand Medicaid.

The S.C. House GOP Caucus Twitter account also reported during Tuesday’s lengthy floor debate that South Carolina’s uninsured rate will be reduced by 71 percent,

"There is no such thing as free money,' said House Ways and Means Chairman Brian White, R-Anderson."

Rep. Murrell Smith, (R-67, Sumter) and chairman of the House budget-writing subcommittee on health care issues, spoke against the Democratic amendment and called for it to be tabled. Without Medicaid expansion, Medicaid would still grow by $2.4 billion by 2020, he said.

“The governor has said we need to deal with that before we deal with expansion,” Smith said.
Contrary to arguments made by expansion supporters, Smith said if South Carolina doesn’t spend the money, it would not go to another state. He also challenged the USC study that projected 44,000 jobs would be created with the expansion.

“I don’t think we’re going to find (that Medicaid expansion is) going to have that economic impact,” Smith said.
House Speaker Bobby Harrell, (R-114, Charleston and Dorchester), said in a prepared statement following the votes that Medicaid expansion would not fix spiking health-care costs, and praised the GOP alternative.

“If more money and more government produced healthier citizens, Americans should be the healthiest population on the planet – but we’re not," he said. "The current system is clearly broken but instead of trying to fix this broken system, Obamacare simply makes it bigger. Unlike the unsustainable new spending of Obamacare, we have proposed real solutions that use existing resources to target more effective health options that will actually improve the health of our citizens."

Haley in a prepared statement Tuesday praised House Republicans for defeating the expansion amendment.

“In overwhelmingly rejecting Obamacare, the House did what is right for the health of our state and the health of our citizens,” she said. “Obamacare would be a disaster for South Carolina, and we should all be thankful to the

House for standing tall and choosing the best road for our people, rather than the road paved by Washington's empty promises.”