One of the biggest sticking points of President Barack Obama’s Affordable Care Act to Republicans is often the Medicaid expansion, which would match state health care funding for people living near or below the poverty line. South Carolina Gov. Nikki Haley and a posse of southern Republican governors are planning to refuse the Medicaid expansion en masse, an act which former Vermont Gov. Howard Dean called “gubernatorial malpractice.”
South Carolina’s rate of residents who lack health insurance is already well above the national average at nearly 20 percent. But under the Medicaid expansion, over 330,000 uninsured South Carolinians who are near the poverty line would see their insurance rate cut by 56 percent. In fact, analysis by Washington Post blogger Ezra Klein shows the Palmetto State is getting a better deal than nearly every other state when it comes to federal Medicaid funding.
Given how badly South Carolina needs the Medicaid expansion and what the state is getting, you might think its leaders would welcome it. Nope! Instead, they’ve lambasted Obamacare as “a government takeover of health care” (which it isn’t) and “the largest tax increase in U.S. history” (which it definitely isn’t). They’re vowing never to implement the Affordable Care Act, following “Senator Tea Party” Jim DeMint’s Civil War-era idea of nullifying the law entirely.
The Republican governors leading the revolt say the Medicaid expansion would threaten states with “financial ruin,” as Texas Gov. Rick Perry put it. Gov. Haley claimed “the price tag to South Carolina taxpayers” would be “an extra $1.1 to $2.3 billion over the next six years,” though estimates put the actual amount between $470 million and $615 million.
But according to a report from Moody’s Investors Service, the Medicaid expansion poses less danger to South Carolina’s finances than the austerity measures forced into the budget by congressional Republicans during a standoff over the debt ceiling last year. Speaking about mandatory cuts to social programs through sequestration, Moody’s Senior Vice President Kenneth Kurtz told Reuters that states “will have greater exposure to the potential risks that will come with efforts to trim federal spending.”
According to Moody’s, if the federal government avoids making changes in spending “in other areas, including, for example the avoidance of significant changes in military spending,” then it will have to make steeper cuts in programs such as Medicaid. That could increase pressure on U.S. states, which are already stressed from growing demand for the program.
“Rising healthcare costs and an aging population will continue to increase Medicaid’s costs and challenge states’ finances, regardless of how federal healthcare reform is ultimately implemented,” said Kurtz.
In other words, Medicaid is going to get more expensive to states whether the expansion happens or not, because health care isn’t getting any cheaper and our people ain’t getting any younger. Under the Affordable Care Act, at least, those increases will be offset by savings in other areas. In fact, Moody’s said that Medicaid costs per enrollee have risen much slower than total U.S. health care spending over the past 15 years — a 3.1 percent increase compared to a 5.5 percent increase, according to Kurtz.
Gov. Haley and other Republicans who oppose the Medicaid expansion say the federal government for putting strain on their states’ budgets. However, they need only look to their own party’s insistence on last year’s austerity measures. As we always say, your budget priorities reflect your ideals. From women’s health to the elderly, Republican ideals are not about making sure access to health care is preserved, and South Carolina deserves better.