By Paul Hyde
Imagine state lawmakers turning away $17.6 billion of our own taxpayer dollars intended to help struggling South Carolinians obtain health insurance.
You don’t have to imagine. We’ve actually done that since 2014, and for no good reason other than, seemingly, to punish our own low-income friends and neighbors in South Carolina.
South Carolina remains one of only 10 states in the nation that still refuses to expand Medicaid eligibility, which could draw down billions in federal funds to provide health care coverage for an additional 345,000 low-income South Carolinians.
The good news is that some state lawmakers want a committee studying health care in South Carolina to at least consider the advantages of expanding Medicaid, according to recent reporting by the SC Daily Gazette’s Skylar Laird.
This would be the first serious effort among S.C. lawmakers in at least 10 years to think about the money lost and lives blighted by their misguided refusal to follow the lead of the 40 other states that have expanded Medicaid.
The 10 states that still reject Medicaid expansion are some of the poorest in the nation.
Mississippi, Alabama, Tennessee, South Carolina and the others could certainly use an infusion of several billion of our own taxpayer dollars to boost our economies.
South Carolina, cutting off its nose to spite its face, has rejected about $1.6 billion annually in federal dollars for Medicaid expansion since 2014, according to calculations by the Appleseed Legal Justice Center.
That adds up to a total of $17.6 billion over 10 years, more than next fiscal year’s entire proposed budget for state taxes. Think of all the good that could do in our state.
A great deal
Medicaid expansion would be a great deal for South Carolina. Federal dollars would pay for 90% of the costs of the expansion. The state would only need to kick in 10%.
Medicaid expansion would create 31,000 jobs and add $7.6 billion in personal income growth in the state over three years, according to Cover SC, a coalition supporting Medicaid expansion.
All adults with incomes up to 138% of the federal poverty level would qualify for the program.
Right now, however, our federal tax dollars are being used to pay for Medicaid expansion in other states “while none of the Medicaid expansion funds are coming back” to South Carolina, according to health policy expert Louise Norris, writing in healthinsurance.org.
Norris writes that between 2013 and 2022, $152 billion in federal taxes have been collected from residents in states not expanding Medicaid, like South Carolina, to be used to fund Medicaid expansion in other states.
Popular support
A 2021 survey by AARP of adults age 50-plus found 80% of respondents — including 69% of Republicans — say they support expanding Medicaid in South Carolina and 73% say that expanding Medicaid in South Carolina is either extremely or very important.
South Carolinians, like others in the non-expansion states, seem reasonable, pragmatic and compassionate.
So, what’s the holdup?
Gov. Henry McMaster and some lawmakers blame struggling people themselves for their health-insurance challenges rather than recognizing that health-care costs have risen exponentially for decades in this low-income state, making insurance unaffordable for many workers.
Antiquated attitudes
State Sen. Wes Climer, quoted by Laird, recently reflected the callous attitude of many lawmakers: “It is unconscionable to me that we would consider expanding that to more — to put more South Carolinians into dependency on the government instead of encouraging them to seek employment and private health insurance elsewhere.”
Some people no doubt agree with that bootstraps mindset. But struggling South Carolina workers can’t simply wave a magic wand and get a better job that offers top-notch health insurance.
If Climer’s strategy worked, South Carolina would have one of the lowest uninsured rates in the nation. Instead, we have one of the highest uninsured rates in the nation, according to KFF.
We still have 521,660 South Carolinians under age 65 who lack health insurance, according to data from the U.S. Census Bureau. And we have the nation’s second-highest rate of medical debt in collection, according to the Urban Institute.
Medicaid expansion, it should be pointed out, is not a partisan issue.
The overwhelming majority of so-called red states have expanded Medicaid in addition to all blue states.
North Carolina was the most recent state to embrace expansion. A longtime conservative opponent of Medicaid expansion, Republican state Sen. Phil Berger, president pro tempore of the North Carolina state Senate, explained in a 2023 commentary that arguments against expansion were no longer persuasive to fiscal conservatives.
It makes no sense to reject our fair share of federal taxpayer dollars when they’re needed in this state to help vulnerable South Carolinians.
It’s past time to expand Medicaid in South Carolina.
Paul Hyde is a longtime journalist and teacher in the Upstate. He worked 18 years for the Greenville News as a columnist, editorial writer, education reporter and arts writer. He holds undergraduate and graduate degrees from Clemson and Harvard universities. He has written for the Houston Chronicle, Dallas Morning News and USA Today, among other publications. He currently is a regular contributor to the Greenville Journal, Atlanta Journal-Constitution and Classical Voice North America.
