Where does Medicaid expansion stand?

In 2012, the United States Supreme Court upheld the Patient Protection and Affordable Care Act with a caveat — individual states could not be compelled by the federal government to expand Medicaid. South Carolina lawmakers and health care lobbyists are currently in a tug-of-war over the issue. Republican lawmakers and state leaders say the program is broken and too expensive. Democrats, doctors and hospital systems across the state are trying to convince the legislature that South Carolinians are among the sickest patients in the country, and that offering health insurance to more state residents is the best route to improving their health. The state legislature will put the debate to a vote in 2013 or early 2014.

Who will it affect?

If passed in South Carolina, Medicaid expansion under the Affordable Care Act would extend coverage to hundreds of thousands of previously uninsured state residents. Health officials estimate 350,000 to 600,000 previously uninsured residents would become eligible to apply. They would largely include low-income single adults with no children. Under current state law, non-disabled adults who are not pregnant and have no children do not qualify for Medicaid, regardless of their poverty level.

Who is trying to oppose the expansion and why?

State Republican lawmakers and Gov. Nikki Haley have expressed adamant opposition to the plan because they say the state can’t afford it. The federal government has agreed to fully fund the plan for three years, but after that, states choosing to participate will have to front some of the money for it — eventually 10 percent of the costs in 2020. After 2020, the federal government will continue to match $9 for every $1 the state contributes to fund the program.

South Carolina Department of Health and Human Services Director Tony Keck also opposes Medicaid expansion. He says the system is broken and extending health insurance eligibility won’t make South Carolinians any healthier.

Who says that the state needs it, and what are they saying?

Hospitals across the state, including the three major systems in the Lowcountry, are lobbying for Medicaid expansion. When the Patient Protection and Affordable Care Act is fully implemented in 2014, the federal government will start decreasing compensation hospitals receive for charity care. When the federal bill was drafted, hospitals agreed to those multi-billion-dollar cuts because the federal government offered to pay for Medicaid expansion. The idea behind the legislation is that if more patients who seek treatment qualify for health insurance, hospitals won’t be burdened with providing as much free, charity care. If South Carolina opts out of Medicaid expansion, hospitals will still face those charity care compensation cuts. The South Carolina Hospital Association argues that South Carolinians — and South Carolina hospitals — will be paying a high price for the Affordable Care Act, but will not realize its major benefits.

What states are more aggressive in implementing it?

Twenty-three states have signed on to expand Medicaid and three more are “leaning” toward participating, according to The Advisory Board Company, a consulting firm tracking coverage of the debate across the country.

Many of the states choosing not to expand coverage are led by Republican governors, although there are exceptions. Republican Govs. Jan Brewer of Arizona and Rick Scott of Florida have recently said their states will support Medicaid expansion.

How much would Medicaid expansion cost South Carolina?

Keck from Health and Human Services estimates that expanding Medicaid coverage under the act would cost South Carolina between $1.1 billion and $2.3 billion during the first six years of the program. During the same time period, the federal government would pay nine times that amount to fully fund the expansion.