Take the money under our conditions or you don’t get the money. That, in essence, is the deal the Obama administration has offered to the states on the costly expansion of Medicaid eligibility.
Though not quite a “Godfather”-like ultimatum, it is an offer that many states have decided they can’t refuse.
But there are justifiable concerns that this Medicaid growth under the misnamed Patient Protection and Affordable Care Act is utterly unaffordable for the federal government — and for state governments — over the long term.
And while New Jersey’s Chris Christie, Arizona’s Jan Brewer and Florida’s Rick Scott are among the Republican governors who have backed down from that ultimatum, South Carolina’s Nikki Haley and Texas’ Rick Perry are among the GOP governors who have not.
The Republican-controlled S.C. House rejected the plan, which would expand Medicaid coverage to all who are at or below 138 percent of the federal poverty level, in a series of party-line votes Tuesday.
While Washington would pay for all of the extra expense for three years, after that, the states would be required to pick up a growing share of the tab until it reached the “match” of 10 percent. That might not sound like much in the abstract, but projections of the additional annual cost for S.C. taxpayers range from $613 million to $1.9 billion by 2020.
In other words, despite calls from business and medical groups within our own state to take the money now, while we can, what happens when our increased obligations exceed our resources later?
And where will Washington get the money to cover its huge share of these extra expenses?
Answer: By spending even more money that the nation doesn’t have.
Gov. Haley, in a written statement Tuesday, hailed the House vote and decried the “public policy nightmare” of Medicaid expansion.
She added: “If history has proven anything, it’s that there is no such thing as a temporary entitlement program, and as House Republicans recognize, Obamacare will be as bad a policy three years from now as it is today.”
Instead, the governor, S.C. Health and Human Services director Tony Keck and the S.C. House leadership support a $75 million initiative aimed at cutting the costs of providing health care to low-income South Carolinians, including bolstering free and subsidized medical clinics in rural areas.
That won’t solve all the state’s problems on health care for the working poor, who would be the primary beneficiaries of the Medicaid expansion.
But accepting a sucker’s deal under take-it-or-leave-it pressure is not a responsible option.
Unfortunately, Rep. Kris Crawford, R-Florence, muddied the water on this topic with an outrageous comment that first attracted widespread attention this week.
The Jan. 29 Charleston Regional Business Journal reported that Rep. Crawford, a physician, said of the Medicaid debate: “The politics are going to overwhelm the policy. It is good politics to oppose the black guy in the White House right now, especially for the Republican Party.”
Rep. Crawford has tried, unpersuasively, to dismiss that ugly perspective as “taken out of context.”
Yet Medicaid expansion isn’t about one state lawmaker’s reprehensible remark.
It’s about yet another move by Washington to mandate more spending that the states simply can’t sustain.
As Sen. Lindsey Graham, R-S.C., warned last week: “Medicaid expansion would be disastrous for South Carolina. It is terrible public policy that we can’t afford and won’t make our people healthier.”
Lawmakers in Washington can keep running up the national debt with huge federal deficits.Their counterparts in state capitals, including Columbia, don’t enjoy that immense — and irresponsible — budgetary wiggle room.
As a prominent politician put it with this prudent alarm: “As we move forward on health reform, it is not sufficient for us to simply add more people to Medicare or Medicaid to increase coverage in the absence of cost controls ... another way of putting it is we can’t simply put more people into a broken system that doesn’t work.”
That wasn’t a Republican governor in 2013.
That was presidential candidate Barack Obama in 2008.
As for “cost controls,” we’ve heard that illusory big government pitch many times before.
Medicaid expansion, at least as currently structured under Obamacare, is an offer South Carolina should refuse.
And truly affordable health care reform is a mission our elected officials in Columbia — and Washington — must accomplish.
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