South Carolina lawmakers have long said they will reject a federal plan to expand Medicaid to more uninsured, low-income residents, and they have vowed that the state could find a cheaper, more effective way to make its citizens healthier.

From the experts, lawmakers

“Our goal should be healthier South Carolinians. If more money and more government produced healthier citizens, Americans should be the healthiest population on the planet, but we're not. The current government-run health care system is clearly broken but instead of trying to fix this broken system, Obamacare simply wants to make it bigger. Instead of buying into the unsustainable spending of Obamacare, this plan uses existing resources to fix and improve the effectiveness of our current health care options.”

House Speaker Bobby Harrell

“I'm glad the Republicans have finally recognized that we have some unmet needs in the state of South Carolina. I think obviously the money that we are putting in federally qualified health care centers is a great thing. They need all the help we can give them. The problem with thinking that's going to be a cure-all is it's not. All that's going to do is hopefully take some of the people that are in the emergency rooms, and hopefully we can treat those in the centers. The problem is that they are still uninsured.”

State Rep. Harry Ott, D-Calhoun

“This (proposal) is targeting hot spots. This is actually going after what we know are the problems. But this is not increasing one more person on Medicaid. This is brings more accountability in.”

Gov. Nikki Haley

“From my perspective, these allocations are not intended as an alternative to Medicaid expansion, but rather to address other important health issues in our state. In particular, several of the initiatives would help to address the maldistribution of health care providers in our state. We have large numbers of physicians in the more affluent and urban areas of our state, while we have too few physicians in the poor and rural areas.”

MUSC President Ray Greenberg

“We are grateful for the support shown by our legislative leaders, and we believe the actions taken by the House Ways and Means Committee reflect the need for a systemic approach to improving our state's health care system. As a hospital community, we continue to believe that increasing access through Medicaid expansion is an integral part of meeting the challenges we face in improving the health status of our state.”

South Carolina Hospital Association President Thornton Kirby

On Thursday, the beginning of one such plan was approved by a state House committee.

Medicaid expansion: What does it mean for SC?

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.

South Carolina Medicaid Director Tony Keck said the plan is the state's first response to rejecting part of the federal law commonly referred to as “Obamacare.”

“We have to focus on health first,” Keck said. “Health is not necessarily the same as health services. Health is not necessarily the same as health insurance.”

The proposal would infuse more than $40 million in state funds into programs designed to make South Carolinians healthier, including one that would encourage doctors to practice in rural areas and another that would expand the Medical University of South Carolina's telemedicine network.

The bulk of funding for the programs would continue to come from the federal government.

The proposal eventually will move to the full House of Representatives for consideration.

Medical University of South Carolina President Ray Greenberg applauded the House proposal, but said it will not replace the need to offer Medicaid to more state residents.

“From my perspective,” he said, “these allocations are not intended as an alternative to Medicaid expansion, but rather to address other important health issues in our state.”

  Reach Lauren Sausser at 937-5598.