Do South Carolinians need more health insurance?

It’s a deceptively simple question.

In fact, it’s one of the most politically-charged debates raging in Columbia right now and the fight to figure out the answer is officially on.

For more than a year, Gov. Nikki Haley and other Republican lawmakers in Columbia have been railing against the federal law commonly called “Obamacare,” specifically one part of it that would extend Medicaid coverage to millions more low-income Americans.

They say Medicaid is already too expensive.

They say expanding it will spell the state’s financial doom.

They say South Carolina will have no part of it.

S.C. Democrats disagree.

On Monday, they introduced a budget amendment in the state House of Representatives that would expand the health insurance program for low-income residents for three years while the federal government foots the bill.

The battle has begun, but it’s far from over.

In South Carolina, no matter your income, single adults with no children who are not disabled or pregnant do not qualify for Medicaid.

For many of these uninsured residents, the emergency room effectively serves as their family doctor — whether they’re seeking treatment for a broken bone, a bad scrape or just the common cold.

Nearly everyone — both proponents and critics of the federal Patient Protection and Affordable Care Act — agree this is an inefficient way to get primary care and an expensive drag on the system.

But this is not a problem unique to South Carolina.

The federal health care law establishes several programs to get more Americans insured.

One way the law will accomplish this is by penalizing those who qualify for insurance but do not enroll.

Starting in 2014, the federal government is also expanding eligibility for Medicaid — anyone earning up to 138 percent of the federal poverty level can sign up.

The South Carolina Department of Health and Human Services estimates more than 340,000 state residents meet the new income threshold under the federal law.

The Supreme Court decided last year that states aren’t required to expand Medicaid because each state will eventually need to pony up some of the money to fund it.

The federal government has promised to pay 100 percent of the expansion costs for three years. After that, states will need to contribute some money, too — eventually 10 percent of the expansion costs by 2020.

Gov. Nikki Haley, members of her cabinet and many Republicans in the General Assembly say South Carolina won’t invest more money in a system that isn’t making South Carolinians healthier.

More than one in five state residents are already enrolled in Medicaid and South Carolina consistently ranks as one of the unhealthiest states in the country.

Many of groups who favor Medicaid expansion, including many Democrats, hospitals and the Charleston Metro Chamber of Commerce, say South Carolina can’t turn its back on billions of federal dollars. Most older South Carolinians agree with them. In a recent AARP poll, 54 percent of 800 adults interviewed disagree with Haley’s position on the issue.

What’s next?

The budget amendment to expand Medicaid is expected to be taken up on the House floor today.

Only time will tell how the General Assembly votes on the issue, but Gov. Haley has vowed to veto any budget that includes Medicaid expansion.

Reach Lauren Sausser at 937-5598.