When a tick bit Patrick Morris a few years ago and the glands in his throat became swollen, he worried he might have Lyme disease.

His glands were fine after all, but Morris didn't hesitate to make an appointment to have them checked at a neighborhood clinic because, like virtually everyone else living in Massachusetts since health care reform passed there in 2006, he had health insurance. It wasn't a policy offered through his employer. In fact, Morris doesn't qualify for comprehensive coverage at work. This was a "Romneycare" plan.

With few exceptions, everyone in Massachusetts has been required to carry a health insurance policy for years now - ever since the state Legislature passed its own health care reform law under former Gov. Mitt Romney. That's why the percentage of residents who aren't insured in Massachusetts is the lowest in the country.

"I don't hear many complaints about (the mandate)," said Morris, 33, who lives in Winthrop, Mass., just outside Boston. "People like being insured - just in case."

A new study published last week in the Annals of Internal Medicine suggests health insurance offers more than just peace of mind. In Massachusetts, researchers found health care reform was associated with decreased mortality. For every 830 newly insured residents, one death was prevented. The results were more dramatic in poorer counties with higher rates of uninsured residents.

The study's authors were quick to note what they discovered in Massachusetts may be unique, but the results have generated significant discussion across the country - especially the implications this may have for states that have not embraced national health care reform. South Carolina is one of about half of all states that will not expand Medicaid eligibility under the federal Affordable Care Act, which was modeled closely after the Massachusetts health care law.

"Clearly, there's enough data out there now to show having health insurance does matter," said Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center.

But Gov. Nikki Haley and conservative state legislators argue that South Carolina can't afford to expand eligibility for its $7 billion-a-year Medicaid program. Even though the federal government will pay for 100 percent of expansion costs through 2017 - and never less than 90 percent after that - they believe there are more efficient, less expensive ways to improve access to the health care system for the uninsured.

With approximately 1 million South Carolinians already enrolled in the low-income health insurance program, they also contend there's not much evidence showing that Medicaid is making them healthier. They say this state's limited resources would be better spent improving roads or investing in public education - some of the "social determinants of health" that shape a society's well-being.

If South Carolina accepted federal money to expand Medicaid, experts believe an additional 344,000 residents would qualify for the program.

Haley's in-house health care expert called the new study "well-designed," but said Massachusetts is different than South Carolina and "Romneycare" is different than "Obamacare."

"You can't generalize this to every state. You can't even generalize this to Medicaid expansion," said Tony Keck, director of the S.C. Medicaid agency. "These research papers are not designed to answer the 'yes or no' question of whether we should expand Medicaid or not."

While he previously called the connection between health insurance and healthy outcomes "very, very tenuous," Keck said Wednesday that neither he nor the governor have ever disputed that insurance provides health benefits.

"We over-rely on health insurance and health services to improve health when we know they are secondary to social determinants. So where do you spend your first dollar?" he said. "The question is 'are there better alternatives?'"

Under his leadership, South Carolina is testing the theory that there are. A new initiative called the Healthy Outcomes Plan is designed to keep uninsured patients with chronic conditions out of hospital emergency rooms and connect them with less-expensive community resources to meet their health care needs. Participation in the Healthy Outcomes Plan is free for these patients, but it does not provide them with health insurance and does not cover their hospital bills in case of an emergency.

The state wants hospitals across South Carolina to enroll about 8,500 patients in the program. There are more than 700,000 residents in South Carolina without health insurance, by a recent U.S. Census count.

"It is mainly a pilot study," said Dr. Rick Foster, senior vice president of quality and patient safety at the South Carolina Hospital Association.

While the Healthy Outcomes Plan is an exciting initiative, it shouldn't be considered an alternative to Medicaid expansion, he said.

Berkowitz said expanding Medicaid and making investments in other important areas shouldn't be mutually exclusive.

"I've always said if the governor and Mr. Keck don't think health insurance matters, I would urge them to refund the state for the premiums for their insurance because clearly they don't need it," Berkowitz said. "If data doesn't drive them, I'm not sure what will."

Haley's spokesman, Doug Mayer, said that South Carolina is not Massachusetts and a one-size-fits-all approach to health care is one the biggest problems with the Affordable Care Act.

"Gov. Haley fought against Obamacare and will continue to do so because she believes, like the majority of South Carolinians, that the best way to improve the health of our citizens is through state-based solutions - not having the federal government force a politically driven and broken system upon us," he said.

Reach Lauren Sausser at 937-5598.