Tony Keck spent the better part of four years in Gov. Nikki Haley’s Cabinet, adamant that South Carolina should not expand Medicaid eligibility under Obamacare.
Nearly 200,000 residents in this state can’t afford private policies or qualify for the low-income health insurance program because of difficult decisions that he helped Haley make.
Now, three months since he resigned his powerful position in her administration, Keck concedes that a recent attempt to expand Medicaid in Tennessee might have worked.
“States are very different. Medicaid expansion might be the best choice for some states, and it might not be in other states,” Keck told The Post and Courier.
Late last year, he accepted a new job as an executive with Mountain States Health Alliance, a hospital system based in Johnson City, Tenn. There, he is partially responsible for government relations.
“Clearly the hospital system here and every hospital system in the United States is in support of Medicaid expansion,” Keck said. “I’m not in charge of deciding whether it’s a worthwhile plan.”
Shelli Quenga, who supports the Affordable Care Act and helps residents enroll in Obamacare policies through the Mount Pleasant nonprofit where she works, said she’s not surprised that Keck is “having to look at things from a different perspective.”
“If I work for McDonald’s, I’m going to say the Big Mac is best. If I work for Burger King, I’m going to say the Whopper is best,” she said. “We’ve all changed jobs before. You have to adapt.”
During Haley’s first term, Keck managed the S.C. Department of Health and Human Services, where he ran the state’s $7 billion Medicaid program. He argued many times to state legislators, local media, national news outlets, even Congress, that the existing Medicaid system is flawed and that he wanted to focus on fixing it.
“Republicans are looking for a way to expand insurance but not call it Obamacare,” he told The Washington Post in 2013. “The goal here is not universal coverage. The goal is getting people healthy. That’s why we’re doing something much different.”
While Medicaid eligibility rules have long varied from state to state, the federal Affordable Care Act intended to even the playing field by expanding access to everyone in the country whose income fell below 138 percent of the poverty level — or about $16,000 a year for a single adult. But the U.S. Supreme Court ruled in 2012 that Medicaid expansion under the new law was optional. Many red states, including South Carolina, initially opted out and have remained firmly anti-expansion. Others, though, have recently reconsidered their options and have been busy working with the federal government to craft plans that fit their own needs.
Republican Tennessee Gov. Bill Haslam announced in December that he spent many months forging a compromise Medicaid expansion plan called “Insure Tennessee” with the Obama administration. It would have extended coverage to 280,000 low-income Tennesseans, according to The Associated Press.
“States have slowly been winning concessions from the federal government that fix some of the longstanding problems” that Republicans have expressed about Medicaid expansion, Keck said. “I don’t think Insure Tennessee completely solved all those problems — in fact, I know it didn’t — but it definitely went a long way to incorporate some ideas that conservatives have been asking for for a long time.”
On Feb. 4, a Tennessee Senate Health Committee defeated Haslam’s proposal. A different Medicaid expansion deal failed to gain enough support among Wyoming legislators on Friday. Some states are still debating the issue. More than half have already expanded Medicaid under Obamacare.
Haley spokeswoman Chaney Adams said the South Carolina governor has no intention of participating.
“What’s good for one state may not be what’s good for another, and Gov. Haley has always said that the job of her colleagues is to do what’s best for their states — and she’s going to do what’s best for ours,” Adams said in a prepared statement.
Christian Soura, who replaced Keck in November as the Health and Human Services director, told state senators last week that his agency continues to evaluate how other states approach Medicaid expansion. “In my opinion, each state needs to make its decisions for itself,” Soura said.
Technically, even though conservative South Carolina leaders aren’t embracing Obamacare, Medicaid rolls are expanding here anyway. Approximately 1.1 million people in South Carolina now receive Medicaid benefits — a 30 percent jump in four years.
Keck is responsible for most of that growth. For example, he implemented a program that automatically enrolls children based on information from other state agencies. In another initiative called the Healthy Outcomes Plan, he asked every hospital in the state to better manage thousands of poor, uninsured patients who keep showing up in emergency rooms.
But circumstances are different in Tennessee, he said. First, the state is bigger than South Carolina and more people there have no health insurance. Hospitals in Tennessee are also paid very little to treat indigent patients who can’t afford their medical bills. South Carolina hospitals receive much more money for similar services.
“I didn’t support Medicaid expansion in South Carolina and I still don’t. I supported getting people access to care in a much different way,” he said.
Keck acknowledged in an interview with this newspaper two years ago that Medicaid expansion might be appropriate in some states.
“If I had to do it again in South Carolina, I would do it the exact same way,” he said. “I’m glad I’m not in the middle of it anymore.”
Reach Lauren Sausser at 937-5598.