Pinckney wanted Medicaid expansion in S.C.

Sen. Clementa Pinckney speaks on the Senate floor at the South Carolina Statehouse in 2014.

In 2013, eight days before Christmas, Sen. Clementa Pinckney loaded a PowerPoint presentation in front of a few constituents at Jasper’s Porch, a lake-front restaurant known for its “award-winning” she-crab soup just off Interstate 95 in Ridgeland.

Pinckney, a Democratic lawmaker and clergyman who died in the Emanuel AME Church shooting last month, used the slides to help explain Obama-care.

“Medicaid expansion would cover 250,000 uninsured in South Carolina,” Pinckney told the group, according to a report published by the Jasper County Sun Times at the time.

“If we don’t act now and expand Medicaid, South Carolinians’ dollars will be sent to other states that are expanding Medicaid,” he said. “This plan keeps your dollars at home.”

In 2013, 27 percent of Jasper County’s population had no health insurance — much higher than the 19 percent statewide average. Pinckney’s message may have struck a chord among the uninsured, but his argument for expanding the low-income health insurance program was apparently lost on his conservative colleagues in the state Legislature.

South Carolina counts itself among a dwindling minority of states that still refuse to expand Medicaid under the Affordable Care Act. A recent Supreme Court ruling offered good news for those who qualify for subsidies to purchase private insurance plans through HealthCare.gov, but some health care experts and Democrats say this state will never reap the full benefits of the federal law until the conservative majority changes its mind about Medicaid.

This was Pinckney’s message all along, some of his supporters said last week.

“South Carolina is more ideological than pragmatic,” said U.S. Rep. Jim Clyburn, D-S.C., who said he spoke with Pinckney many times about the issue. “He knew what the (political) realities were, but that didn’t mean he didn’t have passion to get health care for his constituents.”

The 2010 federal health care law meant to even the playing field for Medicaid eligibility, the rules for which have long varied from state to state. But in 2012, the U.S. Supreme Court decided states could choose for themselves whether they wanted to expand the low-income health insurance program. Initially, South Carolina and about half of all other states decided to decline billions of federal dollars for the expansion.

While an increasing number of states, even those run by some Republican governors, have since changed tack on the issue, a spokeswoman for Gov. Nikki Haley said Thursday that she remains firmly opposed to the Affordable Care Act.

“The governor always admired Sen. Pinckney for being a fighter for the people of his district, that’s how she will remember him, and she, along with so many others, will always cherish and honor his memory,” spokeswoman Chaney Adams said. “But in South Carolina, Obamacare has been bad for our families, bad for our economy and bad for our businesses, and we will continue to work around it as best we can, finding better ways to make health care more affordable and give patients more choices.”

Meanwhile, 30 states have expanded their Medicaid programs under the Affordable Care Act and they’re providing this coverage for their residents without spending additional state dollars.

Medicaid expansion is fully funded by the federal government through 2016. After that, participating states will be expected to chip in some of the cost, but never more than 10 percent of the total bill.

Rozalynn Goodwin, a vice president for the state Hospital Association, said Pinckney fought so hard for Medicaid expansion because he represented and grew up in rural South Carolina.

“It wasn’t some type of party line thing for him,” Goodwin said. The Hospital Association also supports Medicaid expansion. “He was trying to figure out, ‘How am I going to get these people covered?’ ”

Pinckney’s state Senate district included parts of Allendale, Beaufort, Charleston, Colleton, Hampton and Jasper counties. U.S. Census data shows more than 100,000 South Carolinians in those six counties had no health insurance in 2013.

In Pinckney’s eulogy, President Barack Obama called this broad swath of Lowcountry “one of the most neglected in America ... a place where children can still go hungry and the sick can go without treatment.”

To make matters worse, Goodwin said, thousands of residents in Pinckney’s district fall into the so-called Affordable Care Act “coverage gap.”

The federal law only provides discounts to purchase private insurance for customers whose income falls between 100 percent and 400 percent of the poverty level. Everyone below that threshold would have qualified for Medicaid if South Carolina expanded the program. For now, though, they’re left with nothing.

“Eighty-eight percent of the people who would have qualified for Medicaid expansion don’t qualify for anything because they live in poverty. That’s the story for most of rural South Carolina,” Goodwin said. “They are too rich for Medicaid, too poor to get a subsidy and they fall in the coverage gap. They are the working poor.”

A couple of bipartisan attempts to expand Medicaid in South Carolina in recent years have been unsuccessful, but Clyburn is hopeful that will change next year. Expanding Medicaid in Pinckney’s memory would be more meaningful than removing the Confederate flag from the Statehouse grounds, he said.

“The Confederate battle flag is a symbol, and symbols are really powerful, but the effective way to memorialize Rev. Pinckney would be to create a ‘Clementa Pinckney Health Care Law,’ ” Clyburn said. “It’s a simple expansion of Medicaid — that’s all it is.”

Pinckney, speaking to those voters in the Ridgeland restaurant almost two years ago, was optimistic that his Republican colleagues would change their minds.

“I have a feeling that some of the other legislators will have a ‘Come to Jesus moment’ and see things differently and decide to be in favor of Medicaid expansion,” Pinckney said. “Mark Twain said, ‘Never let the facts get in the way of a good story.’ Sometimes those in politics don’t want to let the facts get in the way of what they want to do.”

Reach Lauren Sausser at 937-5598.