COLUMBIA — Calling it a "no-brainer," Democratic legislators asked Gov. Henry McMaster to take advantage of Congress' latest offer and expand Medicaid to tens of thousands of poor South Carolinians.
"It does not make any economic sense to not do this," Senate Minority Leader Brad Hutto said March 30 in the Statehouse lobby, joined by seven other members of his caucus.
Their appeal follows new incentives Congress passed as part of its nearly $2 trillion COVID-19 spending package to encourage more GOP-controlled states to expand the joint federal-state government health plan for the poor.
In South Carolina, the extension is estimated to cover nearly 190,000 additional adults who earn too little to afford federal health care subsidies.
But McMaster has already made clear he will not sign off on an expansion. And the Legislature — which has its largest Republican majority ever in both chambers following November's elections — has no desire to force him to do so.
McMaster told The Post and Courier last week the expansion is still too costly, especially since the incentives are temporary. He said his opposition hasn't changed since 2010, when Congress passed the health care law known as Obamacare, which paid 100 percent of states' expansion for several years.
McMaster and his predecessor, Nikki Haley, repeatedly rejected the idea, saying the state couldn't afford the eventual costs.
"The reason we didn’t like it to begin with is because the federal government’s paying for it at first — and the federal government is us, we’re the ones paying the money into the federal government — but then it would impose a cost after some number of years,” McMaster said at The Post and Courier's Pints & Politics event on March 25. "Pouring more and more money into a system that is full of waste through an enormous bureaucracy … is not the answer."
Sen. Ronnie Sabb, D-Greeleyville, said COVID-19 has shown the importance of health care for all and should change the years-old arguments.
"What's different are the hearts and minds of South Carolinians at the moment," he said.
Senate Majority Leader Shane Massey initially had a single-word response about the possibility: "No."
Asked to expand on his stance, the Edgefield Republican said that beyond the costs, he has a "real philosophical problem in giving free stuff to able-bodied adults" and transforming what is now a program largely for children, very poor families and the disabled.
The federal government already covers 90 percent of the costs of expanding Medicaid coverage to more low-income adults. Thirty-six states have signed on to the expansion. Two more — Missouri and Oklahoma — are scheduled to begin their expansions in July.
More than 1 million South Carolinians are already covered by Medicaid and the federal government currently pays for about 70 percent of the program's cost. The latest enticement would temporarily boost the federal government's share by 5 percentage points for two years. The cost for adults newly eligible under the expansion would be covered at 90 percent by the federal government.
South Carolina spends $1.4 billion in state taxes on Medicaid. The nonprofit Kaiser Family Foundation estimates the two-year boost could send South Carolina a net $600 million through 2023.
The Democrats did not immediately have an estimate for the state's eventual cost, but Hutto said the 10 percent share has to be better than the cost added to taxes or private insurance premiums to cover expenses for the uninsured who show up at hospitals for care.
Sen. Kevin Johnson, D-Manning, argued the state's share of the expense is far outweighed by the cost of people dying or becoming seriously ill without access.
And Sen. Dick Harpootlian, D-Columbia, called it the "best economic development deal I've ever seen," saying the additional money would add health care jobs and make South Carolinians healthy and more employable.
Jamie Lovegrove contributed from Columbia.