Affordable Care Act face-off

December 9, 2013 

South Carolina has decided not to expand Medicaid to cover the Affordable Care Act supplements, which would have provided the state hundreds of millions of dollars for three years to provide for low income individuals and families to receive insurance. Here are two views about it from our Lake Wylie Pilot editorial board members:

Leaving South Carolina residents uninsured is unconscionable

When individuals had taxes prepared last year, they were asked about their health care coverage. If they had no health insurance, they were provided with estimates of what they would pay under the Affordable Care Act. Many of these taxpayers were told they would pay little or no premiums when the program goes into effect Jan. 1.

In South Carolina, and North Carolina, this information was premature. South Carolina has decided not to expand Medicaid to cover the Affordable Care Act supplements to pay for low income individuals and families to receive insurance.

The Hospital Association of South Carolina has agreed to pay an increased provider tax to cover the 10 percent increased costs to the state once the federal supplements drop to 90 percent. Still S.C. Gov. Nikki Haley has declined the help and refuses to allow South Carolina to participate in the program. South Carolina residents can purchase insurance through the federal exchanges, but will not receive the state Medicaid to lower their premiums.

If you fall under the federal poverty level, you can not purchase insurance through the exchange in South Carolina, but are directed to the state Medicaid website. You also will not be eligible for Medicaid. The only choice will continue to be the emergency room.

Although the more than 700,000 South Carolina residents who are uninsured have not been helped by the ACA, they will still have to pay penalties for not having insurance in the future. This is inexcusable.

S.C. decision is fiscally responsible

In the ancient story of the Trojan horse, someone said “beware of Greeks bearing gifts,” a warning that has been sounded (but not always heeded) ever since. In fact most of us have come to realize there is no such thing as a free lunch, whether that applies to a free weekend at a time-share resort or the federally funded plan to fund the initial three years of Medicaid for states that want to sign on to the program. South Carolina, along with 20 others, have wisely chosen to reject this blatant attempt to lure states into the medical exchanges.

Under this plan, the states would have to pick up the tab to cover a portion of the Medicaid costs after 2016 for the newly eligible recipients. How would South Carolina pay for the required state matching funds and the administration costs?

These amounts could be substantial. Considering constrained state budgets, any increase in payments that states would have to make after 2016 would be difficult to bear. Money from the federal government is never free. The money would have to come from us and future generations, necessitating borrowing huge amounts from foreign countries to finance government programs we simply can’t afford. Any such expansion of Medicaid would come with a high price tag.

This prudent decision by South Carolina (and many other states) not to expand Medicaid wasn’t something that was done out of rancor or mean spiritedness. It was done solely as part of the process to conduct financial affairs of the state in a fiscally responsible manner.

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