Medicaid Expansion

What is this all about? According to the Kaiser Family Foundation:

The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($17,774 for an individual in 2021) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations.

KFF: Status of State Medicaid Expansion Decisions: Interactive Map

“Enhanced federal matching rate” means the federal government would cover 95% of the costs for two years, essentially sending those tax dollars back to the states!

However, only 12 states, including South Carolina, have turned down these matching funds and won’t offer this expansion to residents who could benefit. While all states benefitted from the Affordable Care Act, the states that also accepted Medicaid Expansion saw much greater gains in those insured than did South Carolina.1

What would Medicaid Expansion do for South Carolina?

  • Many studies prove out that Medicaid, and its expansion, is indeed a good investment — not just for health outcomes — but for state economies and budgets as well. 2
  • 345,000 South Carolinians would be covered by this expansion
  • 105,000 of these, the poorest of our residents, currently fall in the “coverage gap” and have no realistic access to health insurance at all. They would have access to true healthcare. 3
  • $2.2 billion of federal money, already allocated to South Carolina, would be released and put to this use.
  • Billons of dollars in growth in the health care industry
  • More people willing to work as their health conditions occur
  • Healthcare costs would be lowered for all residents, even those who are already insured
  • Tremendous savings in insurance from the ability to pursue preventative healthcare

Why hasn’t South Carolina adopted this?

Gov. Henry McMaster says: ““The way to good health is good employment, good education.”4 This is ironic given the constant assault on our public education system.

The other commonly used objection is that the short-term gain would get obliterated by long-term losses as the federal help disappears. But here’s a fact we just cannot get around: The money has already been taken from South Carolina and is sitting there doing nothing. At a very minimum, get this money back by accepting the expansion and as the state’s coffers boom and the health of the general population improves, then we can reassess after the two year program.

My position

By this point, we’ve already seen how this has played out in many states across the nation.

Medicaid expansion was associated with a 4.4 percent to 4.7 percent reduction in state spending on traditional Medicaid. Estimates of savings outside of the Medicaid program vary significantly. Savings on mental health care, in the corrections system, and from reductions in uncompensated care range from 14 percent of the cost of expansion in Kentucky to 30 percent in Arkansas.

The Commonwealth Fund, 2020

The facts and evidence are clear. South Carolina would only benefit from accepting Medicaid expansion and should do so promptly.