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House Democrats propose Medicaid expansion plan

Seanna Adcox, Associated Press

COLUMBIA, S.C. (AP) -- South Carolina Democrats said Monday the state needs to expand Medicaid eligibility at least as long as the federal government promises to fully cover the cost. But Republicans contend that's unrealistic.

House Democrats will attempt this week to insert into the 2013-14 budget a one- to three-year temporary expansion of the government health care program for the poor and disabled. Debate on the spending plan for the fiscal year starting July 1 began on the floor Monday afternoon.

"We believe it's a moral obligation," said Rep. Gilda Cobb-Hunter, D-Orangeburg.

Gov. Nikki Haley and the House GOP Caucus adamantly oppose expanding eligibility as called for in the federal health care law, saying the state can't afford the eventual 10 percent match. They argue the state needs to focus on improving residents' health, not putting more money into a bloated, inefficient governmental program.

But while Democrats applaud health care initiatives in the Ways and Means Committee's budget proposal, they contend they're no substitute for extending coverage to hundreds of thousands of additional poor adults.

Democrats hope to win some Republican votes by focusing on the three years when the additional coverage is "free." Legislators would then decide whether to continue the expansion. Under the U.S. Supreme Court ruling that made the expansion an option rather than a mandate, states are allowed to opt in or out at any point.

But Matt Salo of the National Association of Medicaid Directors said the expansion is not free even in the start-up years. Costs include additional administration and the potential of needing to pay doctors more to expand the pool accepting Medicaid patients, he said.

"There is no such thing as free money," said House Ways and Means Chairman Brian White, R-Anderson.

House Minority Leader Todd Rutherford, D-Columbia, said if the state doesn't accept the money, it's allowing its share to be spent in other states.

"We're here today putting 'plan C' on the table," Cobb-Hunter said, arguing that a refusal would also shift health coverage costs to businesses.

She said the three years allows for an evaluation of the true costs and savings. Democrats don't believe estimates that the expansion would cost the state between $1 billion and $2.4 billion extra through 2020.

Cobb-Hunter called the trial period review critical, calling it a "safety valve" if the law doesn't work. But she stressed Democrats aren't advocating ending the program after three years either.

"We're not suggesting that after three years, you pull the rug out from people," she said.

House Majority Leader Bruce Bannister said that's the problem. It's politically impossible to tell hundreds of thousands of people that they'll no longer receive a benefit they've received for three years, he said.

"Once you put people on the roll, you're never going to take them off," said Bannister, R-Greenville.

Haley said she doesn't trust the federal government to fulfill its promises. She vows to veto an expansion, should the budget reach her desk with that included.

"First, there is no such thing as a temporary entitlement program, and second no matter how many promises Washington makes we're not buying it, and we're certainly not putting the people of South Carolina on the hook to the tune of billions of dollars for a program that already doesn't work," said her spokesman, Rob Godfrey.

On Monday, the House approved budget sections that had little to no opposition. The few changes made on the floor included spending $100,000 to repair the Barnwell County Courthouse.

The Medicaid fight will start Tuesday.