SC Dems and Medicaid expansion: Why is common sense a minority position in SC?


You may have read Adam Beam’s story in The State over the weekend about SC House Democrat’s proposal to at least take the three years of free Medicaid expansion that the Feds are offering:

COLUMBIA — Imagine someone offered to give you $4.1 billion over three years, and if you did not take it, your neighbors would get the money instead.

That is the situation South Carolina is in with the federal government, according to S.C. House Democrats who are pushing for the state to expand Medicaid – the joint federal-state health insurance program for the poor and disabled.

The money is not really free, Republicans counter. After three years, South Carolina would have to start paying part of the cost of expanding Medicaid – anywhere from $613 million to $1.9 billion by 2020 – depending on a number of variables.

That’s why Monday, the day that the S.C. House begins debating the state’s $22.7 billion budget, Democratic lawmakers are going to propose an amendment that would accept federal money for the first three years of the Medicaid expansion – when the feds would pay 100 percent of the cost – and, then, automatically end the expanded program…

Well, today, the House Dems held a press conference to talk further about their proposal. The reasons were the usual: It makes no sense to turn down something that won’t cost the state anything for three years, especially when it addresses a critical need. It makes no sense for those of us who have insurance to be paying more to underwrite the most expensive kind of care for people who don’t have coverage. And of course, they hit the angle that it’s the decent, moral, compassionate thing to do.

As for the claim that expansion will cost a couple of billion by 2020, the Dems expressed polite contempt for journalists who would pass that on without investigating its veracity. Gilda Cobb-Hunter called the claim “specious at best.”

I’ll let the number-crunchers sort that out. My point in writing about this is to say that everything the Democrats said today not only made perfect sense, but should be perfectly obvious.

And I have to wonder — why has such a common-sense proposal become a minority position in South Carolina? Because don’t fool yourselves — SC Democrats have little chance of having their way.

Four years ago, the Republican leadership in the General Assembly thought Mark Sanford had lost his mind when he wanted to let stimulus money that was going to be spent anyway be spent elsewhere instead of in South Carolina. And they were right.

Now, the standard GOP position is to turn down this program, just because it has the name “Obama” attached to it.

What’s wrong with us in South Carolina?


51 thoughts on “SC Dems and Medicaid expansion: Why is common sense a minority position in SC?

  1. Steven Davis II

    Because it’s a short-term idea… the Democrat way of fixing things. None of them are looking at the long-term, it’s like buying a house that you can’t afford past three years.

    How is it “free”, Is the Obama printing press 2nd shift starting up again? Aren’t we supposed to be cutting spending?

  2. Silence

    It’s like a crack dealer giving the first hit for free, knowing that it’ll be hard to break the habit later. It’s very hard to get rid of entitlements once folks get hooked. That’s why Obamacare benefits start before the taxes to pay for it do.

    1. kc

      It’s like a crack dealer giving the first hit for free

      Right – health care is JUST LIKE CRACK.

      If you want to know what’s wrong with SC, Mr. W., look no further than your own comments.

      1. Steven Davis II

        It’s easier to give someone something than it is to take it away. If this went through and SC couldn’t fund it in 3 years, do you think we’ll hear about it in the news? People will freak out like they took their paycheck away from them.

  3. Bryan Caskey

    It is true that at first the federal government will pick up nearly 100 percent of the cost for new enrollees made eligible by the expansion, but within the decade these federal subsidies are reduced to 90 percent, leaving SC taxpayers on the hook for 10 percent of the cost—and 10 percent of a very large cost is still a very large cost. Moreover, this assumes that the federal government can be counted on not to further reduce its share of payments in the future.

    Who wants to bet that the number stays at 90%?

  4. Brad Warthen Post author

    Even if we don’t think we can come up with one-tenth of the cost of the program going forward — which I think is ridiculous — there is no excuse for not participating for three years, when it’s free.

    People make like the pressure would be SO HUGE after three years that it would be politically impossible for us to drop out of it. Which makes me wonder what state they think they’re living in. State leaders who are determined to pass up the three free years, as insane as that is, will certainly be willing to say no to the policy when they have to PAY something.

    I make no bones about the fact that I’ll be pushing hard for SC to continue after the three years, because passing up a program for which the state only pays one-tenth is almost, though not quite, as absurd as passing up a free one.

    But if three years are all I can get, that’s three years in which people will get health care and lives will be saved, which is much, much better than no years at all — which is the completely indefensible position taken by the governor and the House GOP.

    1. Silence

      The excuse is that you can’t take entitlements away once people already have them. Name one entitlement program that’s ever gone away.

      1. Brad Warthen Post author

        Well, there aren’t that many, and I’m not aware of any that I’d want to go away.

        I guess we wouldn’t need a separate thing called Medicare if we had a comprehensive way of covering everybody, but until then, I don’t think that should go away.

        What do you think should go away that didn’t?

    2. Steven Davis II

      “when it’s free.”

      When is anything “free”? The funding for this has to come from somewhere.

    3. alwander

      There is not such thing as “free”. Even the apple had a price, “see it is good” but the cost was high.

  5. Silence

    Housing subsidies, mortage interest deduction and Head Start to name a few. A lot of others could be reduced including the 47,000,000 people on SNAP.

    1. Mark Stewart

      Head Start? Head Start?

      As to the others; here is the real problem, SC’s statewide GDP is the fourth lowest in the nation. That isn’t sad, it is scary. We don’t have any economy. Maybe that’s why some are drawn to the anxiety and fear over this mass of poverty and the inchoate feeling of an inability to compete in the evolving economic order that has characterized the state since at least 1830. It is understandable. But maybe we need to just face the truth that we have a fundamental problem that has been metastasizing for almost two centuries, that there are no quick fixes and that the only possible way out is to band aid the present and keep our focus on long term solutions that can begin to form the basis for growth?

      Those would be education and political progressivism (structural evolution); without both SC doesn’t have a bright future.

      This healthcare issue – Medicaid expansion – is not a battle to be fought; it is an opportunity to see that massive, structural change is beginning to get underway in our healthcare system. It will not be easy or clean, but it will come. Our present “system” of healthcare has been unsound and unsustainable; everyone knew it needed to be reinvisioned for the new century. So we are beginning. This is something which is going to present many opportunities for South Carolinians. There will be many economic opportunities which will emerge from this changing paradigm of care. Are we going to seize some of these? Or are we going to dig in our heels and let the future slide on by – again?

      1. Brad Warthen Post author

        South Carolina could pull itself out of its ancient rut if we’d work together to do it. Tragically, our politics is dominated by this petty, ugly attitude of absolute horror that someone else might GET something that you, the taxpayer, had to pay for.

        This obsession with what benefit OTHERS may obtain from a public policy drives the hyperlibertarianism that cripples our state. Amazingly, so many white South Carolinians (and they’re the ones voting for these people) are completely blind to the benefit that THEY accrue from having a well-educated population with adequate health care. To them, it’s all zero-sum — somebody else gets; I lose. It’s all about clinging — self-destructively — to I, me, mine. There is no concept among these people of the fact that you benefit from living in a more functional, affluent community.

        It’s appalling, and it continues to be surprising to me, even after all this time. Because to me, it’s such an unlikely way of perceiving the world…

        1. Silence

          What cripples our state is multifold, but it’s not hyperlibertarian policy. I’d say the biggest thing holding our state back is the weak executive/ strong senate system. The system was designed not to change and to maintain the status quo, and that is EXACTLY what it has done.

          1. Brad Warthen Post author

            Well, you’re exactly right about THAT, and nobody has written more about the problem than I have.

            But we’re worse off now because of the libertarianism. At one time, SC did make some progress under this awful system that we have, because the people in office (reflecting the attitudes of the people electing them) were interested in getting some good things done.

            The methods may have been unorthodox. Fritz Hollings got our tech school system — one of the finest economic development engines in our state — when he was governor by taking a bottle of bourbon with him to visit Sen. Edgar Brown (who was THE power in the state then) and when the bottle was empty, the decision had been made to create the system.

            Now, that wouldn’t happen because the people in office wouldn’t want to create such a system.

            When I did the Power Failure project, which was all about these profound structural flaws in SC government, the structure did indeed seem like our greatest obstacle. It’s still as much of a problem as ever, and you’ll see me keep pushing hard for restructuring.

            But back when we did Power Failure, we had people in office who weren’t government haters. Carroll Campbell was governor, and Bob Sheheen was Speaker. There was a lot more reason to hope that with restructuring, we could move forward.

            Now, we have the problem that Nikki Haley is our governor, which is not much of a selling point for giving the governor more authority. We still need to do it — I believe it would encourage better candidates to run for governor — but the quality of people getting elected these days makes reform a tough sell.

          2. Mark Stewart

            In a sense, the model of our legislative state is an amalgamation of libertarianism and feudalism.

            Those are strange bedfellow, huh? No wonder it has held us back as a society and as an economy.

          3. Silence

            Brad, I’d like to take exception to one point you made in response. You say “we had people in office who weren’t government haters.” The people we have in office today aren’t government haters, but they do play them on TV. We have big-government republicans, big-government democrats, both sets of whom are crony capitalists and possibly a few true libertarian types as well, but not many.

        2. Bryan D. Caskey

          What’s wrong with the politics is how people ascribe bad motivations to the other side. Saying things like the other side is “completely blind to the benefit that THEY accrue from having a well-educated population with adequate health care.” is not helpful.

          Everyone is aware that having a well-educated, healthy population is a good thing. There are just differing points of view on the best path to that goal.

          Saying that people on the other side of the argument have a “petty, ugly attitude” is what’s wrong with politics.

          1. Brad Warthen Post author

            Bryan, I sincerely apologize if you or anyone else who understands the way society works think I was talking about you.

            And perhaps you’re right that someone who values civility as I do shouldn’t use such language about anyone.

            But I must defend myself by saying that there are people out there who truly do not understand how a healthy society benefits them, and are bitterly opposed to programs that they perceive as giving away something to other people — people they regard as undeserving.

            And I think it truly does often take ugly forms. And it’s enormously destructive to South Carolina, including to the people whose attitudes are the problem. And I think it’s tragic for our state.

          2. Steven Davis II

            So Brad, what you’re saying is that anyone who thinks differently than you do is wrong.

      2. Mark Stewart

        Looks like the SC House took the “conservative” choice by choosing to cut off our nose to spite our face.

        Being scared of uncertainty – and of opportunity – is a doubly unfortunate failure.

        1. Steven Davis II

          Huh? Or it could be viewed as knowing well enough that when you’re in a hole you need to get out of the first thing you do is stop digging.

          1. Mark Stewart

            What hole? It was a failure of imagination. I failure to look into the future and to recognize that the existing structure is unsustainable and counter-productive.

            Successful people and societies recognize that change is essential for growth. They embrace experimentation and seek new approaches. Not every experiment works. Most don’t. But the process of creative destruction creates a pull that propels.

            The present healthcare “system” is broken. Everyone has known that for almost thirty years. It just feels comfortable to cling to it – and the fallacies and rationalizations that underpin it.

          2. Steven Davis II

            “Successful people and societies recognize that change is essential for growth. ”

            Then why is it that successful people tend to not back this temporary fix and the majority of people backing it could be considered failures in today’s society. Those who typically want something only if it’s paid for by others.

          3. Brad Warthen Post author

            Except that I don’t, and I really get tired of people who are against everything saying that. I want something for the society that I live in, which includes me, and I want to pay for it.

            What I’m sick to death of is paying for insurance all these years that I can lose at any moment, perhaps when I most need it, insurance that does nothing about covering the larger community I live in, something that profoundly affects the quality of life in my community, its economic vitality, and the cost of my own care.

            I’m tired of wasting money. I want a system that addresses the failings of the one we have. And the only reason we haven’t had a rational system all these years is because of people who have a fit at the idea that somebody else in society might “get” something. It infuriates them. And the fact that it infuriates them appalls me. I’ll never, ever understand how people can look at the world in such a narrow, cramped, resentful, inaccurate, and self-destructive way.

            This Medicaid expansion doesn’t get us to the system I want. But it’s a way to achieve some of the goals of such a system, for the time being. And it makes ZERO sense to turn it down.

            The majority in the House has forfeited any right whatsoever to be seen as good stewards of our state.

          4. Steven Davis II

            Who’s against it Brad, those of us who are paying our way and the way of others who don’t want to pay their way? If I have to work to pay my way, I should have better service than those who don’t pay and expect handouts. It’s kind of an incentive to get and keep a job.

            I’m sick to death of having to pay for others that I don’t know or care about. While we’re at it, why don’t I just pay for the person’s groceries behind me in the checkout line. Oh wait, if she’s using an EBT card, I already am.

            You’re tired of wasting money, so your solution is to spend more money that we don’t have. You just stated that you want the have-nots at the expense of those who have. Why don’t we make it a voluntary contribution, I will pay my way, you can pay your way and the way of as many people as you’d like to sponsor. That way we’re both happy.

            It’s only “right” to you and bud, because you’re striving for a Socialist way of life for this country. You won’t be happy until everyone is equal… regardless of what they contribute.

          5. Mark Stewart

            As an employer, I would ask the basic question: Why should health insurance be tied to being an employee?

            The same would go for retirement funds.

            On the one hand, these things tie employees to their employer. On the other, it restrains growth by inefficiently shackling talent. We are no longer an industrial society of factories and mills. What do you think brought workers off the farms? Opportunity, yes, but also services like schools, healthcare, housing and pensions. We have broken all of those chains; except healthcare. Why not that, too? Why not create a mobil, commited labor pool of individual vendors free to trade their talents without incumberance and without bonds of uncertainty over things not central to the work?

            Steven, you see the paternal world as it was. Those days, outside of government, medical and educational institutions and Fortune 500 companies have gone the way of the rustbelt factory and the southern mill. Those days are coming to a close for all. That’s just the facts. So people can either deal with the evolution, or they can be obstructionists. I don’t hire obstructionists.

          6. Doug Ross


            To achieve your goal of unshackling employees from employer insurance you would have to do that for labor unions and government workers, right?

            Never will happen.

          7. Steven Davis II

            @Mark – It’s not a given to being tied to being an employee, it’s a benefit some companies offer to it’s employees. Same as vacation, retirement, sick leave, etc… The better the benefits, the better employees you attract.

          8. Steven Davis II

            @Mark – So do you ask political related questions in your interviews? Do you base your hiring practices on those questions? If yes, you’re likely setting yourself up for a lawsuit.

            It’s good to know that you wouldn’t hire me, it keeps from wasting yours and my time. Just curious, how many six-figure employees have you hired in the last year?

  6. John

    Silence, your challenge is hard to answer. How do you (or others) objectively define “entitlement?” That would help me answer your question. For example, here are some possible entitlements that have gone: The CCC operated for only ten years; guaranteed empolyment through military conscription was blessedly shortlived, the Space Shuttle expenditures employed a lot of people but have mostly ended, the Rural Electrification Administration is pretty well gone, the WPA is gone; Food Stamps came in, disappeared for ~ 15 years then were brought back because of the medical costs of malnutrition….which of those were entitlements? All? Any?

    And how is the mortgage interest deduction also an entitlement? Are you saying a tax not collected is an expenditure? I’m assuning your objection to “entitlements” is the cost, not the outcome. It the outcome is negative I wouldn’t call it an entitlement, I would use the more inclusive term “wasteful spending.”

    1. Silence

      @John – I don’t consider the CCC, WPA, REA or NASA to be “entitlements” as most folks understand the word.

  7. bud

    Don’t forget the billionaires with their tax breaks for carried interest, corporate jets and dividends. Nor should we leave out big oil, big pharma, big military contractors and other big, big stuff. The housing subsidies, head start probably account for pennies compared to the corporate welfare items. But I will agree that it’s time to phase out mortgage interet deductions starting with second homes.

    1. Silence

      @bud – I don’t consider “carried interest” to be an entitlement, but I do think it should go away, as you do. The corporate jet tax break is actually just an example of equipment being written off over its lifespan, but congress has mucked around with the depreciation rate there, mostly to benefit the sellers of corporate aircraft. I’m not aware of any special tax breaks granted to big military contractors. I won’t touch the oil or pharma questions, but I would say that all corporations should be treated equally under the tax code – as should all people.

      1. bud

        Label it what you like but stuff like carried interest, a lower rate on dividends than wages, excessive spending on the military are all much more costly than head start.

        As for Brad’s point about Hollings and the Bourbon maybe someone should find out what drug of choice Nikki Haley has and offer it up as an incentive.

        1. Silence

          It’s not about which things cost more in raw numbers, bud. A case of Dom Perignon 1955 might cost more than a bottle of Bactine, but won’t be as handy if you need to treat a scrape.
          As a society, we have to do a cost/benefit analysis of how we spend our scarce tax dollars, and how we generate said dollars. We just have different opinions when it comes to tangible and intangible benefits of certain policies.

        2. Steven Davis II

          bud, don’t you have a son in the military? Do you really want him being protected with inferior or outdated equipment?

    2. Steven Davis II

      “Don’t forget the billionaires”

      I won’t if you won’t… and I don’t think you will.

  8. Doug Ross

    You keep ignoring the fact that there are many other states, almost half, who will not be taking the federal money. It’s not a Nikki Haley thing.. it’s not a Tea Party thing.. North Carolina, Georgia, and Virginia are not doing it either. Maybe you need to look into the details a little deeper to understand the reasons why. I know, I know, it’s because everyone is a racist.

    You also ignore the fact that whatever money is coming from the federal government is funded by deficit spending. These aren’t real dollars being taken from our pockets and then given back. They are borrowed dollars to be paid back in the future. They are dollars generated from the printing presses of the Federal Reserve.

    I say take the money only when the budget is balanced.

  9. bud

    You also ignore the fact that whatever money is coming from the federal government is funded by deficit spending.

    So? Interest rates are low so why not spend money on useful endervors like quality health care. We borrowed money to fight WW II, build the interstate highway system and fund quality education for soldiers. All more than paid form themselves many times over. We wouldn’t be the great nation we are today with deficit spending. I say borrow, borrow, borrow so long as unemployment is high. Once its low then we can run surpluses.

    1. Steven Davis II

      “So? Interest rates are low so why not spend money on useful endervors like quality health care.”

      So… is such a good answer in any debate. If you get a credit card application in the mail for 1 year 0% interest, do you sign up for it and use it? If not, why not? The interest rate is low and you could use it to buy yourself something nice.

      When we borrowed in the past, we got something in return. The borrowing wanted now produces nothing.

  10. Mark Stewart

    This “reply” button to a previous comment is creating massive blog communication fragmentation.

    I might vote for it’s abandonment…even though it is helpful in creating dialogue. Because clearly it is less successful as wider communication.

  11. bud

    If you get a credit card application in the mail for 1 year 0% interest, do you sign up for it and use it?
    -SD II

    Actually yes, IF you’re going to buy that nice thing anyway AND you are willing and able to pay it off within the year. I’ve bought several things that way. In finance its called the principal of the time value of money. A dollar today is more valuable than a dollar a year from now. The one caveat is if we enter a period of long-term deflation. In that case we’re in deep trouble anyway.

    1. Silence

      It’s the paying for it when the year is up that seems to be the problem around Washington. Or Main & Gervais.

    2. Steven Davis II

      Even if you know ahead of time that you can’t afford what you’re buying? That’s what keeps repo men in business.

  12. bud

    We just have different opinions when it comes to tangible and intangible benefits of certain policies.

    That’s true and that’s why we debate things. Some folks believe spending as much on the military as the next 10 nations combined makes us safer. I disagree. Some people believe providing health care to everyone is a good thing. I agree. Others do too but for different reasons. Brad finds it useful in a communitarian sense to provide the poplulation with good healthcare. To me that’s not the correct way of looking at this issue. I think it’s a good thing because it helps keep my medical costs low. Doug disagrees because, well I don’t really follow his logic, but it seems to have something to do with his hard-earned money going to benefit some slacker and he finds that offputting somehow.

    In any case the essence of a democracy or in the case of the USA a pseudo-democracy, is to hash out issues in a civil manner then reach some sort of conclusion. Sadly, when it comes to budgeting, healthcare, abortion and virtually everything else we keep fighting the same battles over and over again and nothing ever seems to get settled. Heck we’re even still debating the virtue of birth control! When you can’t even settle that ridiculously obvious issue then we really are in trouble as a nation.

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