The contemptible SC Senate kills Medicaid expansion

Of course, in the Senate’s defense, it is merely doing what the contemptible SC House and our contemptible governor did before them:

COLUMBIA, SC — The state Senate killed Medicaid expansion on Tuesday, the last hope for supporters who wanted to extend health insurance benefits to South Carolina’s working poor.

The vote was 23-19, with two Republicans – Ray Cleary of Georgetown and Paul Campbell of Berkeley County – joining all of the Senate’s 17 Democrats present in voting for the expansion. Four senators, one Democrat and three Republicans, were absent.

The proposal would have accepted $795.8 million in federal money to pay for health insurance for about 320,000 South Carolinians beginning Jan. 1. There would have been no direct cost to the state. Because the proposed Medicaid expansion was an amendment to the state budget, it would have expired after one year. Lawmakers would have had to vote to expand coverage again next year…

Congratulations to Sens. Ray Cleary and Paul Campbell for doing what is unquestionably, indubitably the right thing. I can’t say I know either of them, really, but I’ve heard Paul Campbell speak, and suspect that he’s one of the brightest people in the Legislature. The retired regional president of Alcoa, he’s a man of accomplishment who seems to have a good grasp of how the world actually works. This vote is consistent with that impression.

As for the rest, particularly those who voted against this for no better reason than the fact that it has the name “Obama” attached to it, and that’s what you’re expected to do if you’re a Republican in South Carolina… well, you’ve just demonstrated once again why I hold partythink in such low regard.

Yes, one can rationalize all day and all night about how there are better ways to achieve the goals of Obamacare, but when you’re all done, you haven’t changed the fact that this is the only plan in effect, or likely to come into effect. This is it. You either do it, or give the idea of significantly broadening access to health care the back of your hand.

57 thoughts on “The contemptible SC Senate kills Medicaid expansion

  1. Doug Ross

    Let’s not forget that South Carolina is not alone in doing this. As it stands now, 26 states will likely not accept the expansion.

    This includes several states that voted for Obama in 2012. This isn’t SC going off on a renegade hissy fit.

    Obamacare is a disaster waiting to happen (because the tough parts of it were delayed beyond the 2012 election while the “feel good” provisions were enacted immediately). It’s going to be an ugly fall season for Obama as the exchanges are set up and buckle under the weight of government bureaucracy and inefficiency. Obama will be wishing Benghazi, the IRS, and the AP spying issues were his worst days in office.

    1. bud

      Doug, what would you do about the 40+ million people without insurance? Since we’re paying for them to get treatment anyway doesn’t it just make sense to do so in a sensible way rather than just letting the hospitals pick up the tab and pass it along to those folks who are insured? I just don’t follow the libertarian position on this at all. After all it has been tried over the last 50 years and has failed disasterously.

      1. Doug Ross


        We have never, ever, ever tried a libertarian approach to health care in this country. Well, maybe back in the days before insurance… you know when doctors treated patients and patients paid for the service.

        Remove the government from health care, especially in the Big Pharma area, and you will see prices drop. The system we have now is a result of the lobbyist-politician relationship between the drug companies and insurance companies.

        I’d also go for single payer if there was a cap on how much anyone would have to contribute. If payments into the system are based on income then its still just welfare and income distribution.

        I would also be fine with letting any person buy into the same plan as our elected representatives have. THAT would be the easiest first step.

    2. Scout

      So your point is if all the other kids are doing it, it must be ok? It is the republican party that has gone off on a renegade hissy fit.

  2. Steven Davis II

    Obamacare is no different than a drug dealer, you give them the first dose for free and once you got them hooked you start charging regardless if they can afford it. I know several medical doctors and I’d say 100% of them are against Obamacare. I know small businesses who are reducing employees hours to less than 28 hours per week because they will be “forced” to provide medical coverage for them if they work more than 28 hours per week.

    1. Kathryn Fenner

      Yeah, let those poors get health care and they’ll start stealing your car radio just to get another hit!

      1. Stephen Davis II

        Who pays for it starting Year 2? Or would you suggest SC take it for Year 1 and have it end 365 days later? Doctors are against it, small business owners are against it… just bleeding heart liberals who think people should have everything for nothing are for it. I read where suburban poverty is on the increase, I wonder if that has anything to do with Section 8 housing moving away from the urban areas into the suburbs?

      2. Stephen Davis II

        How are the poor handling medical needs now? Are they going without or just billing it to Medicaid?

        1. Scout

          Many fall through the cracks and don’t qualify for medicaid – i.e. the working poor – they make too much to qualify for medicaid but don’t have jobs that provide insurance. Many who do qualify for medicaid don’t have access to doctors that will take it. So yes many go without.

        2. Barry

          Most just go to the ER- and that’s the most expensive type of care. They don’t pay their bill- and your insurance goes up each year to help cover some of those expenses.

          Typically, most poor people don’t run to the ER first. They wait, and wait, and wait until they can’t stand it any longer- and then go and have to receive extensive treatment for what could have been a fairly simple issue -at one time.

  3. bud

    The healthcare debate reminds me of the JFK assassination in one respect. Since the Warren Commission report first came out there were always groups that came up with all the things wrong with the findings. That was fine until they had to come up with their own theory of what happened. As it turned out every conspiracy theory offered up was much less plausible than the Warren Commission. From the grassy knoll to the four shot to the various Cuban/Russian/mafia explainations turned out to be completely implausible. In the end the Warren Commission findings turned out to make the most sense.

    So how does this relate to Obamacare? The naysayers like Doug rant on and on about what’s wrong with it yet never offer anything better. It’s beyond ridiculous to defend the status quo pre-2009 given the staggering increase in cost, incomprehensible nature of the work-based insurance nightmare. And most importantly the horrible outcomes compared to other nations. So that’s out. So what is a viable alternative? This inquiring liberal wants to know.

    1. Doug Ross


      Max Baucus apparently falls into the “grassy knoll” conspiracy theorists. As one of the architects of Obamacare, he was so sure of its success that he is quitting politics and says it will be a train wreck. If that’s what the supporters think of it, imagine what it’s really going to be like.

      They passed a 2000 page bill without reading it. We will see the results soon. You keep telling yourself that the government can do it. I’ll wait for the results.

      1. bud

        Again Doug, you are good at pointing out the flaws in Obamacare. I could do the same thing with market-based capitalism. So what is your solution?

        1. Doug Ross

          It’s not me pointing out the flaws, bud. It’s the guy who wrote most of the bill.

          My solution starts with removing the government from health care. The amount of fraud alone in Medicare would pay for the health care of millions of people. (This was one of Elizabeth Colbert-Busch’s main themes). Even Obama in 2008 talked about the billions in fraud in waste. What did he do about it?

          The government IS the problem. The free market combined with charities would be a better solution.

          1. bud

            We mostly had that for decades and it failed with the highest per-capita health care costs in the world BY FAR. Combined with a life expectancy approaching that of many third world countries it’s fair to say that a free-market based solution to health care was an utter failure. Government is successfully involved in healthcare everywhere else in the world so that is certainly a better option than relying on greedy healthcare entities along with charities that are already stretched too thin. The definition of insanity is to keep trying something that continues to fail and expecting a different outcome. In the case of free-market healthcare that would be the poster child for insanity.

          2. Doug Ross

            Our life expectancies are more a result of demographics, diet, and lifestyle. You can’t compare the United States to every other country.

          3. Scout

            Doug, you are all about pay for performance for teachers – why should the same concept not apply to healthcare. One main reason healthcare costs are out of whack is costs are not aligned to outcomes. Try as you might, I don’t see how you can blame that on the government. It is inherent in the nature of the service provided. The sicker you are, the more you need to see the doctor, the higher your medical bills will be – how is that not a perverse incentive to keep patients sick. I’m not suggesting any malicious intent on doctor’s parts to do this; I’m suggesting that the gears that run the whole system are pulling in the wrong direction, and this is something that business types, not the doctors themselves, take advantage of, when profits and the bottom line are their concern.

            I don’t know how you design a system that rewards doctors for keeping patients out of their office. Maybe medicare should pay doctors for the services they don’t have to provide. Then they would have an incentive to make sure you don’t need those services and they’d be more proactive in ensuring that outcome. Maybe. I’m just thinking out loud.

            Anyhow – it’s way more complicated than it’s the government’s fault. And here are some more thoughts in that direction.


          4. Doug Ross


            If you pay for performance for doctors, you will see most doctors avoid taking on the sickest patients. People manage to the metrics.

            It’s not hard (for me) to understand that Medicare has the largest pool of people requiring the most care and most healthcare dollars. Old people are going to cost the most to treat. Yet the government handles that in the worst way possible: they negotiate payment schedules that are 30% of normal cost which shifts the true cost to other payers, they are horrible at managing fraud and abuse in the system, and they have so much bureaucracy (especially when it comes to prescriptions) that significant effort is spent by providers and patients trying to work through the mess. If there is one entity that should not be involved in health care it is the government. They have no incentive to do it right.

          5. Scout

            ” Yet the government handles that in the worst way possible: they negotiate payment schedules that are 30% of normal cost which shifts the true cost to other payers,” – Doug

            Except when the normal cost is not the true cost. Did you follow the link I included above? Healthcare charges have little to do with true cost according to the recent Time magazine article by Steven Brill referenced in the link above. You can agree or disagree with that assessment but I still say the dynamics involved have little to do with the government.

          6. Doug Ross

            What aspect of the health care system ISN’T under the heavy hand of government? Medicare, Medicaid, FDA, HPAA, Obamacare…

            I worked for two years at Duke Medical Center in their billing center. Medicare payments were not close to anything paid by any other entity. And the fraud alone would probably cover the health costs of poor people who really need it. But since there is no incentive to control costs and manage fraud, the money is stolen. It’s TENS OF BILLIONS of dollars every year.

        2. Steven Davis II

          bud would you prefer the flaws be pointed out by medical doctors? Because if you are, you could go ask any of them and I bet the vast majority would say let you know why they are against it.

          1. Kathryn Fenner

            Like the SC Hospital Association, which urged the acceptance of the Medicaid money?

          2. Stephen Davis II

            Kathryn, most doctors I know have already stopped taking on new Medicaid patients. Hospitals and doctors aren’t the same thing.

          3. Doug Ross

            My anecdotal experience with doctors I know aligns with Steven’s statement. A good friend who is a top ortho surgeon in the area told me he would rather quit medicine than be forced to practice under more control of the government. Another ob gyn I know thinks Obamacare is a disaster waiting to happen. These are not uninformed people.

      2. Doug Ross

        Siimple question, bud – how is it that health care costs have spun out of control during the time of Medicare and Medicaid? It has been said that 50% of a person’s health care costs are incurred in the last six months of life. Those are typically Medicare recipients.

        Maybe we need an honest discussion about prolonging life at the end stages rather than allowing nature to take its course. I know in my father’s case, after he fell into a coma following surgery several years ago, the bill for two weeks of intensive care was over $200K – this after the doctors told us that even if he lived, he would be completely incapacitated, blind, etc. On the other end of the spectrum we see more and more done to save premature infants at lower and lower weights. Many of them survive with profound disabilities requiring hundreds of thousands of dollars of ongoing care. I was in a Sunday School class many years ago with a doctor who was the head of the premature infant department. He told me he was seriously conflicted over whether it was better to save the pre-terms who would face such disabilities. These are the conversations that we need to have.

        1. bud

          Fair enough. That type of discussion will be branded as “death panels” if the government gets involved. If private healthcare providers are tasked with the decision ultimately money becomes and issue and we will end up with healthcare rationing based on wealth. This is a very difficult subject to discuss but I agree it’s one worth having.

  4. Bryan Caskey

    “Contemptible”…people don’t use that word too much. Good word, though. Odious is also a good one that I’d like to see get more use.

    1. Juan Caruso

      As you wish, BC. …

      Obama has overseen an administration rife with disingenuous rhetoric, secretive machinations, divisive application of federal regulations, and several fatal terrorist attacks on the homeland (post establishment Homeland Seurity).

      Among the more odious shortcomings, none has been more disgusting than Major Nidal Malik Hasan’s continuing status as a jailed innocent, since 2009, for 13 counts of premeditated murder and 32 counts of attempted murder at Fort Hood.

      1. Mark Stewart

        Wow, didn’t see that one coming! I must be out of some media loop.

        That’s the big problem in the country?

        1. Juan caruso

          Nice try, MS, please do not attribute to me whatever far-fetched drivel you contrive ( I know lawyers have been trained to discredit opponents) unless you also include and wish to contradict my actual words.

          Did I refer to any “big problem in the country”? Not at all; I clearly specified “Among the more odious shortcomings”. By the way, that shortcoming has become a “red flag” indicator of the administration’s penchant for ‘foot dragging’ in serious matters (i.e. response to request to beef up security in Benghazi), as well as dubious claims by POTUS of not being in the loop on IRC 501(c)4 abuses.

          I seem to remember that “notice to the agent satisfies notice to the principal”. So, perhaps you would be good enough to share what exempts an administration (full of lawyers) from the expected business-like discipline found in public schools, hospitals, and state governments.

      2. Silence

        Don’t forget Major Hassan’s $275k worth of salary that he’s collected while sitting in jail.

      1. Bryan Caskey

        A word that I use very sparingly is shameful.

        I said that to the opposing lawyer and her client in a mediation once. It was the strongest word that I could think of at the time that was not a curse word.

  5. Doug Ross

    If I allowed the government to do anything it would be to regulate the advertisements of prescription medicines. We are a pill popping country thanks to all those ads. Depressed? Take a pill. Can’t sleep? Take a pill. Can’t be the sexual stallion you were when you were twenty? Take a pill.

    Prescription drugs should be handled by doctors alone. All those advertising costs have to be recouped somehow…

  6. John

    What is contemptible about this decision (I agree with Bryan, the word has great impact) is that the Legislature could have decided to save the Feds that much money any time by, for example, asking the Feds to close Fort Jackson, refusing federal highway funds, refusing Army Corps of Engineer funds, barring universities from pursuing federal grants/accepting federal student loans…the list is endless. But instead we have decided it’s better to refuse health care funding for the poor? How patriotic of us to sacrifice our poor for the good of the national debt. If only we had more of them to give up we could help the country even more! What spite toward Obama must consume those Legislators who would target health care over the many, many other sources of funding we could discuss.

    Re Doug’s comments, which can’t go unremarked – will I be willing to pay more taxes to avoid the euthanasia and infanticide you seem to be alluding to? Yes. Do I feel bad that you will too? No. And I REALLY hope your pediatrician friend was speaking of quality of life issues and compassion for the individual, not costs, when you talked about preemies at Sunday School.

    1. Doug Ross

      Yes, the doctor was talking about the quality of life issues (which come at a ridiculously high cost). He was seriously conflicted about whether doing everything possible was the best course.

      Since when is letting nature take its course euthanasia or infanticide? There are two parties who should be the only ones involved in such decisions – the patient (or parent) and the doctor.

      1. bud

        There are two parties who should be the only ones involved in such decisions – the patient (or parent) and the doctor.

        That’s not even close to realistic. If a patient wishes to continue living but may only do so at the expense of someone else who may also choose to continue life then someone has to make a rationing decision.
        That is a fairly common situation especially regarding organ transplants. If a rich and otherwise healthy 62 year old is on a heart transplant list competing with a similiarly healthy but uninsured 30 year old then in a market-based situation the rich guy is likely to get the heart. That’s a form of rationing. Or we could have the government make the decision that the young guy gets it and the costs are passed along to folks that are insured. The government solution is characterized by conservatives as “death panels”. The market solution is simply free enterprise.

        1. Doug Ross

          I’m talking about end of life, bud, not transplants that would likely extend a life for a significant time. As far as I know, they wouldn’t do a heart transplant on someone with end stage lung cancer. Those types of decisions are made all the time.

        2. Stephen Davis II

          Survival of the fittest… it’s nature’s way. Go against it and well you have… us and our problems.

      2. John

        Since when is letting nature take its course euthanasia or infanticide? – Doug

        Since we gained the ability to intervene, which is what differentiates “medicine” from “watching.” After that everything else is a moral choice.

        etting nature take its course? That’s not really what medicine is all about, unless we’re going to change its name to “watching.”

        1. Doug Ross


          So we have doctors expend every possible resource no matter what? That’s not how it works now. Decisions are made every single day in hospitals to stop treatment.

          1. John

            Seriously? Yes, we expect doctors and hospitals to do that. That’s why penniless people can walk into an emergency room and expect care, because human life is generally valued in our society. Of course our state government has just decided the hospitals/caregivers need to pay the cost for that care, which probably will reduce the resources those have to work on improving their overall care options for everyone. Specifically, since some of our hospitals are for-profit, we’ve decided that businesses need to pay for a service that the federal government wanted to pay for. Get that? We’re shifting tax burdens for caring for the poor from a combined personal/business derived tax stream to a hidden tax on health profits. But that’s OK because we just showed Barak Obama….what? We fail at ethics and math too? I bet that took HIM by surprise…

            But if ethics and basic math fail as reasons to have done this then here is another “business” related reason – a lot of part time jobs in this state employ people who depend wholly or partially on Medicare for health benefits. If the business is lucky that part-time position will grow into a full time job. That means when small businesses grow that growth can be partially subsidized through Medicaid during the transition for an individual position. Now, since we rejected the expansion, we have fewer resources available to help business subsidize benefits for part timers. Weren’t we supposed to be the pro-business state? Or is it more important to be the anti-Obama state?

    2. Stephen Davis II

      “will I be willing to pay more taxes to avoid the euthanasia and infanticide you seem to be alluding to? Yes.”

      You mean just like the same plans some of the European countries have that the medical programs that the liberals are asking for?

  7. Brad Warthen Post author

    Less than an hour ago, I received a release from the Senate Republicans boasting of what they had done. Here’s the portion of the release that appeared in the original email:

    The Senate Republican Caucus has once again taken a stand on Obamacare!

    Yesterday, we BLOCKED Democratic efforts to create a massive new Medicaid expansion called for by Obamacare.

    The move will save South Carolinians untold hundreds of millions of dollars over the coming years.

    The first thing I want to note is the main point… There is no explanation as to why this was a bad thing, beyond the TWO references, in the first two sentences, to it being a part of OBAMAcare.

    Unless, of course, you are sufficiently gullible as to be taken in by the absurd claim that “The move will save South Carolinians untold hundreds of millions of dollars over the coming years.”

    That, of course, is an out-and-out lie.

    For the first three years of the program, the state would contribute nothing. And approving participation THIS year in no way commits the state to continue past that initial period — after which the feds would still pay 90 percent of the cost.

    We know why the Senate killed this, and it has nothing to do with the cost.

    1. Brad Warthen Post author

      Just in case you’re having trouble following this, I refer you again to this passage in the news story:

      Because the proposed Medicaid expansion was an amendment to the state budget, it would have expired after one year. Lawmakers would have had to vote to expand coverage again next year…

      There is therefore no way, by any stretch of the imagination, that the Senate’s action saved South Carolinians a single penny, much less “untold millions of dollars.”

      Actually, the exact opposite is true: The Senate’s action prevents many millions in federal funds from flowing INTO South Carolina, while at the same time paying for health care for people who otherwise would lack access to such care.

  8. Ralph Hightower

    Of course. But isn’t this the same group that wants to nullify Federal laws?

    Why not do something that we’ve done in the past?
    Secede from the United States.

  9. Mark Stewart

    Some people simply decide to move away from the state when things like this happen. It’s just that kind of statement made by the legislature.

  10. Doug Ross


    Why do you congratulate the two Republican Senators who supported Medicaid expansion by name but assign the “contemptible” tag to the nameless, faceless SC Senate? Wouldn’t it be fair to say that anyone who voted against Medicaid expansion is then contemptible? And wouldn’t the person(s) who led the effort be the most contemptible? Who are they?

    And what about this contemptible cretin who introduced a bill in the U.S. Senate to allow every state to opt out?

    9/21/2011 U.S. Senators Lindsey Graham (R-South Carolina) and John Barrasso (R-Wyoming) today introduced the Medicaid Flexibility for States Act to allow states to ‘Opt-Out’ of Obamacare’s costly expansion of Medicaid.

    “”I’m confident that if given the chance a large number of states would opt-out of Obamacare’s forced Medicaid expansion,” said Graham. “In South Carolina, expansion of Medicaid under Obamacare will add an additional $1 billion in state matching funding requirements. When fully implemented nearly 30 percent of South Carolinians will be eligible for Medicaid. States like South Carolina can simply not afford this burden. Our bill takes the issue out of Washington and puts it back in the states. I would hope every Senator, regardless of party, would give the people of their home state a chance to be heard.”

  11. bud

    Doug, while I share your contempt for Lindsey Graham in this case his role in the feckless refusal of billions of dollars is pretty minor. What is important is what our state legislature has done. The same folks who willingly shovel money at Boeing are now the ones refusing a modest step toward healthcare for all. They are the ones who at the moment are contemptable.

    1. Doug Ross

      Are the Medicaid expansion dollars funded by federal deficit spending? If so, then all we are doing is paying for today with tomorrow’s dollars. And that cannot continue indefinitely.

      If someone said “We will cut military spending by the amount required for Medicaid Expansion” I would support it. But there are never choices made.. never priortization… it’s more, more, and more. Want to do a direct trade of foreign aid dollars for U.S. health care spending? Fine. Want to abolish the Department of Education and throw all that money into health care for the poor? Fine.

  12. bud

    Agreed. We should cut defense, foreign aid and education at the federal level to pay for healthcare for all.

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