The Medicaid expansion debate heats up

The advocates of expanding Medicaid in South Carolina were out in force last night at the USC School of Law auditorium.  Hundreds of people turned out to hear presentations by three supporters of the expansion and one opponent, Tony Keck the Director of the SC Department of Health and Human Services.

In his remarks, Mr. Keck chastised the first speaker for barely mentioning health while focusing on the economic reasons for providing Medicaid to South Carolinians up to 138% of the federal poverty level.  His position and that of his boss, Governor Nikki Haley, is that spending money to expand Medicaid to hundreds of thousands of uninsured low income citizens is not the best way to improve their health. 

One of the two slides Mr. Keck showed was the underpinning of this argument.  The slide of a map showed federal data on health outcomes for Medicaid recipients in the state.  Those with Medicaid in the I-95 corridor of shame had far more health problems than Medicaid recipients outside of that area.  This demonstrated, according to Mr. Keck, that government health insurance was not a good determinant of health outcomes.  Better education, jobs and personal decisions along with genetics were more important to better health than simply having health insurance.

When I was recognized to speak, I pointed out that the map he was of present Medicaid recipients but that these were not the people we were actually talking about.  I wanted to see a map of the uninsured South Carolinians who would be eligible for Medicaid under the expansion and how their health outcomes compared with today’s Medicaid recipients.  I predicted that we’d see a big difference between the two groups with those with Medicaid having better health.

Mr. Keck responded with more of the same concerns that expanding Medicaid was not going to be successful in improving health.  But I was able to get in one last question.  Did he think that there would be a different health outcome for a person at 50 percent of the federal poverty level with a child who has Medicaid under our law compared to a person at 60% of the federal poverty level who does not have Medicaid today. 

Mr. Keck responded that of course the person would be better off with Medicaid than without it.  “But at what cost?" he added.

Cost?  Wasn’t this debate supposed to be about health?  When the proponents cite the economic benefits, they get criticized.  But when the opponents of expansion agree that having Medicaid will yield to better health outcomes than not having it, then they evoke “COST”. 

This is going to be an interesting legislative session.