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Medicaid Expansion by the Back Door


Many South Carolinians are starting to realize that, despite the promises of our governor and many legislative leaders to the contrary, Obamacare is already being implemented in our state. It isn’t happening because of one vote on one law to comply, but rather through the quiet taking of federal dollars attached to Affordable Care Act (ACA) programs. 

Medicaid is, for all practical purposes, already being expanded under provisions of the ACA even though the state hasn’t officially opted in to the ACA Medicaid expansion. Programs such as “express lane” eligibility would automatically enroll children who meet certain criteria, and hospitals would be allowed to enroll a patient in Medicaid through “presumptive eligibility,” which permits hospital personnel trained by the S.C. Department of Health and Human Services (SCDHHS) to apply a simplified set of requirements to declare a patient Medicaid-eligible. In addition, SCDHHS is changing our state’s Medicaid formula to broaden eligibility by altering income requirements through a methodology contained in the ACA.

So Medicaid expands, and likely will continue to expand until the lines blur so much that South Carolina finds itself complying with the Medicaid expansion terms.

[Click here to read SCPC’s analysis of ACA in South Carolina]

If all of this seems confusing, it’s designed to be. Medicaid, the ACA and the South Carolina budget process are sufficiently confusing to prevent most citizens and even many lawmakers from deciphering the many ways in which new programs are folded into existing programs to ensure that the ACA becomes policy in our state through federal funds. 

It’s hard to know whether a law passed in South Carolina three years ago could have stopped the ACA from practically becoming the law, but it’s almost certainly true that it won’t help at this point to pass one bill declaring Obamacare null, void, unenforceable or anything else. It’s true that our state has the sovereign authority to refuse to participate in a federal program, but it isn’t true that we can do so while still accepting federal funds to implement it.

The only way to free our state from Obamacare, Common Core or any other federal program we don’t like is to refuse the federal dollars that trigger the programs and instead fund services with state dollars. 

Of course, given the secrecy of the budget process and the complexity of the web of agency programs, we’ll have to mandate a clear process that the Legislature and the governor must follow when it comes to taking federal dollars and committing us to federal mandates. That can be done by following a long-ignored state law that requires a very detailed – and public – budget process. Currently the state budget is cobbled together in scores of committee and subcommittee meetings, and the public has no practical way to know what lawmakers are taking from the federal government. Following the state’s budget law would begin to change that by forcing them to begin in January with a coherent state spending plan (the governor’s executive budget) and debating it in the open.

That’s where South Carolinians would have their best – indeed, only – chance to demand that lawmakers turn down federal dollars and instead fund essential services with state money. 

We can’t afford to be lulled into a false sense of security by settling for a law that sounds good but does nothing to stop elected officials from sneaking in federal dollars and triggering Obamacare mandates. It’s going to be difficult enough to stop what they’ve already done, but we can if we demand they start rejecting the dollars through the 2014-15 budget.  

Ashley Landess

Viewpoints

Obamacare Medicaid