Puppet State

November 14, 2013

Inside Insight

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ariail puppet state

Breaking the Ties That Bind

By Ashley Landess

Obamacare might be the worst law we have seen yet from Washington, but it’s not the worst we will see if we don’t get serious about making the long-term fix.  Short of Congressional repeal of the Affordable Care Act, there is only one way to stop it in South Carolina: force state politicians to say no to the money and the mandates. It’s time to make the tough choices to cut programs we don’t need and fund core government services with state dollars.

It isn’t as if the money coming from DC is ours. That tired argument doesn’t fly anymore. For every dollar sent to DC our state gets around $1.92 back, and a big chunk of that money is debt.  We are digging ourselves – and the next generation – into a bigger hole by taking the federal dollars that come with Obamacare. The mandates that kick in as a result of accepting federal money are costing many South Carolinians not just more in health care costs, but their jobs as well. Businesses are cutting back and shutting down even as we lose our doctors and our insurance plans.

South Carolinians may have believed they were safe from Obamacare – after all, their politicians made a lot of promises to protect them from it. Unfortunately, they weren’t forthcoming about the fact that they’ve already been participating in the Affordable Care Act by implementing its programs and taking the federal money that goes with them. Programs such as “auto-enroll” are in place and already expanding Medicaid rolls even without officially “opting in” to Obamacare expansion (although we can’t be sure that isn’t also being triggered). And hospitals are now authorized to “presume eligibility” for patients coming through their doors, and that means they can enroll those patients in Medicaid (another risk of expansion)

The state is already requesting more than $300 million to expand Medicaid under “current” eligibility. See how this works?

Barring full Congressional repeal – which would be extremely unlikely – there’s only one fix to all this, and it doesn’t involve trusting state politicians to do better by us than the feds have. Rather, it is to force our state officials to disclose all costs to the private sector – both to individuals and to businesses – every time they are poised to take federal dollars. State politicians have an obligation to understand and disclose all the ramifications of taking federal money. It isn’t accurate to say the federal government takes our sovereign authority to manage state programs from us. Rather, our state lawmakers and our governorvoluntarily forfeit it when they take federal funds and trigger the mandates and costs that come with them. Therefore, it is the responsibility of our elected officials in South Carolina to fully understand and then disclose to citizens all consequences of federal funding of state programs. When the president promised we could keep our insurance and our doctors, our state officials should have forced federal officials to put that in writing before agreeing to accept any dollars associated with Obamacare. And if the feds don’t have the answers we need, then clearly our legislature and governor have no business taking the money and triggering the mandates with which citizens are forced to comply.

It’s a simple concept, actually. And the process by which this “contract” could be outlined for the public already exists in our state law. The governor is required to submit the state budget in great detail, along with all revenue sources. State law also requires the disclosure of some federal funds and the mandates accompanying them.  And the legislature is required to hold open, joint hearings of both finance committees to consider the governor’s budget.

A few minor changes in the law (the mandated disclosure of all federal funds/strings/costs by every public entity, the outlining of the terms of the “contract” for accepting federal funds) and citizens could be informed on the front end before their elected officials obligate them to costly federal mandates that have a dramatic impact on their freedom. It’s already happening now, with state officials blaming DC. That isn’t the way it works, and the governor and legislative leaders know it.

The fix to the problems with health care lies in the only system that has ever produced both quality and affordability – the free market in which providers and patients deal with each other and in which freedom of choice and innovation exist for both sides without the interference from politicians. The goal must be to identify and eliminate all barriers to freedom in the health care system so that South Carolina has the highest quality health care in the nation, with access possible for all our citizens – including our lowest income citizens. That goal won’t be achieved through more federal dollars or even better ideas for reforming the current system.  We’ll only have the best health care system in the country – and even in the world – through a full free market.  It’s the only system that’s ever provided anything close to that, and it’s time our elected officials gave it back to us.