COLUMBIA, S.C. (AP) — The South Carolina House on Tuesday rejected attempts by Democrats to temporarily extend Medicaid eligibility to hundreds of thousands of poor adults.
The House voted 73-45 and 74-42, along party lines, on proposals to expand eligibility while the federal government covers all but some administrative costs.
The votes followed nearly five hours of pleading as Democrats asked Republicans to break from their caucus' stance and insert the expansion into the 2013-14 budget. Democrats made a religious appeal in calling expansion of the government health care program a moral obligation, frequently citing scripture concerning treatment of "the least of these."
Rep. Joe Neal, a Baptist pastor, told his colleagues they will account for their vote before God.
"If our citizens don't have access to health care, we rob them of all meaning of life," said Neal, D-Hopkins. "What did you do for the least of these? We'll all have to answer that question. Did we do what was right — what was fair?"
The 2010 federal law initially made Medicaid expansion mandatory. But the U.S. Supreme Court ruling made it optional for states. At least 22 states and the District of Columbia have signed on to covering adults up to 138 percent of the federal poverty level.
Republican Gov. Nikki Haley and the House GOP caucus oppose the expansion, citing costs. They contend the state needs to focus on improving residents' health, not adding people to an inefficient, bloated governmental program that already covers more than 22 percent of South Carolinians.
Growth in the current Medicaid system is expected to cost an additional $2.4 billion in state revenue through 2020. That includes $156 million in the budget plan being debated in the House this week. Medicaid accounts for nearly a quarter of the general fund spending, after growing by 26 percent in the last five years.
"That is the fastest growing section of our budget. We need to deal with that before we get to the expansion," said Rep. Murrell Smith, R-Sumter, chairman of the Ways and Means subcommittee that writes the budget's health care section.
Democrats gave Republicans credit for initiatives in the budget plan intended to improve health while lowering costs. The programs, funded through savings realized over the last year, are designed to increase access to health care in rural areas and steer people away from hospital emergency rooms, where care is expensive, to primary care in free or low-cost health clinics.
But they're not a substitute for extending coverage, said a succession of Democrats who came to the podium.
"I support every initiative to make outcomes get better. I accept your half of the equation. Why do you steadfastly say 'no' to our side?" said Rep. Harry Ott, D-St. Matthews. "We are still making political decisions because someone's decided it's in their best interest to be opposed to Obamacare rather than provide health care to half a million South Carolinians."
Democrats argued it makes sense to extend coverage for at least three years while the federal government promises to cover the costs. Officials can evaluate later whether to continue coverage as the state match grows to 10 percent, they said.
"Help us get those people in the desert some water," Ott said. "If it runs out in three years, at least they had access to three years of good coverage."
They point to studies showing the state would get $11.2 billion in federal funding through 2020 if it accepts the expansion — more than $4 billion of that coming in the first three years.
Republicans countered it would be politically impossible to toss people off rolls once they're enrolled. Even the first three years aren't free, Smith said, with the state needing to pick up administrative costs.
The state's actuaries estimate the expansion would cost the state between $613 million and $1.9 billion extra through 2020. The next seven years with the full 10 percent match would be even more expensive.
Medicaid director Tony Keck said that doesn't include the costs of adding 170,000 already-eligible people who are expected to sign up for Medicaid over the next two and a half years even without the expansion, as people learn of the option and enroll to avoid fines. Their coverage must be paid according to the regular state match rate of 30 percent.
In the end, Democrats knew they didn't have the votes but appealed to voters who may be watching to call their legislators and share their stories.
"We're up here talking because we hope those of you outside those walls who know someone down on their luck who doesn't have health insurance," said Rep. Gilda Cobb-Hunter, D-Orangeburg. "You have a face to attach to these numbers."