The Medicaid rejection:Cutting off other people's noses to spite them

Governor Nikki Haley, a Tea Party-backed Republican, was among the first state leaders to oppose expanding Medicaid after the U.S. Supreme Court ruled that the federal government can’t make states do so. Caught between poverty and pressure to curb government’s power, South Carolina illustrates the forces at play in the nation’s capitals amid the broadest changes to the health care system since 1965.
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In South Carolina, the law would add about 500,000 people to Medicaid, said Tony Keck, whom Haley appointed to head the Health and Human Services Department.

“We simply can’t support this,” Haley and Keck said in a July 3 statement. “We are not going to jam more South Carolinians into a broken program, a program that stifles innovation, discourages personal responsibility, and encourages fraud, abuse and overuse of services -- and that, by the way, costs us billions of dollars.”

Republican governors of Louisiana, Florida, Iowa, Mississippi, and Texas also oppose the plan to boost the scale of the health-care program. Texas Governor Rick Perry said today he won’t do anything to implement the president’s law. In his state, about 25 percent go without health insurance, the nation’s highest rate, according to Census Department figures.

“I stand proudly with the growing chorus of governors who reject the Obamacare power grab,” he said.
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The state where the Civil War began also long been suspicious of ceding power to the federal government, said Bruce Ransom, a political scientist at Clemson University in Clemson, South Carolina.

One of the state’s U.S. senators, Jim DeMint, is a founder of the Tea Party Caucus. In 2009, then-Governor Mark Sanford sparred with the Obama administration and his own Legislature, seeking to use $700 million from the stimulus program to pay down debt instead of spending on the economy.

“Federal aid, federal programs -- unless it’s for the military -- are not good things,” Ransom said, summarizing voters’ views. “That plays here. The conventional wisdom says that’s a winning hand.”

Keck, South Carolina’s top health official, said the state’s illnesses are driven by poverty and that money poured into Medicaid would best be used elsewhere. Keck said he and Haley favor block-grant funding that would hold the state accountable for set outcomes, such as lowering obesity.

“We should spend our money getting more people jobs with health insurance,” said Keck, the state’s top health official. “If we’re going to talk at all about targeting the uninsured, it has to be with a completely different system than Medicaid.”

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.