Research & Commentary: South Carolina Medicaid Expansion

Published November 12, 2012

South Carolina will soon have to decide whether to expand its Medicaid programs by accepting additional federal funding. The federal health care law requires states to expand their Medicaid eligibility to all individuals with incomes less than 133 percent of the federal poverty level or no longer receiving federal Medicaid. The Supreme Court, however, ruled states could not be forced to expand their programs in order to continue receiving current levels of federal support.

Those in favor of expansion say it will allow better access to care for more of South Carolina’s neediest residents. Those opposing expansion say the program is already unduly expensive. Opponents include South Carolina’s Medicaid director, Tony Keck.

The federal health care law is projected to cost South Carolina approximately $70 million, based on figures that estimate half of those eligible for Medicaid are already enrolled in the system. Keck contends that figure is likely a conservative estimate. South Carolina’s Medicaid agency anticipates 205,000 already-eligible residents will be added to the Medicaid program “as people learn of the option, enroll to avoid fines, lose insurance through their jobs or opt for Medicaid over paying private premiums,” writes Seanna Adcox for The Associated Press.

As Keck told AP, “I can’t caveat this enough to talk about the uncertainty in the projections. If 75 percent show up [for enrollment], we’re automatically behind.”

Another concern is that full federal coverage of new enrollees will end in 2020, leaving the state to finance the expanded rolls on its own, increasing its financial woes.

Expanding a system that already provides insufficient care will not guarantee better health care access. Instead, it will guarantee longer waiting lines for patients and huge costs for taxpayers. South Carolina should be wary of greatly expanding a system that is already fiscally unsustainable.

The following documents offer additional information about Medicaid expansion.

SC Medicaid Director: Predictions Could Be Way off
South Carolina Medicaid Director Tony Keck explains to The Associated Press why Medicaid expansion could cost the state far more than expected.

Increasing Dependency Is Not Compassion
The Idaho Freedom Foundation describes the poor condition of the state’s Medicaid program and the fiscal ramifications of expansion.

Idaho Report on Government Waste
In a comprehensive study, the Idaho Freedom Foundation identifies the areas of Idaho’s state government where there is waste, fraud, and abuse.

Medicaid: To Expand or Not To Expand
Nicole Kaeding of Americans for Prosperity argues states should avoid expanding their Medicaid programs because doing so would support the flawed and expensive federal health care law, place heavy financial burdens on the state, and expand an already broken system.

Research & Commentary: States Should Avoid Medicaid Expansion
Kendall Antekeier of The Heartland Institute explains the Supreme Court ruling on Medicaid expansion and urges states to avoid expansion. “States should think twice about giving up more control of their Medicaid programs only to further expand a system that is already fiscally unsustainable,” she writes.

Ten Principles of Health Care Policy
This pamphlet in The Heartland Institute’s Legislative Principles series describes the proper role of government in financing and delivering health care and provides reform suggestions to remedy current health care policy problems.

The End of Federalism: How Obamacare Will Impact States
A fact sheet from The Heritage Foundation outlines the consequences of expanding Medicaid programs to match federal requirements.

Mario Loyola: Challenging the Constitutionality of Obamacare’s Medicaid Expansion
In a podcast for Coffee & Markets, Mario Loyola describes why he and many other analysts consider the federal health care law’s Medicaid expansion to be unconstitutional.


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database at

If you have any questions about this issue or the Heartland Institute Web site, contact Heartland Institute Manager of External Relations Kendall Antekeier at [email protected] or 312/377-4000.