If there is one number that ought to frighten Governor Henry McMaster as he launches his re-election campaign it is this one: 73. A 2019 Winthrop University poll shows that 73% of South Carolinians approve of the expansion of Medicaid. Only 16% oppose it.
McMaster is in the 16%, a lonely place to be.
As one response to the Coronavirus pandemic, the federal government encouraged the states to expand Medicaid to all uninsured single persons earning $18,000 or less, or to a family of four earning $37,000 or less. The federal government said it would pick up 90% of the costs of this expansion.
Thirty-eight states saw this is a no-brainer. They signed on. But South Carolina is one of just a dozen states that did not. McMaster has refused. As a result, according to the South Carolina Legal Justice Center, 188,000 South Carolinians who could receive health insurance through Medicaid are being denied it.
McMaster, as usual, is about a half century behind the times. He is still fighting old wars against that Republican bugaboo: “entitlements.”
When Medicaid was first offered in 1965, South Carolina delayed more than two years in implementing it.
Following this pattern, former Governor Nikki Haley in 2013 opposed an expansion of Medicaid as part of the Affordable Care Act, turning it into a partisan political issue. “We will not expand Medicaid on President Obama’s watch,” she said. “We will not expand Medicaid ever.”
Continuing this hostility, McMaster told the Associated Press: “The way to good health is good employment and good education.” In other words, buy insurance yourself, if you can afford it.
McMaster argues that expanding Medicaid will eventually bust the state budget. As more and more people enroll, the state will have to pick up its small share of the costs. This is a reliable Republican scare tactic, even though Medicaid is now only 23% of the state budget.
In addition, Republicans see Medicaid as a back-door strategy to produce a public option for health insurance. The GOP has always preferred private insurance, despite its high cost, administrative inefficiency, and frequent interference with doctors’ decisions on what is best for the patient.
McMaster has refused to expand Medicaid eligibility even when presented with evidence that his policy damages precisely those workers the state needs most right now. Georgetown University’s Center for Children and Families found that the uninsured include restaurant workers, construction workers, cashiers, and many who kept the economy running during the pandemic.
Given South Carolina’s dependence on tourism and the hospitality industry, one would think McMaster cares about the welfare of cooks, servers, hotel workers, and so on. But he clearly does not. He cut off enhanced federal unemployment benefits to force the unemployed back to work, even if many don’t earn enough to afford health care.
McMaster will have to explain to voters why their tax money is going to Washington to help fund the expansion of Medicaid to citizens of OTHER states, but not to South Carolinians.
Clearly McMaster’s obstinacy is rooted in a visceral dislike of entitlement programs. So let’s talk about entitlements.
McMaster either doesn’t know or doesn’t care that entitlements in our society often go to the prosperous. Indeed, their entitlements, or hand-outs, helped make them prosperous.
A list of such entitlements could be book-length. But here is a small sample: If you make money through the appreciation of stocks, the capital gains tax rate is lower than if you pay taxes on a salary as a working stiff. Why? It’s an entitlement for the rich. Does McMaster benefit from this lower tax rate? Perhaps he will tell us.
If you can afford to buy a home and take out a mortgage, you can deduct the interest payments on that mortgage from your gross income, thereby lowering the taxes you pay. Has McMaster done this? If you can’t afford to own a home or can’t get a mortgage, you don’t get this entitlement.
Similarly, if you make charitable contributions to cultural, educational, religious or other tax-exempt organizations, you can deduct those contributions from your taxes. Does McMaster benefit from this?
Republicans have starved the IRS for funds so that it is now grossly understaffed and less able to undertake complex audits of the wealthy. This has permitted the wealthy to get away with all sorts of tax scams. For at least fifteen years Donald Trump and his company were tax cheats. The IRS never bothered to look closely at their operation. Trump illustrates how the rich don’t pay their fair share of taxes. They are “entitled” not to.
So let McMaster defend his brand of entitlements for the rich, but not the poor, as he campaigns in the coming months. Joe Cunningham, Mia McLeod and other Democrats will explain how his failure to expand Medicaid hurts rural hospitals, piles medical debt onto the uninsured, punishes essential workers, and damages the health of thousands of South Carolinians.
When McMaster is ousted, South Carolinians will finally get the health care now available to citizens of 38 other states.
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Blogger David M. Rubin is the former Dean of the Newhouse School of Public Communications at Syracuse University. He is a former columnist for the Syracuse Post-Standard and an expert on First Amendment law (speech and press). He lives in Summerville.