Published March 11, 2013

In deciding to support the Medicaid expansion under the Affordable Care Act, this is what the governor had to say: “This country is the greatest in the world, and it’s the greatest largely because of how we value the weakest among us. It shouldn’t depend on your ZIP code or your tax bracket. No mother or father should despair over whether they have access to high quality health care for their sick child. I cannot in good conscience deny (our citizens) that need access to health care.”

That’s what the governor said. Not Gov. Nikki Haley, but Florida’s Republican Gov. Rick Scott. Even though he has been and remains an ardent foe of “Obamacare,” he came to the conclusion that it was simply unconscionable to deny access to medical care to several hundred thousand Floridians who would be covered under the Medicaid expansion. Scott recalled the struggles of his late mother raising five children on a limited income: “I remember my mom’s heartbreak when she struggled to find health care for my brother. I don’t want any parent to worry like my mom did.”

Bill Settlemyer, founder of the Charleston Regional Business Journal

As quoted in a column last month by The Washington Post’s Dana Milbank, Scott and other conservative Republican governors have come to the same conclusion. Ohio Gov. John Kasich urged lawmakers to “examine your conscience,” adding that “I can’t look at the disabled, I can’t look at the poor, I can’t look at the mentally ill, I can’t look at the addicted and think we ought to ignore them. For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can help them.”

Arizona’s Republican Gov. Jan Brewer, also no friend of the president or of Obamacare, put it this way: “With this move (accepting the expansion) we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctor’s offices and emergency rooms. Health care premiums are raised year after year to account for expenses incurred by our hospitals as they provide care to the uninsured.”

The list goes on: Michigan Gov. Rick Snyder said the expansion makes sense “for the physical and fiscal health of Michigan.” New Jersey’s Chris Christie, also a foe of Obamacare, said that “These people (who would benefit from the expansion) are consistently among those who need help the most — men and women who have suffered trauma in their lives, live with mental illness, rely on New Jersey’s emergency rooms for primary health care needs, or those citizens who lack insurance or access to treatment.”

Compassionate conservatives?
Remember back when George Bush described himself as a “compassionate conservative”? I’ve often pondered why it would be necessary to campaign using that label, unless too many voters perceive that conservatives generally lack compassion for the least among us.

In the personal realm, that is certainly an unfair characterization. Conservatives, many of whom are deeply religious, give generously of their time and money through their churches, through nonprofits and through personal hands-on volunteer work, helping those in need not only in their communities but through mission work that crosses international borders.

But all too often, conservatives draw a bright line between compassion in the private realm and compassion that can only be fully exercised through collective action in the public realm. This is the case with the Medicaid expansion. How can it be either moral or compassionate to refuse to extend health care coverage to more than 300,000 of our fellow citizens? All of the Republican governors quoted above have come to the conclusion that there is both a moral and a financial case to be made for implementing the Medicaid expansion in their states.

Gov. Haley should put concern for the least among us ahead of political ideology, as other Republican governors have done. I have heard speculation by some that the governor is sticking with her opposition to the expansion because she has “national political aspirations.” I don’t know whether that’s true, but if it is, I would advise her to consider that last year’s presidential election put to rest the idea that the Republican Party is more likely to recapture the White House by choosing the most conservative candidate they can find, much less anyone who styles himself or herself as a Tea Party conservative. That may play well in South Carolina, but not on the national stage.

Drop your insurance coverage
Tony Keck is South Carolina’s director of Health and Human Services. He is highly intelligent and has impressive credentials as an expert on health care policy.

Yet Mr. Keck wants you to cancel your health insurance coverage. He thinks you’re wasting your money, which could be better spent on furthering your education or taking other steps that, statistically speaking, will improve your odds of enjoying good health.

Right now you’re thinking to yourself, “You must be kidding me!” Well, yes, I am kidding you to the extent that Mr. Keck has not recommended that everyone cancel their health coverage. But the rationale I’ve just described is one of the linchpins of his argument on behalf of his boss, the governor, for opposing the expansion of Medicaid under the Affordable Care Act.

Mr. Keck points to the World Health Organization’s data suggesting that only 10% to 20% of the disparities in health among population groups is due to their access to health care. Other “social determinants” such as health behaviors and personal choices, income and employment, education, genetics, social supports, race and place are much larger contributors. Some of those, of course, can’t be changed, but many of them can, to good effect. So, Mr. Keck argues, instead of opting for more medical coverage, let’s focus the state’s resources on the other factors in order to achieve better health outcomes.

The big flaw in that argument, however, is the same flaw that would exist if Mr. Keck advised you to drop your own insurance coverage and spend the money on something else that might improve your overall health and well-being: If you become seriously ill, you need medical care, not a graduate degree. If you’re badly hurt in a car wreck, you won’t be asking EMS to take you to an employment office instead of a hospital so you can look for a better job.

The least among us need health care coverage every bit as much as those of us who are more fortunate. Conservative Republican governors in other states have begun recognizing that this is simply the right thing to do, and that, as Michigan’s Gov. Snyder said, it makes sense “for the physical and fiscal health” of his state. As a matter of conscience, as a moral imperative, and as a matter of sound public policy, Gov. Haley and the members of the General Assembly should follow the example set by other Republican governors and do the right thing for our state.

Bill Settlemyer is a founder of the Charleston Regional Business Journal. Reach him at bsettlemyer@scbiznews.com.