South Carolina advocates for better health, lower health care costs and limited government have little to cheer about after Thursday's Supreme Court ruling upheld much of Obamacare.
Instead of providing real solutions, the law simply hides our problems from public view by pouring hundreds of billions of government subsidies into a broken health care system allowing Washington to declare "victory" while continuing to ignore the real health challenges facing Americans.
The Supreme Court ruled that, as constructed, the individual mandate was technically unconstitutional, but then simply renamed the "mandate" a "tax" and let it stand -- the only bright side being the public now knows the mandate for what it is: one of the largest federal tax increases on the middle class in recent U.S. history.
And while some see victory in the court's ruling that the federal government cannot force states to expand our Medicaid programs, it still leaves us with the status quo -- a broken, one-size-fits all program that will spend almost $6 billion next year in South Carolina while undeniably failing to improve the health of our people.
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To hear Obama tell it, all it takes to be healthy is a Medicaid card.
If that were true, South Carolina should be one of the healthiest states in the nation, as almost one in four South Carolinians received Medicaid last year. But it's not true -- in fact, far from it. We are currently ranked 46th.
Yet year after year individuals, employers and taxpayers pour more and more into health care services.
Every dollar more a family spends on health care is a dollar less spent on something like a mortgage or a college fund. Every dollar more an employer spends on health care is a dollar less spent on hiring, pay raises and investment. Every dollar more spent by the state on Medicaid is a dollar less spent on other needs like education, infrastructure, and tax relief.
And somehow Obama wants us to expand Medicaid ever more, adding more than 500,000 people in 2014, an expansion that means almost one in three people in South Carolina would receive government-run health care.
The price tag to South Carolina taxpayers? An extra $1.1 billion to $2.3 billion over the next six years.
We simply can't support this. 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 over use of services -- and that, by the way, costs us billions of dollars.
The good news is that in South Carolina, in spite of most provisions of Obamacare, we are working with employers, hospitals, private insurers, doctors and patients on the real problems that affect the health and well-being of South Carolina. Instead of just pouring money into Medicaid we've been working to change the way we deliver care in our state.
This includes investing in primary care and patient centered medical homes, serving more individuals living with disabilities in their homes rather than institutions, focusing on key health problems, such as infant mortality, reducing Medicaid administrative costs, encouraging payment reform and holding Medicaid health plans and providers more accountable for performance. If taxpayers are going to foot the bill, they deserve real results.
But the president and congressional Democrats have shown time and time again they simply don't believe that states should be trusted to govern themselves. They believe in a one-size-fits-all federal approach that favors Washington special interests and Washington bureaucrats.
We couldn't disagree more. We believe the only way to real health reform is through local action, on the ground, that empowers patients and their doctors.
It's why we support block grants that hold the state accountable for improvements in health, but free us from useless federal red-tape. It's why we will continue to lead the way on physician and hospital payment reform, birth outcomes improvement and cutting administrative costs. And it's why, in spite of last week's ruling, South Carolina will continue to lead the ongoing national fight against Obamacare.
Nikki R. Haley is governor of South Carolina. Anthony Keck is director of the state Department of Health and Human Services.