South Carolina lawmakers have a monumental decision to make in early 2013, one that will impact the health and the economy of the state and its citizens for years to come.

Gov. Nikki Haley is opposed to Medicaid expansion, called for in President Barack Obama’s Affordable Care Act for people who earn up to 138 percent of the poverty level.

The law also requires Americans to buy health insurance or pay a penalty. Under ObamaCare, the federal government will pay for Medicaid expansion through 2016, then pick up 95 percent of the cost through 2019 and 90 percent thereafter.

The new health care law, however, allows states to opt out of the Medicaid expansion, and that’s exactly what Haley and her Medicaid Director Tony Keck want to do, saying South Carolina can’t afford to pay for the match.

Keck says the money would be better spent finding ways to help people stay healthy and reducing health care costs rather than expanding Medicaid coverage.

Advocates of Medicaid expansion in South Carolina – 22 groups including the AARP, the League of Women Voters, the American Heart Association, the March of Dimes, the NAACP, the Primary Health Care Association and the United Way Association – note that more than 329,000 South Carolinians earn less than $15,000 a year and don’t have health insurance.

They say Medicaid expansion would cover more working adults and families, arguing that if expansion isn’t accepted, the costs would fall on the state’s hospitals or other health care providers, and threaten hospitals with closure.

Tom Dandridge, Regional Medical Center CEO, agrees.

But Phil Noble, a Charleston businessman and president of the S.C. New Democrats, insists the argument that the state cannot afford the small additional funding to pay for Medicaid expansion doesn’t hold water.

We reiterate the position that South Carolina cannot afford to turn down the expanded Medicaid coverage and stand by as other states spend that federal money – our own tax dollars – to provide health care to their most vulnerable citizens while hundreds of thousands in the Palmetto State go without the medical coverage and access to medical care they desperately need.