When Maine voters took to the polls Nov. 7, nearly 60 percent bucked the longstanding position of their conservative governor and voted to expand Medicaid eligibility under the Affordable Care Act. 

South Carolina now finds itself among a dwindling minority of states that continue to refuse billions of federal dollars for the purpose of growing the low-income health insurance program. 

But Maine’s vote hasn’t changed the opinion of Gov. Henry McMaster, who, like his predecessor Nikki Haley, vocally opposes Obamacare. His office offered a prepared statement about McMaster’s unchanged position.

“Not expanding Medicaid has proven to be the right choice for South Carolinians,” said McMaster spokesman Brian Symmes, “and the governor doesn’t believe there is any reason to reconsider that decision.”

Joshua Baker, South Carolina’s newly named Medicaid director, refused to answer questions about the issue.

Meanwhile, the S.C. Department of Health and Human Services, which administers the $7.6 billion Medicaid program in this state, deferred all questions to the Governor’s Office and could not estimate how many South Carolinians would qualify for the program if state leaders opted into the expansion. 

The agency “can’t provide estimates on populations we’re not taking care of,” said Medicaid spokeswoman Colleen Mullis. 

The 2010 Affordable Care Act was written to provide Medicaid coverage to anyone whose income falls below 138 percent of the federal poverty level. In South Carolina, an estimated 170,000 adults belong in this group, according to the nonprofit Kaiser Family Foundation.

But a 2012 U.S. Supreme Court ruling made Medicaid expansion optional because each state must eventually pay for one-tenth the expansion’s cost. South Carolina, and 17 other states, have so far opted out. 

Christian Soura, South Carolina’s former Medicaid director who now works as vice president of policy and finance for the S.C. Hospital Association, said the federal government has recently become more willing to work with individual states on compromise Medicaid expansion plans. Some of these plans target specific groups, such as homeless adults or patients struggling with substance abuse. 

He said the federal Centers for Medicare & Medicaid Services have made it clear “their door is open and they’re ready to accept pitches from states.”

“The question now is,” Soura said, “what is it that you want your health care system to do?”

Results of a 2013 Winthrop Poll suggest more than half of respondents in South Carolina favor Medicaid expansion. In 2015, most respondents considered it “one of the most important issues.” Even so, Soura doesn’t see South Carolina following in Maine’s footsteps. 

“In many states, voters can go to the polls and force their state government to do something,” he said. “That’s now how laws are set up here.”

But that won’t keep Medicaid expansion from cropping up on the campaign trail.

Rep. James Smith said he plans to make the issue part of his platform in his bid for the 2018 Democratic nomination for governor.

In addition to helping more South Carolinians receive health coverage, the state should not miss out on the thousands of jobs and billions of dollars in subsidies that just go elsewhere in the nation, the Columbia attorney said.

“All we are doing is giving up on an entire economic community that is ours,” Smith said. “This stick-our-head-in-the-sand approach is not working.”

Catherine Templeton, the former state health department director, and Lt. Gov. Kevin Bryant, both running against McMaster for the Republican nomination for governor, disagreed with Smith. 

“Congress needs to get its act together and repeal Obamacare so we can have more control over how we manage our own money in state,” Templeton said. 

Bryant, an Upstate pharmacist, argued that South Carolina can’t afford to expand Medicaid eligibility because the program is already too big. 

“We’re out of money,” Bryant said. “Medicaid spending is over a third of our budget now, where is used to be in the neighborhood of 15 percent. Even without expansion under Obamacare, it is growing at an unsustainable rate.”

To his point, even though South Carolina has not expanded Medicaid eligibility, enrollment has grown 13 percent in recent years. More than 1 million South Carolinians are enrolled in the program. Most of them are children. 

Editor’s Note: This article was updated Saturday afternoon after Gov. Henry McMaster’s office responded to questions posed earlier this week. 

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Will South Carolina expand Medicaid? Gov. Henry McMaster’s administration says no.