According to a recent study published in Health Affairs, South Carolina has one of the highest rates of Medicaid physician participation, largely tied to its high Medicaid reimbursement rates. Any honest assessment of South Carolina's program would conclude that the state considers Medicaid and our citizens' health an important priority. So when Gov. Haley says South Carolina won't accept the expansion of Medicaid under the Patient Protection and Affordable Care Act, she does so because she believes that its version of expansion will ultimately hurt the poor, hurt South Carolina, and hurt the country by doubling down on a system that already delivers some of the lowest value in the world.