Governor Nikki Haley, a Tea Party-backed Republican, was among the first state leaders to oppose expanding Medicaid after the U.S. Supreme Court ruled that the federal government can't make states do so. Caught between poverty and pressure to curb government's power, South Carolina illustrates the forces at play in the nation's capitals amid the broadest changes to the health care system since 1965. In South Carolina, the law would add about 500,000 people to Medicaid, said Tony Keck, whom Haley appointed to head the Health and Human Services Department.