COLUMBIA, S.C. — South Carolina’s strategy for implementing President Barack Obama’s health care law is simple: We’re not.
The state health insurance plan, which covers 417,000 people, will not comply with the Affordable Care Act. Last week, the state’s Public Employee Benefit Authority voted to keep the plan as it is, rather than comply with the rules that take effect in 2014.
And, Wednesday, S.C. Health and Human Services director Tony Keck made his case to a state Senate committee about why South Carolina should refuse $3 billion in federal money to add 513,000 people to the state’s Medicaid program, which provides health insurance for the poor and disabled.
Lawmakers ultimately will decide that issue in what is expected to be one of the most heated debates of the 2013 legislative session. That debate could well pit health care advocates, doctors and hospitals against Republicans, who control the General Assembly.
Keck’s case was well-received Wednesday by Republicans but criticized by Democrats.
“Our opposition to the Affordable Care Act is we believe they started out asking the wrong question: ‘How do we get as many people in the U.S. health insurance as possible?’” Keck told members of the Senate Medical Affairs Committee. “If you ask, ‘How do we improve the health of the United States,’ that’s a different question.”
It is cheaper for the state health plan not to comply with the Affordable Care Act.
Not complying means the state does not have to pay for preventative health screenings – including physicals – for everyone on the state health plan. By not complying, the state health plan’s costs are expected to increase 13 percent in 2014. If it did comply, the health plan’s costs would increase 16 percent, according to an estimate by Gabriel Roeder Smith & Co., the consulting firm hired by the state.
But not complying locks the state into its current health plan and bars any changes. That’s a problem, because the state health plan for retirees has one of the largest and fastest growing deficits in state government – $10.1 billion. But Art Bjontegard, chairman of the Public Employee Benefit Authority, said, right now, “It’s better to stick with the known than the unknown – particularly when such large numbers are involved.
“This is not something you deal with like getting a tattoo, where you get it done once,” he said. “We will keep coming back to this annually but probably more frequently than that.”
Gov. Nikki Haley supports continuing the existing state health plan but revisiting that decision each year, according to her spokesman Rob Godfrey.
One thing Haley does not want to negotiate is the prospect of expanding the state’s Medicaid program.
Under the Affordable Care Act, states have the option of expanding their Medicaid programs to cover all adults living at below 138 percent of the federal poverty level.
But Keck said the state can’t afford to expand its Medicaid rolls. Expanding Medicaid would add about 513,000 people and increase South Carolina’s share of the program’s cost by $1.7 billion by 2020.
Keck told the Senate Medical Affairs Committee on Wednesday that the state is having a hard enough time paying for the people who are already eligible for Medicaid. Keck has asked for a $193 million increase in next year’s budget. But the state only has $190 million in new money to spend.
Democratic state senators challenged Keck, saying, by not expanding its Medicaid program, South Carolina is leaving $3 billion of federal money on the table – money they say will be spent anyway.
“As a state, we have some responsibility to the United States. We’re not just going to be takers,” Keck said. “We’re going to be givers. Takers want to take as much money from the federal government as possible. Can we afford to do it more?”
Sen. Darrell Jackson, D-Richland, countered by arguing if South Carolina refuses to expand its Medicaid program refusing the extra federal money that would come with that expansion – the federal government still will spend the money, just not in South Carolina. Sen. Brad Hutto, D-Orangeburg, said refusing to expand Medicaid would mean fewer S.C. jobs in health care and other fields, adding Keck had not done an analysis to determine the effect of an expansion on the state’s economy.
“Three billion coming into this state – increasing jobs, increasing salaries – what would that mean for this state?” Hutto said.
Keck countered saying the federal government would have to borrow more than half of that $3 billion. “Health policy needs to be designed around improving health and not be designed around jobs.”
Some Democrats implied Republicans were opposing the health care law solely because a Democratic president supports it.
“We have a habit sometime of refighting old battles and reliving the Civil War. It sounded like you are heading down that track,” Sen. Clementa Pinckney, D-Jasper, told Keck. “It seems that part of your premise today is, ‘This is what we are going to do and that’s it.’ And I guess I just want to remind this committee ... this is a legislative matter.
“We have not decided.”
Reach Beam at (803) 386-7038.
