COLUMBIA, SC — Gov. Nikki Haley, who wants the state to reject expanding Medicaid, called a news conference Wednesday to draw attention to her plan for the state to pay 19 rural hospitals more for caring for uninsured patients.
As the Republican governor’s news conference wrapped up in the State House lobby, state Rep. James Smith, D-Richland, offered the Democratic response from a second podium that had been rolled up nearby, just before Haley began.
While most political observers expect the Legislature will side with Haley on Medicaid expansion, the dueling news conferences showed that passion runs high on the subject.
The plan to pay the rural hospitals more actually had been announced Jan. 17. Haley’s news conference Thursday provided few new details. It came after Haley and Tony Keck, director of the S.C. Department of Health and Human Services, met with rural hospital executives in her office to discuss the plan. Staff members from the S.C. Hospital Association, among Haley’s most outspoken opponents on the issue, weren’t invited to the meeting.
Administrators and employees from several rural hospitals, who are members of the association, stood behind Haley as she spoke.
Dr. Troy Gamble, chief medical officer at Williamsburg Regional Hospital in Kingstree, said the added state money will help his facility, which lost about $1 million last year, “move in the direction we want to move.”
Keck said 13 of the 19 rural hospitals have lost money over the past four years. One of the 19, Bamberg County Memorial Hospital in Haley’s home county, closed last year but is still on the list of those eligible for the money. Keck said state and local leaders haven’t given up on plans for a Bamberg-area facility.
Dr. John Hicks, a cardiologist at Clarendon Health System, took offense when a reporter asked Haley if she was “throwing a bone” to the rural hospitals to get them to oppose expanding Medicaid, the joint federal-state medical insurance program for the poor and disabled. For a rural hospital that’s running a deficit, “it’s not throwing a bone, it’s throwing a life raft,” Hicks said.
Leaders of the Hospital Association, which represents rural and urban hospitals, found it odd that Rich D’Alberto, president and chief executive of the Laurens County Health Care System, wasn’t included in the meeting with the governor. Laurens is one of the hospitals eligible for the added state money for rural hospitals.
But D’Alberto, chairman of the Hospital Association board, also has spoken out in favor of expanding Medicaid. Keck said D’Alberto’s absence was inadvertent and a late invitation had gone out to him.
The program advocated by Haley will pump about $20 million a year in what is called Disproportionate Share Hospital payments to facilities in rural areas. Those payments help reimburse hospitals for service given to uninsured patients.
“If we can bring up health care in rural areas, we can bring up health care for all of South Carolina,” Haley said.
Keck said the program will be paid for by shifting money within the current pot of $461 million a year in Medicaid funds designated for covering care for the uninsured at hospitals. Most hospitals had been repaid about 57 cents on the dollar for that care. Starting July 1, the 19 rural hospitals will be reimbursed fully.
Keck said giving the rural hospitals more money does not mean that urban hospitals will get less. Changes in the insurance marketplace under the Affordable Care Act in 2014 will reduce the number of uninsured in the state, which should reduce the need for the disproportionate share funds, he said.
Haley said the Medicaid expansion debate and the need to pump more money into rural hospitals “are two totally different conversations.”
Others disagree.
“Pitting urban vs. rural, governor, is not the way to improve the state of South Carolina,” Democrat Smith responded. “We need more access to health care in all of South Carolina.”
Haley is making “petty political theater out of our state’s health,” he said.
Even if the state turns down the proposed federal expansion of Medicaid to cover all adults making less than about $15,000 a year, hundreds of thousands of the uninsured will continue to show up at emergency rooms, where hospitals can’t legally refuse them care, advocates of expanding Medicaid say.
“We don’t need to encourage emergency care,” said Rozalynn Goodwin, director of policy research for the Hospital Association. “We need to encourage primary care and medical homes.”
