Instead of paying for more poor people to have health insurance, S.C. Republicans on Wednesday offered to pay hospitals more to keep poor people out of emergency rooms.
The Republican health care proposal would pay hospitals $35 million next year to steer the uninsured away from emergency rooms, which they often use for nonemergency care, and into free health clinics. Republicans want to give an additional $10 million next year to the state’s 20 federally qualified health clinics to help pay those clinics to treat those patients.
The plan, part of a proposed $23 billion budget for the state’s fiscal year that starts July 1, would not spend any new money on health care. Instead, the state would pay for it by using $62 million that the state Department of Health and Human Services received last year but did not spend.
The S.C. House’s Republican leadership is presenting the plan as an alternative to complying with the federal Affordable Care Act, commonly called Obamacare.
The Affordable Care Act allows states to expand Medicaid – the joint federal-state health insurance for the poor and disabled – to anyone who makes less than 138 percent of the federal poverty level, or about $15,000. In South Carolina, that add about 500,000 people to the state’s Medicaid program.
Democrats support the Affordable Care Act, saying it would help the poor and the state’s economy through the influx of billions of federal dollars.
However, Republicans, who control the House and state Senate, generally oppose Obamacare, saying it would be too expensive. While the federal government initially would pay all the program’s cost, after the third year that support would drop to 90 percent. The remaining10 percent would have to be paid by the state, costing more than $1 billion in total by 2020, according to estimates from state health officials.
“You could either insure everybody, or you could try to control spending and have better outcomes,” said state Rep. Murrell Smith, R-Sumter, chairman of the House Ways and Means health care subcommittee. “Everyone agrees there is excess cost in health care right now. Our job, what the state of South Carolina wants to do, is take that excess cost out by improving health and improving access.”
State Rep. Gilda Cobb-Hunter, D-Orangeburg, applauded Republicans for proposing to give more money to the health clinics, noting they care for the uninsured. But she said giving $10 million to health clinics is not enough to replace health insurance for the poor.
“I don’t see it as a substitute for Medicaid expansion,” she said. “But I do see it as a stopgap until the political rhetoric dies down and reality sets in.”
Other Democrats were less diplomatic.
Tyler Jones, spokesman for the S.C. House Democratic Caucus, called the Republican plan “insulting.”
“It doesn’t even insure one new person,” he said. “It’s a non-starter with Democrats or anyone who takes this issue seriously.”
In addition, the Republican plan includes:
• $20 million – $6 million in state money and $14 million from the federal government – to pay rural hospitals 100 percent of their cost for uncompensated care that they give low-income patients, a proposal Republican Gov. Nikki Haley unveiled during her State of the State address.
• $8 million to expand a tele-medicine program at the Medical University of South Carolina.
• $7 million for the Optional State Supplement program, which helps “aged, blind or disabled persons” pay for community residential-care facilities
• $3 million for a program to help repay the student loans of doctors who agree to work in underserved areas of the state
While South Carolina’s GOP leaders remain stridently opposed to Obamacare, some Republicans elsewhere are having second thoughts.
Florida Gov. Rick Scott Wednesday became the seventh Republican governor to publicly endorse expanding Medicaid in his state under Obamacare. Democrats cheered because Florida, under Scott’s leadership, had led the resistance to Obamacare, filing the first suit questioning its constitutionality.
Meanwhile, Gov. Haley praised the S.C. House Republicans for their health care plan.
"This is a strong plan focused on targeting hotspots of poor health in South Carolina,” said Rob Godfrey, spokesman for Haley. “Unlike Obamacare, it doesn’t pretend that simply giving people a Medicaid card makes them healthy.”
That might be good politics in South Carolina, said state Rep. Harry Ott, D-Calhoun. But, he added, it is “not good policy ... for the state of South Carolina.”
“At some point,” said Ott, a member of the budget health care subcommittee, “we have got to get over the political problems that are being created in this state by simply saying, ‘We don’t like anything the federal government does.’ ”