I ALWAYS thought the huge flaw of Obamacare was that it didn’t do nearly enough to encourage prevention, which is the only way to improve our health while reducing our medical costs. Little did I realize the perverse power of anti-Obamaism.
It turns out that Obamacare already is making South Carolina healthier. Or at least it’s about to, if all the Republican initiatives to counter it take hold.
From paying hospitals to set up emergency-room alternatives to focusing on obesity in the communities where it’s taking the greatest toll, GOP politicians suddenly have become our state’s most aggressive public-health advocates.
And after years of doing absolutely nothing proactive to improve the public health — it took decades just to raise the lowest-in-the-nation cigarette tax, despite reams of studies demonstrating that slashes teen smoking — they’re putting forth smart proposals. Proposals they never would have dreamed of if they hadn’t been trying to find ways to justify turning down the most generous match the federal government has ever offered to expand Medicaid eligibility.
The budget that the House will take up in a week includes two fine public-health initiatives that support efforts by Gov. Nikki Haley’s pro-public-health, anti-Obamacare Medicaid Director Tony Keck and our new obesity-fighting DHEC Director Catherine Templeton.
In the more substantive change, hospitals would be paid to contract with primary-care physicians to “co-manage chronically ill uninsured high-utilizers of emergency room services.” That is, to provide regular treatment for those patients in order to avoid the emergencies that drive them to the most expensive care available, which we all pay for because federal law prohibits hospitals from turning them away.
That’s something a few hospitals already have experimented with on their own dime, with impressive results. The budget would put $10.5 million in state funds — $35 million once the standard federal match is applied — toward this program.
It’s a smart approach because we spend three-quarters of our health-care dollars treating people with chronic conditions — with the overwhelming majority of that treating people who haven’t been doing the things necessary to manage their conditions. With proper treatment, some chronic diseases are reversible, and others can be managed in a way that saves a tremendous amount of money, and suffering.
Which leads us directly into the second public-health initiative in the budget: obesity prevention. Ten state agencies would be required to work with DHEC on a plan “to facilitate an environment that decreases body mass index,” in part by making sure schools comply with a 2005 state law that increased the physical activity requirements and sought to reduce the availability of junk food in public schools.
This proposal is more symbolism than substance, putting a legislative imprimatur on anti-obesity work that already is going on at the initiation of Ms. Templeton, who got fired up this summer after she learned that obesity is one of the primary causes of chronic conditions, and the problem that kills the most South Carolinians, makes the most South Carolinians sick and, if prevented, would save South Carolina the most money.
The current focus of the anti-obesity crusade is an effort by Department of Social Services Director Lillian Koller to blacklist some particularly unhealthy foods and beverages from purchase with food stamps. In a state where a third of the population is obese and another third is overweight, telling people that taxpayers aren’t going to subsidize their soft drinks and candy and chips is, as Ms. Koller said at a news conference last month, a “duh” idea.
It’s true that care needs to be taken in drawing an off-limits list, as Rep. Bakari Sellers keeps reminding us, because poor people, particularly in rural areas and urban ghettoes, don’t always have access to reasonably priced healthy food.
But there’s a lot of distance between the healthy eating that foodies embrace and Pepsis, Fritos and Twinkies. Surely we can agree that there are some foods and beverages that ought to be just as off limits as alcohol and cigarettes already are. Soft drinks top that list.
Of course, that’s easier said than done, with a federal Agriculture Department that sees its primary job as protecting the food and beverage conglomerates and routinely rejects attempts to limit food stamp purchases.
Are these GOP initiatives all part of a cynical attempt to make turning down the federal Medicaid expansion look respectable? Probably, at least on the part of the legislators and the governor. And we shouldn’t buy the idea that this is an either-or choice, that pursuing these plans negates the need to expand Medicaid eligibility.
But regardless of the motives, the ideas are smart. And ironically, they demonstrate that states have a lot more flexibility to make Medicaid work than we’ve been led to believe. Although states need more flexibility, we shouldn’t underestimate how far a little energy and creativity can go.
Reach Ms. Scoppe at (803) 771-8571 or firstname.lastname@example.org. To read her series on chronic conditions, go to thestate.com/scoppe.