Proposals aimed at improving residents’ health particularly in rural areas of South Carolina were part of $75 million in Medicaid money including in a spending plan advanced by the House budget-writing committee Thursday.
South Carolina Republicans contend the state needs to focus on making people healthier, at a reduced cost, and not simply add people to an already-bloated Medicaid system. They have repeatedly refused Democrats’ efforts to expand Medicaid eligibility under the federal health care reform act.
The $6.3 spending proposal approved by the committee for state taxes, now moving to the House floor, instead contains what Ways and Means Chairman Brian White called a Medicaid overhaul.
“It’s about changing habits and making South Carolinians healthier,” said White, R-Anderson. “We need to get better outcomes. At the end of the day, we’re trying to get more with our dollars.”
Democratic Rep. Harry Ott said he applauds the efficiency effort, but wants it done in conjunction with providing insurance to hundreds of thousands of additional people.
“All those things need to be done,” said Ott, D-St. Matthews. “But in no way is it an alternative to Medicaid expansion. It’s fixing a problem in the delivery system.”
The plan follows ideas advocated by Medicaid director Tony Keck and focuses on rural areas his agency has mapped out as hot spots of poor health. It includes:
• Reimbursing 18 rural hospitals 100 percent of their costs for treating patients without health care. Keck touts it as a way to shift $20 million annually to hospitals that have a much higher share of patients who can’t pay and are much sicker.
• Expanding access to specialists in rural areas with incentives for doctors to practice there.
• Expanding the telemedicine network, in which specialists can diagnose patients and consult with local staff around-the-clock from afar. Currently, 17 hospitals are in the network, but only four of them are in rural areas.
“Telemedicine has the potential to be transformative,” said Rep. Kris Crawford, R-Florence, an emergency room doctor.
The plan also seeks to move treatment of the uninsured away from expensive hospital emergency room visits to qualified health clinics that provide free services. It puts an additional $10 million toward the clinics and free prescription drugs.
It also doles out up to $35 million to hospitals as incentives for innovative care, to include steering frequent ER visitors to clinics for primary care.
The head of the state Hospital association praised the plan for innovation, while continuing to call for Medicaid expansion.
The ideas “reflect the need for a systemic approach to improving our state’s health care system,” said president Thornton Kirby. But “we continue to believe that increasing access through Medicaid expansion is an integral part of meeting the challenges we face in improving the health status of our state.”
Republican Gov. Nikki Haley adamantly opposes expanding eligibility of Medicaid to more poor adults, saying the state can’t afford the eventual cost. She praised the House GOP plan.
“Unlike Obamacare, it doesn’t pretend that simply giving people a Medicaid card makes them healthy,” she said. “Instead, it invests limited state dollars on our biggest problems and demands accountability for outcomes from the health care system.”
Democrats point out that the expansion won’t cost the state anything for three years. The state would eventually pay a 10 percent match.
“All we have to do is simply say we want to provide health care to more people in the state,” said Ott. “At some point, we’ve got to get over the political problems created in this state by simply saying we don’t like anything the federal government does.”
He criticized Republicans for funding their plan, in terms of the state’s portion, with one-time money from the Medicaid agency’s reserve fund. If Republicans were serious about fixing the system, he said, they would pay for it with recurring money.
But White said the initiatives will continue to be funded through the savings they create.
In January, Keck told the Ways and Means Committee that initiatives he’s already enacted are savings tens of millions of dollars. Those included lowering administrative rates to managed care organizations and ending payments for unnecessary early deliveries, which were being scheduled for convenience but are more expensive and can result in even more costly intensive care stays.