The Greenville News
February 3, 2017
By Liv Osby
With changes to the Medicaid program anticipated under a repeal of Obamacare, efforts are underway to bolster the federal health insurance program for the poor in South Carolina.
But even supporters hold out little hope that they’ll succeed in a state that has refused to expand the program up to now.
One proposal is the South Carolina Access to Health Care Act, introduced this month by state. Rep. Gilda Cobb-Hunter, D-Orangeburg.
The bill is based on the program in Arkansas — a predomiately red state — and would enable uninsured residents to get a voucher from Medicaid to purchase insurance on the private market.
“I introduced it because after years of trying to get the state to expand Medicaid to provide health care coverage to uninsured people went nowhere, I saw the Arkansas model which was supported by Legislature there,” Cobb-Hunter told The Greenville News. “And after talking with colleagues and the former insurance commissioner in Arkansas, I thought it was something we could try here.”
Of South Carolina’s 4.8 million residents, 35 percent are low-income, according to the Kaiser Family Foundation. And 19 percent of its residents were on Medicaid or the Children’s Health Insurance Program (CHIP) in 2015 — three quarters of them in working families, the nonprofit reports.
Those programs cover one in eight adults under 65, two in five low-income people, two in five children, three in five nursing home residents and two in five disabled people, according to Kaiser.
But 11 percent of the population still has no insurance.
Cobb-Hunter said her bill is about using existing Medicaid funds to devise a plan that the state Department of Health and Human Services says will work.
“Don’t get me wrong. I support single-payer,” she added. “But what is more important to me is providing health-care coverage for South Carolinians, so I’m willing to explore anything that worked elsewhere. It’s not the best plan, but it does answer the state’s question about developing a state plan based on our needs.”
Cobb-Hunter said she doesn’t think the chances are much better under Gov. Henry McMaster than they were under Gov. Nikki Haley, who adamantly opposed expanding Medicaid. As attorney general, McMaster filed suit in 2010 to overturn the Affordable Care Act.
The bill is in the House Ways and Means Committee, which is chaired by Rep. W. Brian White, R-Anderson. He could not be reached for comment.
“We live in a world of alternative facts and as such, I don’t have a lot of hope that this will go anywhere,” Cobb-Hunter said of her bill. “But I am an eternal optimist and I will keep trying.”
Meanwhile, Frank Knapp, executive director of the South Carolina Small Business Chamber of Commerce, is leading an effort that hopes to ensure the state gets its fair share of Medicaid funding if, as many expect, the program is changed to cap federal funding and give states block grants instead of the funding formula now used.
“If that decision is based upon what Medicaid funding states are getting now, South Carolina is at a big disadvantage because we did not expand Medicaid as 31 other states did,” he said. “And therefore we would not be getting those expansion dollars, which are in the billions.”
Knapp argues that the Legislature should do something now, either by passing Cobb-Hunter’s bill or by telling the DHHS to seek a Medicaid waiver for an expansion to put the state’s funding on a par with states that did expand.
If federal funds are allocated based on existing levels, South Carolina’s residents, workers and economy will suffer, he said, because the less Medicaid money hospitals are paid, struggling rural hospitals may be forced to close. And that will affect small businesses.
“If you lose a rural hospital, your whole economy suffers,” he said. “There are less paychecks. Less consumer demand. And many Medicaid recipients are working for small businesses. It’s an economic issue as well as a health issue.”
South Carolina Hospital Association spokesman Schipp Ames said the group’s main concern is making sure that the state is not negatively affected by a block-grant formula that holds it to lower eligibility and flexibility because it didn’t expand Medicaid.
While the association has no recommendations at this time, he said SCHA hopes to work with McMaster and the Legislature to see that South Carolina can achieve parity with the states that did expand coverage.
“We … are working with our congressional delegation to understand more about the replacement plans that are coming together in Washington,” he said. “Much of what we do in South Carolina will depend on what they do in DC.”
Cobb-Hunter said there’s no escaping the fact that more than 22 million people now have health care coverage, including hundreds of thousands of South Carolinians, because of the ACA.
“And those of us who have health insurance need to understand that until we cover everybody, we will still be paying for (the uninsured) because our premiums increase through cost shifting,” she said. “At some point we need to connect the dots between hospitals having shortfalls and the cost of uncompensated care.”
While Knapp and his associates are “talking to the Legislature,” he said they haven’t yet identified anyone who will champion the cause.
But he said it’s not even a partisan issue any more. Last week, he said, 10 Republican governors from states that expanded met with the U.S. Senate finance Committee to say they don’t want to lose the extra Medicaid money they’ve been getting under the ACA.
“We need to sit down and have a conversation about it,” Knapp said. “It will come down to leadership and Gov. McMaster.”
When he filed the suit, McMaster said Obamacare would cost the state of South Carolina billions of dollars for just the expansion of Medicaid alone.
But Knapp said the issue is no longer Obamacare, but how the state can maximize federal Medicaid dollars under the Trump administration.
“Ironically, South Carolina can use the Medicaid expansion provision of Obamacare to hopefully get more federal Medicaid money in the block grant program under the GOP Congress and Republican president,” he said. “The Republican governors of states that did expand Medicaid are fighting to keep their additional money under a block grant program. South Carolina should join them.”