Medicaid debate yields questions, few conclusions in Rock Hill

dworthington@heraldonline.comMarch 19, 2013 

— They agree on the goal, a healthier South Carolina.

They disagree how to get there.

Should South Carolina accept new federal Medicaid funds that would insure the working poor and give them access to preventive health care, lessening the chance they would get chronic, costly diseases?

Or should the state forgo the federal money and instead work to reduce waste in a “broken” health-care system – applying the savings to things such as education and creating jobs, factors that affect a person’s health as much, if not more, than a doctor?

No conclusions were reached during a news conference Tuesday morning at Winthrop University and a discussion later at York Technical College’s Baxter Hood Center. But participants, as well as the 100 people who attended, said the forums raised key questions that need answers as the S.C. Legislature considers whether to accept or reject expanded Medicaid funding.

The House has voted against expanding Medicaid in South Carolina. The Senate has not made a decision. Gov. Nikki Haley has consistently said she’ll oppose taking the new Medicaid funding.

Arguing for expanding Medicaid was Katherine Record, a senior clinical fellow in the Health Law and Policy Clinic at Harvard University and Rozalynn Goodwin, director of policy research for the S.C. Hospital Association.

“Health care has to be our No. 1 goal,” Record said.

Tony Keck, the state’s Medicaid director, explained the state’s reasoning for opting out of the expanded program. He said there are lots of things to fix in Medicaid and health care in general. But the money being made by hospitals now “is not going into the pockets of the poor.” He said the state needs to “put the brakes” on expanding Medicaid and see “who is benefitting from this.”

The three traded facts, figures – and even a few well-placed barbs – during a two-hour discussion Tuesday evening.

Finally, the numbers became too much for Doris Martin of Rock Hill, who had been patiently listening.

“We’re talking about human suffering ... people with no money, no insurance. ... People are going to get sick, you have to take care of your own,” she said.

Her passion earned Martin a round of applause from the audience and some contrition from Keck and the other panelists.

“I feel for the child who goes to an awful, terrible school, for the children of parents who can’t get jobs,” Keck said. “You have to think about that suffering, to think more globally than just Medicaid expansion.”

At a morning news conference, Dr. David Keely of Rock Hill said participating in the expanded Medicaid program was an easy decision.

“It is a simple matter of life or death,” Keely said.

Keely said studies show life expectancy increases 6 percent when people have regular, preventive doctor visits.

In South Carolina, that would mean 2,455 people wouldn’t die prematurely, he said.

Getting uninsured people into a “medical family” is one of the goals of the expansion of Medicaid under the Affordable Care Act, commonly called Obamacare.

The federal government would pay 100 percent of the costs for the first three years – about $4.1 billion for South Carolina. After that the state would be responsible for 10 percent of the funding by 2020. Estimates for the state’s responsibility range from $613 million to $1.9 billion, depending on how many people enroll in the program. State Democrats had proposed taking the money for three years with an opt-out option at that point. Their efforts failed in the state House.

As many as 500,000 South Carolina residents could quality for the new program.

Keely said Medicaid insurance is similar to public education. Years ago, people determined that public education should be accessible to everyone. The same should be true for health-care insurance, he said.

Record, the senior clinical fellow at Harvard University, said the plan before the South Carolina and other state legislatures is vastly different from the current Medicaid system. Under the current system, Medicaid is a federal-state funded program that helps provide care for the aging, blind, and people with disabilities, as well as low-income families with children.

Eligibility in the new program would be based on income, people making less than 138 percent of the poverty level would qualify – about $16,000 for a single person and $32,500 for a family of four.

The new Medicaid program was “created to help people in poverty or those right above it,” Record said.

Debbie Hayworth, president of the United Way of York County, said a person making the minimum wage of $7.25 an hour would make $15,080 per year if they could get 40 hours of work per week.

When living expenses are included, a single person would need to make $9.61 per hour, she said.

Hayworth said the United Way and its 31 partners are seeing an increase in demand for services and a drop in resources. Requests for funding being evaluated by the York County United Way are up 25 percent from 2012.

The York County United Way and some of its partners provide the “safety net” services for the area’s poor.

“Access to affordable health care may minimize the need for safety net services for those that fall through the cracks including the poorest of the poor and also our working poor,” she said.

Don Worthington •  803-329-4066

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