State might pay doctors, dietitians to treat South Carolina’s poor obese

abeam@thestate.comFebruary 6, 2014 

  • Obesity in South Carolina

    31.6% Percentage of South Carolinians who are considered obese

    30.8% Percentage of S.C. Medicaid recipients who are considered obese

    No. 8 South Carolina’s national obesity ranking

    SOURCE: Centers for Disease Control

— The state’s Medicaid program will begin paying doctors and dietitians to treat poor obese South Carolinians as part of its continuing effort to tame its out-of-control health care costs.

Now, South Carolina’s Medicaid program, which provides health insurance for the poor and disabled, only pays physicians to treat obesity-related diseases, such as diabetes, and does not pay dietitians at all. But a new proposal would pay doctors to treat obesity, while also paying dietitians to work with patients to keep the weight off.

“In a nation that is getting fatter and fatter and fatter, South Carolina is among the fattest,” said Tony Keck, director of the state’s Medicaid program. “Even with all the money we have been spending over the past 20 years in terms of growth in health care, the country is slowly killing itself through obesity.”

Almost 32 percent of South Carolinians are obese, defined as having a body mass index of 30 or higher, a weight-to-height ratio used as an indicator of obesity. Among the roughly 1 million South Carolinians on Medicaid population, about 30 percent, or 150,000, are obese. Nationally, South Carolina is the eighth-fattest state, according to the federal Centers for Disease Control and Prevention.

Republican Gov. Nikki Haley said she supports the change. Last year, Haley proposed asking the federal government for permission to bar food-stamp recipients from using that aid to buy junk food. That proposal, opposed by most Democrats, is pending.

Goal is ‘improving health’

South Carolina’s Medicaid budget has increased $1.1 billion since 2011 because of the state’s growing Medicaid population – “member months,” one person on the program for a month, have increased to 13.3 million in 2014 from 9.1 million in 2009 – and the increasing costs of health care. State officials attribute much of those higher costs to obesity-related health problems.

The anti-obesity coverage would pay for up to six visits a year with a physician and six visits with a licensed dietitian, a nutrition specialist who has a five-year degree who also is registered with the state. State officials estimate about 86,000 people, or 60 percent of South Carolina’s obese Medicaid recipients, would participate.

If 60 percent do participate, officials estimate that the cost to the state’s Medicaid program would be an extra $10.5 million. Most of that money would come from the federal government. However, $3 million would come from state taxpayers.

The state’s Medicaid agency has requested the taxpayer money. But even if lawmakers reject that request – unlikely given the support of Haley and legislative Republicans and Democrats – the agency says it still will start the program by cutting other programs in its budget.

“The goal here ... is to make people healthier and to reduce spending on health care, and that goes hand in hand,” said state Rep. Murrell Smith, R-Sumter, chairman of the House budget subcommittee that oversees Medicaid’s budget. “We are not just giving people a health insurance card and saying, ‘You go get medical treatment.’ We are working on improving health.”

Smith’s comment was a reference to the federal Affordable Care Act, which offered South Carolina billions of federal dollars to expand its Medicaid program to 300,000 additional South Carolinians. The Republican-controlled Legislature refused to expand Medicaid, saying, in part, that what was needed, instead of insurance coverage, was a way to improve poor South Carolinians’ health.

‘Major problem on the table’

Democratic reaction to the proposal from Republican Haley’s Medicaid agency was muted.

“It sounds like a good idea. But it still leaves the major problem on the table, as not enough of our citizens have access to affordable health care,” said state Rep. James Smith, D-Richland. “By doing initiatives like (the anti-obesity effort) and expanding (Medicaid), more (would) be eligible to see doctors.”

Nina Crowley, past president of the S.C. Academy of Nutrition and Dietetics, said the plan would create more jobs for dietitians. She added that private insurance plans tend to follow Medicaid’s lead, meaning the coverage could be expanded into the private sector.

Dr. Bruce Snyder, president of the S.C. Medical Association, said dietitians could help “interrupt that cycle” of obese parents teaching their children to eat poorly.

“We tend to teach our children to eat and prepare foods the same way we do,” he said. “It’s a whole lot better to improve one’s lifestyle than it is to treat a disease process at the end of bad habits.”

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