Health care changes loom

Governor’s plan would affect older and low-income residents

By RODDIE BURRIS

Staff Writer

CHARLESTON — South Carolina’s low-income and older residents are more likely to see major changes in how they purchase and receive medical care, under plans outlined by Gov. Mark Sanford Thursday.

Congress’ narrow approval Wednesday of $35 billion in cuts to the major entitlement programs of Medicare, Medicaid and student loans have cleared the way for South Carolina and other states to alter their insurance plans.

Among the changes:

• New co-payments for doctor visits

• Co-payments for non-emergency visits to a hospital’s emergency room

• Requirements that Medicaid recipients belong to a medical home network

Additionally, South Carolina could become part of a 10-state pilot program to test health savings accounts for Medicaid recipients.

Such a switch, potentially the most dramatic change, would allow most of the state’s 850,000 residents using Medicaid to pay for care, either directly or through private health insurance.

It is not clear when the state will know whether it can proceed with the accounts, though it plans to apply. Other changes could be in place by January 2007.

Sanford had pushed for all of these changes in a waiver application to the federal government.

Sanford, in a news conference Thursday, said because of Congress’ action he can achieve much of his Medicaid agenda without the waiver submitted to the federal government in December.

“What we’re after is a culture of health in South Carolina,” Sanford said, standing in a lab at the Medical University of South Carolina, surrounded by several physicians. “It’s about time to raise awareness on this culture of health in South Carolina.”

Like other governors, Sanford says the state’s $4.6 billion Medicaid program is too expensive. He said he proposed the waiver as a means of slowing the growth in the program.

Judith Solomon, senior fellow at the Washington D.C.-based Center for Budget and Policy Priorities, a research group that focuses on low-income Americans, had labeled Sanford’s waiver proposal as “risky business.”

“(Congress’ action) poses less risk than what they were proposing,” Solomon said. But children and the poor would be better off with no changes to Medicaid, she said.

The federal Centers for Medicare and Medicaid Services, which oversees Medicaid, must still approve any changes to Medicaid in South Carolina, whether they come by budget bill or Sanford’s waiver.

State Health and Human Services director Robbie Kerr said his agency will discuss with the centers what to do with the pending waiver request.

Kerr said those discussions will determine whether South Carolina should pull the waiver entirely, adopt some of the measures in the waiver to the budget bill, or seek a series of smaller waivers to meet Sanford’s remaining goals.

Advocates say the savings accounts that could be created would offer recipients more choice and create incentives for consumers to save on health care costs.

The health savings account concept state officials had sought is different than the concept Congress and President Bush have discussed.

Critics said Sanford’s concept was riskier and could leave sick Medicaid recipients without medical coverage, or with gaps in coverage, if the patient miscalculated expenses or had a catastrophic event.

In the end, Sanford’s version of health savings accounts, described in the waiver as self-directed care, was limited to a pilot program available to only 5 percent of Medicaid recipients.

Health savings accounts have been criticized for having high deductibles that may not align with the population. Critics also question whether health savings accounts will save money in the end.

Some of those who had fought Sanford’s waiver request said they like the current path better.

Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center, an advocacy group for poor communities, is pleased the health savings accounts would be a pilot program.

Other challenges to Medicaid changes still loom. A group of rural health clinics have sued Sanford and Kerr, contending that legislative approval must be part of reforms.

Reach Burris at (803) 771-8398 or rburris@thestate.com.

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