Concerns still linger, but the final version of Gov. Mark
Sanford’s Medicaid reform proposal appears less troublesome to some
critics than the original.
Sanford’s office sent the final version of a comprehensive,
controversial waiver request to Washington on Wednesday.
The significant changes in the new plan would:
• Reduce proposed co-payments
• Limit self-directed care to a
pilot program
• Eliminate cuts to most
children’s medical services
• Restore nonmaternity medical
benefits to teens who become pregnant
“I have to say, I’m glad we saw some movement, because I don’t
want to look ungrateful,” said Sue Berkowitz, director of the S.C.
Appleseed Legal Justice Center, which advocates for the poor. “I’m
glad they made some of the concessions we were asking for.”
Judy Solomon, a senior analyst at the Center for Budget
Priorities and Policy in Washington, D.C., spoke against Sanford’s
plan at a U.S. Senate hearing in Charleston last month.
“They definitely made some improvements, particularly in the
(co-payments),” Solomon said Wednesday. “They have definitely become
more moderate.”
However, Solomon said, research shows that even moderate
co-payments cause the poor to lose medical services.
State officials have asked the Centers for Medicare &
Medicaid Services to approve the proposal by the end of the year.
The earliest the changes could begin would be July 2006.
A lawsuit challenging the governor’s authority to make the
changes without the Legislature’s consent could affect the plan’s
implementation.
Sanford has quietly pushed to reform Medicaid in South Carolina
for nearly two years. He devised an initial plan that would have
radically altered the 40-year-old program that provides health care
for the state’s poor, elderly and disabled.
The governor’s latest plan still would:
• Convert Medicaid to a private
insurance plan
• Cap benefits for recipients
• Be among the first in the nation
to impose co-payments on the poor
• Eliminate a more comprehensive
children’s benefits package for 19- and 20-year-olds in favor of a
skeletal adults benefits package.
But even critics acknowledge that the new plan is not a “block
grant” that would limit future enrollments, as first feared.
Sanford says the plan will slow growth in Medicaid and help
deliver a higher quality of health care.
“Given the remarkably different health care needs of individuals,
it makes sense to give people a choice in their health care plans,”
Sanford said. “This will ultimately ensure better health care
outcomes.
“At the same time, the competition between plans has proven in
other settings to help rein in growing costs.”
Critics dispute that claim and say Sanford’s plan would add
millions of dollars in new administrative costs. Right now, those
costs are about 3 percent to 4 percent of the total cost of the
program — far better than private insurance.
Without changes, Medicaid will account for nearly 29 percent of
the state budget in 10 years, Sanford says. If unchecked, it would
force the state to choose between spending money for schools or
health care.
Up to 1 million residents, or a quarter of the state’s
population, depend on Medicaid as their primary health insurance.
More than half are children; the majority of recipients are
black.
Sanford said the plan would help the state slow the growing cost
of Medicaid by $300 million over five years, if it is approved. Even
so, the state still would spend up to $11 billion on health care for
the poor during that same time.
Critics say that’s not much of a savings, and it comes at the
expense of medical benefits, rather than through other Medicaid
disparities.
A coalition of residents and a group of rural health clinics have
sued Sanford and Health and Human Services director Robbie Kerr, who
oversees Medicaid in the state and who wrote Sanford’s proposal.
Sanford’s proposal, and the rising cost of Medicaid nationwide,
has placed the state at the forefront of a growing national
discussion.
“This is a proposal that could blow up in the governor’s face,”
said Michael Cannon, director of Health Policy Studies at the Cato
Institute, a conservative Washington think tank.
By allowing limitations on the self-directed health care option,
Cannon said, Sanford is dangling an enticement for more people to
sign up for Medicaid.
“In that Sanford is making Medicaid enrollment more valuable,
he’s going to increase enrollment and dependence on the
program.”
But Cannon also praised Sanford’s effort to rein in Medicaid as
“a positive step.”
Kathleen Stoll, of Families USA, a liberal Washington, D.C.,
think tank, said Sanford’s revised proposal is still built on the
“dangerous” idea that the state can accurately predict how sick
someone who relies on Medicaid will be in a given year.
“The concept of (defining) how much a person will need to spend
on health care makes no sense,” Stoll said. “The proposal gives the
state the power to guess a person’s health in the future.
“If the state guesses wrong, the person who gets sick and needs
health care will be hurt.”
Reach Burris at (803) 771-8398 or rburris@thestate.com. Staff
writers Lee Bandy and Lauren Markoe contributed.
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