Medicaid overhaul heads to Senate floor

COLUMBIA -- A bill overhauling the state's Medicaid program passed the Senate Medical Affairs Committee on Wednesday, but the panel's chairman pointed out that the measure may pose a quandary for the governor if it makes it to his desk.

Last week, Gov. Mark Sanford said he was considering taking legal action to put an end to the practice of legislators packing bills with unrelated amendments.

However, the Medicaid bill that's headed to the Senate floor includes amendments for higher cigarette taxes and lower income taxes that Sanford's aides lobbied for last year.

Should this bill clear the Legislature, the governor would face a tough decision, said Senate Medical Affairs Chairman Harvey Peeler, R-Gaffney. "Would the governor veto it because of what's attached to it?" Peeler asked.

"There's an ocean of difference ... between a Medicaid reform package and a Christmas tree bill that includes everything under the sun for multiple constituencies," Sanford spokesman Will Folks said.

Besides, Folks said, "it's a moot point. There's no way a cigarette tax increase is going to make it through the House of Representatives."

Senate Finance Chairman Hugh Leatherman said the tax amendments may not even make it to the House. "I don't see any mood in the Senate for doing that," he said.

The perspective on so-called bobtailing "depends on whose ox gets gored," Leatherman said.

The income tax proposal jeopardizes the whole bill and continuing efforts to pass a cigarette tax increase

to pump money into Medicaid programs, said Sen. Linda Short, D-Chester, chairwoman of the Medical Affairs subcommittee that handled the bill.

The bill's supporters are not sure how much money Medicaid programs would save with the overhaul, but they are confident that they will slow rising costs. Medicaid is a health insurance program for children, the elderly, poor and disabled.

At about $550 million, South Carolina's contribution to federal Medicaid programs now is the state's second largest budget item. Spiraling costs the past few years have forced legislators to scramble for cash to support Medicaid, which has prompted several failed plans to raise cigarette taxes to bolster the program's budget.

Peeler, whose brother lost a heated Republican gubernatorial runoff to Sanford two years ago, said Medicaid priorities need to be reordered.

The program needs "to take care of sick South Carolinians ... not the hospitals," Peeler said.

To control costs, the bill allows the state to match Revenue Department income tax data with information to make sure patients are eligible and requires checks to make sure patients don't have other insurance.

The legislation also sets up a task force to look at ways of reducing how frequently people use emergency rooms for routine conditions, such as earaches.

"The emergency room has become the primary care physician in South Carolina," Peeler said.

The senator had tried to include elements of government restructuring in the bill, but Short and others said that could scuttle it. A bill restructuring state agencies already is on the Senate calendar and the issues should be debated separately, Short said.

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