Gov. Mark Sanford told a one-man U.S. Senate subcommittee hearing on Friday that South Carolina will have to raise taxes, cut other services or cut Medicaid unless it fixes that program's problems now.

But critics of changes to the program said the plan will leave low-income residents at risk of losing many of their benefits and could actually raise the state's costs.

The comments came during a hearing at the College of Charleston of the Federal Financial Management subcommittee of the U.S. Senate's Homeland Security and Governmental Affairs Committee. The only member of the subcommittee who attended was freshman Sen. Tom Coburn, an Oklahoma Republican who was in the U.S. House with Sanford.

The hearing focused on the state Department of Health and Human Services' sweeping proposal to overhaul Medicaid.

The plan would give most of the state's 850,000 Medicaid recipients personal health accounts they could use to pay for premiums for private insurance plans or spend on their choice of health care.

The hearing was purely an information-gathering session. The U.S. Centers for Medicare and Medicaid Services, not Congress, must approve or reject the state's plan.

Nevertheless, Coburn said he is interested in ideas about how to shore up Medicaid, which is expected to be a lower priority for the federal government in coming years, with Medicare and Social Security taking more of the budget as baby boomers begin to retire.

'There's not going to be a significant increase in Medicaid,' said Coburn, himself a physician as well as a longtime foe of government spending in general. 'The money just is not there. There's no way we can keep our commitments at the federal level to what we want to do.'

South Carolina's plan has been championed by conservative groups around the country. It was written with the help of Michael Bond, director of the Center for Health Care Policy at the conservative Buckeye Institute.

But critics called the hearing a publicity stunt. Only one of six people who testified Friday was a critic of the plan. 'This hearing had as much validity as a Central American show trial,' said state Sen. Brad Hutto, D-Orangeburg.