Gov. Mark Sanford's hopes that his proposed reforms to control Medicaid costs while providing better care to about one fifth of the state's population hasn't gotten far with the S.C. legislature in two years, but that hasn't dimmed his vision.

At his cabinet meeting Tuesday, the governor reasserted his call to combine the state's health-care programs under an umbrella agency and will hit the chicken-dinner circuit this fall to deliver his message to individuals and civic leaders.

Health and Human Services Department Director Robbie Kerr said the more than 900,000 South Carolinians, who are among the state's neediest, won't get better until care among the disparate agencies is coordinated.

Some political analysts believe the governor's plan may stand a better chance next year because it isn't an election year, but also because of the fallout from this year's election. Already a key player among state lawmakers has been defeated in the Republican primary held last month. Rep. Rick Quinn, R-Richland chaired the Ways and Means Medicaid subcommittee, with responsibility for the departments of Health and Human Services, Social Services and Mental Health and other health agencies. Rep. Rex Rice, a Republican on the committee who bucked Quinn and the House leadership this spring when he backed a hefty cigarette-tax increase to create a recurring source for Medicaid spending, has been mentioned as a leading candidate to replace Quinn, according to The Associated Press. New leadership could "shake loose" new life for the cigarette tax and for a recurring source of health care funding, Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center, told the AP.

The governor contends that it's difficult to get accountability for nearly $1 billion or about 25 percent of the Health and Human Services budget, because it flows to other agencies.

Medicaid costs about $4 billion to administer in this state, and nearly 70 percent of that is federal money. The state's 30 percent contribution eats up about a tenth of the state's $5.6 billion General Fund.

An additional concern is the growing number of people on Medicaid, including those older than 65 and those with disabilities and mental illnesses, and those with behavioral health problems who cost vast sums of money that the state can't do anything about, according to the governor. In six years the cost of Medicaid programs has increased by nearly $1.5 billion.

While the legislative approval to combine agencies and control cost may be necessary for accountability and oversight, other inexpensive ways may be found to improve health care for the needy. Health and Human Services already is seeking to initiate one thing to improve behavioral health. Brainstorming may allow officials to be more creative. The state is asking federal officials to allow it to join 39 other states to offer smoking cessation aids to Medicaid clients. This could have an enormous effect on the quality of health care by reducing the amount of care needed.

In the face of legislative opposition, creative brainstorming is the type of thinking that the state needs to improve health care to people with severe health problems. As the governor begins his budget hearings later this summer, surely he will be asking for additional thinking of this type, too.