House Republican proposes alternative to Medicaid expansion
COLUMBIA — A Republican state lawmaker unveiled a plan Thursday that proposes South Carolina accept billions in federal funding for expansion of Medicaid under the federal health care law but instead use the money to create medical savings accounts for the uninsured.
Accept three years of federal funding intended for expansion of Medicaid under the Patient Protection and Affordable Care Act.Until the end of 2016, use the money to start the “Responsible Consumer Health Care Program” within the S.C. Department of Health and Human Services.Apply for the federal waivers necessary to start the program.Allow South Carolinians who would be eligible to receive coverage under the Medicaid expansion — those making up to 138 percent of the federal poverty level — to enroll in a managed care plan and have a medical savings account. The plan would provide health benefits to recipients with co-payments.Eligible residents would receive up to $500 in preventive care without co-payments each year.Starting in 2015, the state would no longer participate in the disproportionate share program that currently covers some of hospitals’ costs for treating uninsured patients. That’s because many more residents would have health insurance under the program created by the bill.Source: House Bill 4095
The bill by Rep. Kris Crawford, R-Florence, already has bipartisan support from about 75 co-sponsors.
The GOP-controlled Legislature has rejected S.C. Democrats’ attempts to expand Medicaid under the Patient Protection and Affordable Care Act, commonly referred to as “Obamacare.”
And Republican Gov. Nikki Haley also is opposed to Medicaid expansion, which was made optional for states by a U.S. Supreme Court ruling last year.
Medicaid is a joint federal-state program that provides coverage to the needy and disabled.
Haley and many Republicans argue expansion is too expensive in the long run and won’t solve the state’s health problems. Democrats say the expansion would bring needed coverage to hundreds of thousands of South Carolinians and create abundant health care jobs in the state.
Now, Crawford, an emergency room doctor, has proposed a third option, saying the General Assembly hasn’t done a good job of weighing the issue.
His bill is called the “Truth in Health Financing and Responsible Consumer Health Care Act.”
“I’ve expressed my concern over the lack of thoughtful discussion on what we should do,” Crawford said. “What was frustrating was not really having a robust discussion about the best policy discussion.”
Crawford’s measure would use the federal money for the first three years of expansion when states’ costs are fully covered to allow South Carolinians to sign up for health spending accounts.
He said his proposal was inspired by a program in effect in Indiana called the “Healthy Indiana Plan.”
That program was created by former Gov. Mitch Daniels and the Indiana General Assembly in 2007 and provides health care coverage to the uninsured, who make contributions to the plan.
Crawford’s bill would commit the state to the program for three years through 2016. Crawford said the idea is to gather data and see how well the plan works before deciding whether to pursue it beyond three years.
Under the Affordable Care act, states begin paying part of the cost of expansion, reaching a maximum of 10 percent in 2020.
The Crawford-proposed program would be administered by the S.C. Department of Health and Human Services and run through managed-care organizations contracted with the state.
If the bill passes, the state would have to get waivers from the federal government to be able to use the Affordable Care Act expansion funds in a different way than originally intended.
Other states also are weighing the possibility of seeking waivers for their own Medicaid expansion alternatives.
Arkansas is pursuing a plan that would use expansion funds to provide private health coverage for the uninsured.
Haley’s administration quickly blasted Crawford’s proposal Thursday.
“It’s Obamacare disguised as a ‘private solution’ and would have terrible consequences for South Carolina,” Haley spokesman Rob Godfrey said.
The S.C. Hospital Association, which favors expansion of Medicaid, said it was pleased Crawford introduced the proposal.
“We commend Rep. Crawford and all of the bill sponsors for making a positive step forward with a coverage alternative as opposed to just saying ‘No’ to keeping our dollars in South Carolina,” said Rozalynn Goodwin, director of policy research and a lobbyist for the association.
“We’re committed to working with Rep. Crawford to make sure the bill accomplishes the goals of coverage expansion.”
Crawford drew fire and made national news earlier this session after he was quoted in January as telling a group of doctors at the Statehouse that “it is good politics to oppose the black guy in the White House” with regard to the Medicaid expansion. He said in March that his comments were not presented in context.