In the executive suite on the 11th floor of a former bank building in downtown Columbia, a folk art painting propped up against the wall warns, “Look busy, Jesus is coming.”
This is Tony Keck’s office, but he doesn’t need to bother looking busy. As director of the state’s Department of Health and Human Services, he is busy — too busy even to hang his pictures.
In less than three years, Keck has emerged as a powerful voice in Gov. Nikki Haley’s Cabinet, a major rebound after he candidly admits he was passed over for a promotion to lead Louisiana’s health department in 2010.
The 45-year-old also has been a lightning rod during this General Assembly session, carrying Haley’s opposition to President Barack Obama’s national health care program to state legislators.
He does it with composure and a Midwestern accent, almost always in business suits and cowboy boots, a fashion statement he said he picked up in Baton Rouge.
The core of Keck’s message is that Medicaid, and health insurance generally, isn’t making people healthier. He can’t justify spending more money to expand what he sees as an inefficient program, even if the federal government is offering the state billions of dollars to make that happen.
“It’s hard for people to understand, to come to grips with how profoundly broken the system is,” Keck said.
He has told lawmakers this many times. Stacks of paper and folders full of data cover most of his office’s flat surfaces, signs of late-night research leading up to his recent testimony at a Senate committee hearing in early May.
“I’m to the point where I’m done convincing,” he said. “I don’t think I’m going to have a magic chart that all of a sudden converts a bunch of people.”
Keck’s main job is to run the state’s health insurance agency. He oversees a $6 billion operating budget, more than 1,000 employees and about 1 million Medicaid policies for low-income adults and children.
Since taking the job, he has increased Medicaid enrollment by 16 percent, but Haley said his focus on improving public health, not just paying insurance claims, has been a revelation for the department.
“Tony Keck is such a jewel of a find for South Carolina,” Haley said. “HHS is being run right for the first time.”
She also calls him “incredibly smart,” a compliment repeated by many colleagues, even those at odds with his arguments.
“Tony is very bright,” said Thorton Kirby, president of the South Carolina Hospital Association, a group lobbying for Medicaid expansion. “He is passionate. Normally that’s something I like because it means he’s energized and ready to work. On Medicaid expansion, he’s passionate in another direction.”
Keck grew up in Michigan, studied engineering at the University of Michigan and took a job as a health care consultant after graduation in 1989. By 1998 he was offered the top management spot in Johnson & Johnson’s Latin American consulting division in Chile.
He said he got his “true education” while running St. Thomas Health Services, a low-income clinic in New Orleans in 1995 and 1996.
“I spent two years just trying to keep the lights on in the place. Literally, I’d had to run outside when the guy was going to turn the water off and beg him not to do it,” he said. “Every once in a while the doctors and I wouldn’t take our paychecks, but I counted on that Medicaid check (for the clinic), because that Medicaid check always came on Friday.”
Now, Keck makes about $155,000 a year, but only eight years ago he was living in a FEMA trailer in Birmingham, Ala. A doctoral student at Tulane University in 2005, he was forced out of New Orleans when Hurricane Katrina hit.
“I had evacuated from New Orleans twice before that,” he said. But with Katrina, “strange things were starting to happen. The sky was a bizarre color. It was creepy. I knew it was different than those other times.”
Months later, Keck returned to his New Orleans apartment, still damp and “just disgusting,” he called it — bearing in mind the blessing of government aid when he needed it most. He soon became involved in discussions about rebuilding the city’s health care system.
“I was just itching to be part of it,” he said. “I just started showing up at meetings and being a loudmouth guy.”
Loud enough to be heard, it seems. In 2008 he was appointed chief of staff of Louisiana’s Department of Health and Hospitals, and the following year became a policy adviser to Gov. Bobby Jindal. In 2010 he returned to the Department of Health and Hospitals as deputy secretary. He hasn’t yet managed to finish that PhD.
In 2010 Congress passed the Patient Protection and Affordable Care Act. Keck, whose political leanings have drifted right over the years, calls it a missed opportunity.
“What I realized over time is that a lot of the policies that had been implemented to presumably help people became more about the institutions to help people than they actually became about the people themselves,” he said. “Quintupling the investment in public health in this country could have been revolutionary. And instead ... you’ve got a bill that spends more money instead of making the tough choices.”
The law spells out a variety of ways to help Americans enroll in health insurance — financial penalties for individuals who don’t purchase a plan, fines for employers who don’t offer affordable coverage, and Medicaid for everyone who makes up to $15,856, or 138 percent of the poverty level. The poverty threshold for families is higher.
Money traditionally given to reimburse hospitals for charity care will be redirected to states to help pay for Medicaid expansion. The federal government has agreed to pay 100 percent of expansion costs for three years starting in 2014, and at least 90 percent, in theory, forever.
But last year the Supreme Court ruled that states aren’t obligated to accept that money. It’s been Keck’s job to convince lawmakers that an estimated 340,000 people in South Carolina eligible under the expansion plan won’t become healthier by getting Medicaid cards.
In many ways, Keck’s public relations campaign against expansion has been an easy sell to conservative lawmakers who control the General Assembly.
But in dollars and cents, the federal investment over the next three years alone is a projected $4.1 billion for South Carolina. Hospitals, including the three major systems in the Lowcountry, are applying heavy pressure for the state to accept the money.
“I think there are a lot of folks who want that money,” Keck said. “I have a hard time knowing what’s going to happen.”
On May 2, a bipartisan bill signed by 75 lawmakers was filed in the S.C. House of Representatives. It would allow South Carolina to take the federal Medicaid expansion money, but re-purpose it into health savings accounts for the poor.
Keck was intentionally not consulted before the bill was filed, but the number of calls and text messages he fielded from his staff, the governor’s office and legislators that afternoon underscores his influence.
“The bottom line is if Tony Keck does not support that bill, it’s probably for a good reason,” said Rep. Bill Herbkersman, R-Bluffton, one of seven Republican legislators who eventually scratched their names from the proposal.
The bill was sent to a committee for discussion, and it’s unlikely to come to a vote before the Legislature breaks for the year June 6. On the chance that Keck is asked to officially weigh in, it’s guaranteed that many lawmakers won’t agree with his position, but most of them will listen.
“I’ve come in and I know I’ve been sort of, you know, I haven’t been shy about trying to get done what I want to get done, saying what I think,” Keck said. “There are a lot of people who could react to that the wrong way, coming from another state. The reality is that the people here, even the people who I have to disagree with ... they’re all good people and they’ve all been generous to me with their time.”
By many accounts, Keck’s future is bright.
“While Tony Keck is a leader in South Carolina, it won’t be long before Tony Keck is a leader across the country when it comes to health care issues,” Haley said.
Kristy Nichols, commissioner of Louisiana’s Division of Administration and one of Keck’s close friends, also predicts that he is headed for the national stage.
“He’s just that bright and he’s that good of a leader, in my opinion,” said Nichols, who introduced Keck to his second wife, Shannon Robshaw, in 2006.
Until then, he insists his boots are firmly planted in South Carolina, and for at least a few more weeks, he’ll continue his crusade against Medicaid expansion as the legislature wraps up the debate, acknowledging that there’s a possibility that the future might prove him wrong.
“There’s going to be a chunk of states that do expand. There’s going to be a chunk of states that don’t, and in five years we’ll have the answer — where is it going better?” he said. “And I would think that everybody should be happy with that outcome.”
Reach Lauren Sausser at 937-5598.