COLUMBIA -- Every day, an average of 112 people -- most of them the newly poor -- sign up for free government health care in South Carolina.
Since the recession officially hit in December 2007, some 3,300 people a month, on average, have signed up for Medicaid in a state that outpaces the nation for poverty, obesity and diseases such as diabetes. Yet, South Carolina's political leaders have been among the most vocal in the country in opposition of the new health care law.
The new law is intended to provide insurance coverage to a portion of the nearly 17 percent of state residents estimated to be without it. But it won't come cheap: The law will cost the cash-strapped state nearly $1 billion more over the next decade, even after the federal government kicks in its share.
Advocates and academics alike say the federal plan is critical for South Carolina's future prosperity. Healthy workers draw in new businesses, they say, and an educated population starts with children who aren't sick when they go to school.
But many say Medicaid is only part of the answer to South Carolina's grave health care needs. Others think government-run health care should not be the solution.
'In that black hole'
Judy Woods picked up and moved from San Francisco with her fiance, Dennis French, to Hanahan to be close to family. They left behind their health insurance with two steady paychecks that provided them with more than $100,000 a year, sold most of what they owned and took for granted that they could find work and visit the doctor when they needed.
A year and countless job applications later, the couple -- both in their 50s -- bring in $1,000 a month from a part-time job Woods landed cleaning vacation homes on Isle of Palms. Their Medicaid applications were rejected for a variety of reasons even though they make far too little to afford health care.
"We're in that black hole," Woods said.
More than 90,000 people have been added to South Carolina Medicaid rolls since the economy turned sour and countless more find themselves in the same predicament as Woods and French.
In 2014, nearly half a million will be able to sign up when the new controversial health care law is completely rolled out. That will cover a majority of the estimated 750,000 individuals without insurance today.
Woods and French have turned to the Dream Center Clinic, a free, volunteer-run clinic that exists to pick up some of the spillover -- people in North Charleston and Hanahan who are not insured and can't afford to pay to see a doctor.
"The Dream Clinic has saved us," Woods said. "Definitely."
Sue Berkowitz, director of the South Carolina Appleseed Legal Justice Center, said the state needs to focus on the problem and find more ways to meet the health care needs of its people. She is happy to see the increase in Medicaid enrollment, because that means some more people who need health care will receive it. But the needs are great and continue to grow every day as the state struggles to climb out of the deep and prolonged economic downturn, she said.
"People need to remember: it's policemen, your nextdoor neighbor, it's the kid who sits next to your child in class -- these are all people who are trying to do everything they can to make it in this economy," Berkowitz said.
The conservative concerns
Ashley Landess, president of the S.C. Policy Council, a conservative think tank, said the new health care plan is an ill-conceived, train-wreck of a law that the country cannot afford. South Carolina's lawmakers already are spending more than they should and the state needs to take another approach to addressing the health care needs of its people, Landess said.
"Pull back and ask the ultimate question: Is this state healthier for so much government spending? No. A growing Medicaid budget, growing Medicaid rolls. What we're doing is not working," she said.
The state's economics cannot be separated from the health care issues, Landess said. States with better economies have healthier people, she said.
"Put the free market back in charge of the state's economy and create more jobs and a thriving private sector," Landess said.
The tea party movement has formed an uprising against the health care law. Conservative political candidates pledge to work toward the law's repeal. And the state's own Attorney General Henry McMaster, a Republican, has led the charge nationally to declare the law unconstitutional. McMaster and attorneys general from 19 other states argue that the law stomps on the constitutional rights of Americans by requiring that every person have health insurance or pay a penalty. The U.S. Department of Justice is waging the court battle to uphold the law.
'Health reform is the solution'
Mark Tompkins, a health care expert and political science professor at the University of South Carolina, said the rapid Medicaid enrollment illustrates that South Carolina is a poor state where many people have medical needs that aren't being met. A healthy population is a keystone to economic progress, he said.
"The solution is to embrace the opportunities we're being offered," Tompkins said. "Health reform is the solution. People talk as though everything is going to happen tomorrow. It's years away. We have plenty of time to plan for these things."
The state projects that the new health care law will cost $1 billion over the next decade. That's about $100 million a year for the state to put toward a core government service, Tompkins said. The federal government will pay 100 percent for the expanded care in 2014 and 2015. The state will be required to put up 5 percent of the cost in 2016 and 2017. After that, the state will owe 10 percent while the federal government pays 90 percent of the share for all the people who signed up for Medicaid as part of the expansion.
South Carolina will benefit more than other states because the need is greater here than elsewhere, Tompkins said.
As for the national debt to be incurred, he said, "Health care, like education, is an investment in the future."
Tompkins also noted that the new health care law has elements promoted by Republicans in recent years. One example is a competitive marketplace to purchase insurance as called for by former Massachusetts Gov. Mitt Romney in a Wall Street Journal editorial in 2006.
"The practical reality is, this was their plan," Tompkins said.
Jenny Sanford, South Carolina's former first lady, said the state's answer to health care needs is a cultural shift. As first lady, Sanford launched a statewide initiative called the Healthy South Carolina Challenge. The idea was to motivate the public through speeches, contests, awards, weekly tips and other methods to encourage people to make healthy choices.
The focus of the initiative is to create a population that eats nutritious food, stays active and does not smoke, a population that, over time, will lower the state's health care costs. Incentives by government and corporations that focus on lifestyle and disease prevention are part of a smart multi-level approach to the state's health care needs, she said.
Sanford said the results of her initiative can't be quantified and that the efforts need to be sustained and promoted by the media to change people's behaviors.
Robbie Kerr, a health care consultant and past director of the state Department of Health and Human Services, said Medicaid is part of the answer but that government has to target its resources. For example, he said 5 percent of the Medicaid clients run up 50 percent of the costs. The people who have the largest Medicaid tabs are typically those with chronic diseases, and to address chronic diseases the state needs to work on prevention, Kerr said.
As alternatives to government-run health care, officials point toward faith-based programs and public-private partnerships to help address the need. Several such programs are operating in South Carolina.
Ronald Ravenell, executive director of the Franklin C. Fetter Family Health Center, said needs are growing. The health center has sites in Berkeley, Charleston, Colleton and Dorchester counties that receive 39 percent of their $8 million operating budget from the federal government and 61 percent from patient fees and patients using Medicaid and Medicare or private insurance.
As it is now, 55 percent of the health center's 20,000 patients are uninsured, up from 36 percent in 2005, Ravenell said. People without insurance are charged on a sliding scale based on their income, but the center also serves people who are insured, and those insured patients help keep the organization afloat, he said.
"We are here to see the population that needs us the most," Ravenell said.
The Fetter center, established 41 years ago, is part of the national community health network that will double in size from 20 million individuals to 40 million with an infusion of federal cash from the new health care law in 2015. Exactly what it means for South Carolina is not yet clear.
Bill Bartoccini, executive director of the Dream Center Clinic, said the clinic is working to take care of the people who need help. It is an offshoot from Seacoast Church that opened in January 2009. Donations and grants combined with nearly 300 volunteers, including about 150 medical professionals, allow the clinic to function, Bartoccini said.
Bartoccini said the clinic relies, in part, on prescription donations from Welvista to fill patients' needs.
Welvista is a nonprofit health care network that serves the uninsured by providing them with free prescription drugs from pharmaceutical companies. People pay an annual fee of only $20.
Ken Trogdon, chief executive officer of Welvista, said the network is a public-private partnership that uses government investment to enable a team of pharmacists and staff to distribute $50 million in medicine to 20,000 people throughout the state.
Leslie Pye of Charleston said for about the past year and a half Welvista has provided him with heart medicine and insulin.
"If it hadn't been for them, I don't know if I'd be living," Pye said.
South Carolina lawmakers have cut $500,000 in funding for the program for the second straight year, Trogdon said. Meanwhile, the number of patients looking toward Welvista for help has grown by the "thousands" within the last year, he said.
"There is a new face of the uninsured," Trogdon said.
The face of people such as Judy Woods and Dennis French.
Waiting at the Dream Center Clinic on a recent day for her volunteer doctor to refill her prescriptions, Woods reflected on her situation. She said she never thought it was possible to fall so far so fast and find so little government help after a lifetime of working and paying taxes.
Gubernatorial candidates Nikki Haley, the Republican nominee, and Vincent Sheheen, the Democratic candidate, weighed in on the rapid increase in the state's Medicaid enrollment with proposed solutions for meeting the state's health care needs.
Haley said the increased enrollment is a symptom of another problem.
"I think what we're really talking about is the rising cost in health care," Haley said. "That's why so many people are uninsured."
Washington mandates contained in the new health care law are the problem, she said. The solution can be found in tort reform, allowing insurance companies to cross state lines and offering incentives to small businesses, among other fixes, she said.
" 'Obama Care' is probably the worst thing that we can be doing for the citizens of the state," Haley said. "This is the time we need leaders to stand up and say, 'Enough is enough.' "
Haley said, as governor, she would form a coalition of other governors to discuss health care needs and how to reform what's in place.
Sheheen said the rising demand for Medicaid is indicative of the another problem: high unemployment.
"When you have one the highest unemployment numbers, those other issues arise," he said.
The fundamental step toward meeting South Carolina's health care needs is to make sure residents can access private insurance through an employer, Sheheen said.
"When people aren't working they can't afford to purchase insurance so they wind up on Medicaid," he said. "The only real accessible insurance is through their employer."
With regard to the new federal health care law, Sheheen said state leaders have an obligation to push back on aspects of that law or any other that don't help the state. Sheheen said he is looking at the details as more becomes known about the new health care law to make sure it's what's best for South Carolina.
The new health care reform law, called the Affordable Care Act, will be fully effective in 2014, but some changes that open up coverage are available sooner.
--For people with "pre-existing conditions," the new Pre-existing Condition Insurance Plan already has begun covering uninsurable Americans who have been denied coverage and have been without insurance for at least six months. The program is intended to be a stopgap until 2014 when insurers cannot discriminate against adults with pre-existing conditions. The changes come sooner for children. In September, insurers will be banned from denying coverage to children with pre-existing conditions. Insurance companies agreed to cover those children on March 29.
--As of Sept. 23, adults 26 and younger can stay on their parents' insurance, although more than 65 of the nation's leading insurance companies are providing coverage immediately. Coverage will become available for all others after Sept. 23 depending on when an individual's policy is renewed within the next year.
--For uninsured and low-income families, $250 million will be available this month for community health centers across the country to increase the number of people they can serve. In Berkeley, Charleston, Colleton and Dorchester counties, the Franklin C. Fetter Family Health Centers provide medical care for people on Medicaid and Medicare, those without insurance and people with private insurance. For families without insurance, the centers charge them based on a sliding scale.
--For seniors in the "doughnut hole," 4 million Medicare Part D patients will be mailed $250 checks, beginning in June. The money is intended to help cover part of the out-of-pocket prescription drug costs. The "doughnut hole" is a gap in coverage after seniors have paid $2,830 for prescriptions in a given year. Coverage picks back up after their drugs have cost $6,440.
--For the insured who get sick, the law prohibits insurance companies from rescinding coverage when their policyholders get sick. The insurance industry announced in April that it would voluntarily end the practice immediately.
What are Exchanges?
Eventually, states will begin to establish new Exchanges, available to all Americans, including those who can't get insurance through their jobs. Starting in 2014, the Exchanges -- which Congress envisioned to be competitive, consumer-centered health insurance marketplaces -- will attempt to make purchasing health insurance easier by providing "one-stop shopping." Consumers can compare and buy health insurance coverage at the Exchanges. But Americans are not obligated to choose new insurance. Those who are satisfied with their health care coverage can keep what they have.
--Members of Congress will be getting their health care insurance through the Exchanges in 2014.
--In South Carolina, nearly half a million more residents will have access to Medicaid coverage on Jan. 1, 2014.
For more information, go to www.healthcare.gov, an interactive website that provides individualized information, or call the U.S. Department of Health and Human Services at 1-877-696-6775.
South Carolina tops the national average for many chronic diseases, such as diabetes, and has high rates of obesity. Here's a look at the statistics:
An unhealthy state
--33.7 percent of children are overweight and obese, compared with 31.6 percent nationally.
--62.8 percent of adults are overweight and obese. Nationally, the rate is 60.8 percent.
--10.3 percent of adults have diabetes. Nationally, the rate is 8.3 percent.
--193 people out of every 100,000 die from heart disease in South Carolina, compared with 191 across the United States.
--20 percent of South Carolinians smoke, while the rate is 18.3 percent nationwide.
But South Carolina doesn't top every list:
--458 people in every 100,000 have cancer. Nationally, the rate is slightly higher at 462 people.
--South Carolina is slightly lower than national average when it comes to asthmatic adults. The state rate is 8.3 percent. The national rate is 8.5 percent.
Looking for help?
--U.S. Uninsured Helpline, 1-800-234-1317.
--S.C. Department of Health and Human Services, 1-888-549-0820 or www.dhhs.state.sc.us.
--Dream Center Clinic, a free clinic for low-income North Charleston and Hanahan residents, 225-1115 or www.dreamcenterclinic.org.
--Welvista, a public-private partnership that provides free prescription drugs to low-income individuals who are uninsured, 800-763-0059 or www.welvista.org.
--Franklin C. Fetter Family Health Center, nine locations that accept patients with or without insurance, 722-4112 or www.scphca.org.
Reach Yvonne Wenger at email@example.com or 803-926-7855.