Whether you call it the Affordable Healthcare Act or Obamacare, it is coming but lawmakers in the state and those in the medical industry still do not know how it will impact residents of South Carolina.
Health care, and the changes set to kick in next year, was the topic at this week’s Waccamaw Neck Republican meeting where the guests speakers were Bruce Bailey, CEO of Georgetown Hospital System, as well as Sen. Ray Cleary and Rep. Stephen Goldfinch.
One issue lawmakers are dealing with in Columbia is whether to expand the Medicaid program in South Carolina which would make health care available for about 500,000 more people who cannot afford health insurance policies.
The members of the House of Representatives have already voted down the measure 73-41, but the state Senate still has to deal with the issue.
If expansion is passed, those who would be eligible are those single people earning about $15,000 a year or less or a family of four bringing home $32,000 or less.
The Republican-controlled House says the expansion will be too expensive and had doubts about whether it will improve the health of South Carolina residents.
But Cleary seemed to favor expansion, saying for the first three years the costs will be paid by the federal government, not the state.
He said the state can use the three years to find ways to cover the costs once portions of the federal funds are not available or, after three years, the expansion could be dropped.
“Would you like me to tell you I am now or tell you I am firing you three years from now?”, Cleary said as an analogy. “Most people would say three years from now because they could use that three years for planning.”
He said another reason he supports the expansion is because without it, the state may not be attractive to new businesses or industry looking for a place to locate.
“Do I like Obamacare? No. Do I think it will work? No. But, at the end of the day it will affect us all in one way or another,” Cleary, a dentist, said.
Goldfinch told the audience he voted against expansion when the matter was before the House last week because his constituents told him that is what they wanted.
He said there are several factors that have to be considered concerning expansion. One, he said, whether it passes or not, uninsured residents will still be using the services of hospital emergency rooms.
He also said the biggest problem is that too many of the uninsured in the state are unhealthy.
“The underlying problem is they are uninsured and unhealthy. That is what is killing us. We are in the stroke belt here in South Carolina,” Goldfinch said. “There are a lot of ways to make people healthier but these are tough decisions.”
He said ultimately, the cost of expansion can only be funded in one of two ways; raise taxes or cut providers.
“We could have one million new Medicaid patients on the rolls by 2020. What that will do to our quality of care is why I voted no,” he said.
Goldfinch said if expansion comes about he would like to see work requirements for those receiving the benefits.
Bailey agreed with Goldfinch on the problem of uninsured residents using the emergency rooms for primary care.
He said Georgetown Hospital System has an annual budget of about $300 million. However, he said, the hospitals provide about $30 million annually in charity work and they have about $40 million each year in bad debt.
He called Obamacare a “grand bargain made in Washington” that will result in $150 billion in reimbursements the medical field will no longer receive from the Medicaid program. He said for GHS, that — along with cuts resulting from the sequester — will equate to about $11 million per year in losses.
He said when the plan was being devised in Washington, lawmakers figured since everyone will have insurance coverage under the new healthcare act, there would be no more hospital charity cases, so things should even out financially.
“I never agreed with that math problem,” Bailey said.
He said the forecasted $11 million annual deficit GHS is facing must be plugged somehow in order for there to be money for new people, doctors and facilities.
“People, even the uninsured, use a lot of health care services. The emergency room is a wasteful place to get primary care. Someone will have to pay for it. It may be that we have to jack up our rates and charges more than we should have to,” Bailey said.
Bailey said the hospital tried a program several years ago where staff members tried to show repeat emergency room users the benefits of using general practice doctors to help with their non-emergency medical needs.
“No one showed up” for the program, he said, saying America has a “cultural” and an “expectation” problem.
By Scott Harper
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