2020 vision National health care may mightily expand state Medicaid, billsBy Bill Davis, senior editor MARCH 26, 2010 -- More than 40 percent of South Carolinians may be receiving health care through the state by the year 2020, thanks to President Barack Obama signing into law a national health care reform bill earlier this week, according to state officials and observers.
The bigger shock may be in who will have to pay for it, not to mention how big the bill will end up being.
Currently, close to 20 percent of South Carolinians are covered under the state’s Medicaid program, according to Jeff Stensland, spokesman for the S.C. Department of Health and Human Services.
Stensland said even though the ink hasn’t completely dried on Obama’s health care bill, it could result in a “61 percent increase” in those covered by Medicaid in the state.
That could increase the percentage of state residents getting Medicaid to 32 percent, he said, as the new programs will bring more applicants than are currently enrolled.
The biggest area of change, he said, will be in the numbers of single, childless adults who will be covered by the federal program when the reforms are phased in in 2014.
"Nightmare" scenario ahead
Stensland’s boss, DHHS executive director Emma Forkner, has already warned state government that her agency faced a “nightmare scenario” after the 2010-11 fiscal year when federal stimulus dollars dried up.
Stensland said that to get those federal dollars in the first place, the agency had to increase its rolls of Medicaid-eligible citizens. Now, he said, the beleaguered agency faces increased enrollment with decreasing dollars in the face of a federal mandate.
“This hasn’t made our job easier,” said Stensland.
Currently, approximately 10 percent of the state’s population (430,000 people) are covered under the state employees’ health plan, according to Rob Tester, who is in charge of the plan, which covers state employees, some municipal workers, teachers and others
There is a big difference between Medicaid and the state health plan, in that, enrollees in the health plan support their health care via contributions and Medicaid is underwritten by tax dollars.
Combining the projected 32 percent Medicaid enrollment with the 10 percent covered by the state health plan, the projected number of citizens getting their health care in South Carolina could hit 42 percent within 10 years.
Who's going to pay? Csiszar asks
“Who’s going to pay for all this?” asked Ernst Csiszar, a former national insurance bigwig and state insurance regulator who now teaches risk management at USC. “You’re looking at him every morning when you shave in the mirror.”
According to DHHS spokesman Stensland, Obama’s reform bill could require an additional $900-plus million in state dollars to be pumped into Medicaid by 2020.
House Ways and Means chair Dan Cooper (R-Piedmont) said he wasn’t sure where that money was going to come from. When asked if this meant a higher likelihood of raised taxes in the near future, Cooper said he didn’t know.
Stensland said the money demands won’t begin until 2014 at a relatively manageable $50 million, but would escalate quickly from there.
One of the potential funding sources could be an increase cigarette tax. This year, the House sent over a proposed General Fund budget that included a plan where the per-pack cigarette tax would be increased from a national low 7 cents per pack, to 37 cents per pack.
Csiszar said there are more concerns over what is currently known about the effects of the national health care bill.
“This is a blatant unfunded mandate,” said Csiszar. “It’s déjà vu over and over and over again, where the feds pass a law, and good part, not all of it, passed onto the state to twist in the wind.”
Expansion is good for state, Knapp says
S.C. Small Business Chamber president and founder Frank Knapp, however, sees the Medicaid expansion as a “good deal” for the state.
“My understanding is that the federal government will, eventually, cover 90 percent of the expansion,” said Knapp.
He added that all the expansion would result in money being “directly infused into our estate’s economy,” and the result would be more jobs, economic development and opportunities for low income people in the state.
Meanwhile, Csiszar said states, like South Carolina, are faced with a list of difficult, and potentially unfeasible, options. “Like raising taxes or cutting programs like education to pay for all this.”
Additionally, Csiszar said Obama’s bill may have made health care more available, but it may not have made it more affordable. For states, that is.
Crystal ball: People see what they want to see in Obama’s bill and its ripple effect. Conservatives decry it as an expensive and un-American maneuver. Others just see the numbers that will now have health care -- a projected 32 million nationally. Regardless, the sight of the coming (tax) bill may make both sides blanch.
3/19: Environmental issues find middle ground
3/12: Next year's budget may be bloodbath
3/5: Fines, fees make up bigger part of budget
2/26: Tough choices on Corrections
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Light meeting schedule aheadMeeting agendas in both the House and the Senate will be light next week. The House’s will be the lightest, as it has furloughed itself for two weeks, at a $100,000 savings to taxpayers, and will not be in session. The Senate, which will furlough the week following Easter, will have two important meetings on Tuesday, March 30. The first will be a Finance subcommittee that will tackle House Speaker Bobby Harrell’s economic development bill at 1:30 p.m. in a yet-to-be-announced meeting room. At 3 p.m. in 308 Gressette, the full Judiciary Committee will meet to discuss an ethics law related to Gov. Sanford’s misdoings in South America, a host of family law bills, and a response to the federal health care bill signed into law this week, among others. With the House’s $5.1 billion General Fund budget on their desks, senators will also begin their own rounds of budget and proviso hearings and meetings this coming week, too.
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The mid-session doldrumsAfter the big push in the House to get the budget passed, and the big push in the Senate to get bills out of committee before the budget arrived, expect a lull for the next few weeks. The House will return to committee work for the second half of the session, as will the Senate, but not with the same fervor, as the House is up for election this year, and senators know they have another full year to push through legislation before facing an election year.
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ESC to become governor’s headacheThe Senate passed a bill this week that would not only move the troubled Employment Security Commission into Gov. Mark Sanford’s cabinet, but also included a plan to pay down the state’s unemployment agency’s massive debt over the next few years. Under the plan laid out in the bill, the current commissioners overseeing the agency, which borrowed nearly $900 million dollars from the federal government in recent years, will be removed and replaced by a panel of legislators and appointees. It will combine the ESC with another, new department to help people get more jobs. The key to paying down the debt, according to Senate President Pro Tempore Glenn McConnell (R-Charleston) is to change how much companies pay into the system. According to the bill, which will be sent to the governor this week, those companies that rarely lay off workers will see their rates rise slightly, while those that regularly do, such as some manufacturers who close down shop to retool machines on a seasonal schedule, will see their rates more than double. McConnell said the changes will make the system work better. Sentencing reform passes Senate The Senate this week passed an omnibus sentencing reform bill that was intended to save the state money by reserving prison beds for more dangerous criminals. First-timers and nonviolent offenders, such as those who commit check fraud, would be given sentences of supervision rather than incarceration. The running deficit at the state Department of Corrections has been the impetus for the bill, which received bipartisan support along the way. The bill would also lengthen prison stays for more dangerous criminals. The reform package now goes to the House, where it could have a more contentious fight, as members there are in a reelection year and may be more reluctant to seem in any way soft on crime.
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SC moving into economic recoveryBy Andy Brack, editor and publisher MARCH 26, 2010 -- You might not believe it from what you see around you, but economists say South Carolina is coming out of the recession. “We still have a long way to go,” said Ryan Sweet at Moody’s Economy.com in West Chester, Pa. “The recovery is likely going to be slow and uneven, but we’re moving in the right direction.” Frank Hefner at the College of Charleston agrees: “The optimism now is we’re no longer pessimistic. So, in other words, the bottom has been reached.” A recent study by Moody’s Economy.com shows 22 states, including South Carolina, moving to better days. Sweet says two factors pushed South Carolina into recovery, compared to a November report by the company that showed it on the edge of recovery: A slight uptick in hiring and a steady increase in industrial production.
He said the state experienced hiring of about 10,000 new jobs over the last three months. Such an increase is positive because businesses generally are “very reluctant” to hire right now due to past uncertainty. For the last several months, industrial production also has increased, Sweet said. “This is pretty much a business-led recovery,” he noted. “Consumers appear to be lagging and that’s not unexpected, given the very high unemployment rate in South Carolina.” While unemployment may rise in the coming months, South Carolinians need to keep in mind that rising unemployment doesn’t necessarily mean the economy is getting worse. Hefner said it’s typical in an area coming out of recession for unemployment to rise. When people stop looking for work, agencies stop counting them among the “unemployed” because they’ve taken themselves out of the job market. But when jobs become more available, those people often opt in again, which increases the labor pool more than the growth in new jobs. Hence, there is higher “unemployment” even though jobs are growing. Hefner said a better indicator to look at to determine an economy’s health is job growth. “You’ve got to see that job growth,” he said. “As you eventually see positive job growth, the unemployment rate will reduce and wage (growth) will follow later.” Sweet said South Carolina’s emergence from the recession seemed to be following a typical pattern. As the economic engine begins to rev up and businesses see more demand for their products, they’ll increase production. But because many manufacturing businesses have excess capacity now – some invested during the recession to build capacity – they can rely on productivity gains for awhile before they have to hire workers. Whatever pans out, the recovery is going to take a long time – up to two years to return to where we were before the whole mess started, Hefner said. “This time last year,” Sweet said, “consumers were panicked. “Now that the economy is improving, not only in South Carolina but nationwide, workers are becoming a little less nervous about their jobs.” * * * * * IT’S SADDENING AND WORRISOME to see how some nuts around the country are so irked about the new federally-passed health care reform bill that they’re making death threats, using inappropriate slurs and hurling bricks at buildings. U.S. Rep. Jim Clyburn, the South Carolina Democrat who is third in power in the House, received a faxed copy of a noose at his office. He was on target this week when he pointed to GOP leaders to set a better example and not inflame angry taxpayers. “These kinds of things happen when people in authority do not do what they can to tamp this down,” Clyburn told CNN late Wednesday. “We saw the other day, Sunday, [Republican] members on the floor cheering when people were up in the balcony jeering. That should not be. We're giving aid and comfort to these people, and this stuff gets ratcheted up.” Resorting to threats and violence in a civil democracy is not acceptable. If you’re mad with the guys in office, register to vote and get involved in the political process to kick them out – something it took far too long for congressional Republican leaders to say this week.
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S.C. Chamber of CommerceThe public spiritedness of our underwriters allows us to bring Statehouse Report to you at no cost. This week's spotlighted underwriter is the South Carolina Chamber of Commerce. As the premier advocacy organization in the state, the South Carolina Chamber of Commerce will serve as the unified business voice for promoting an economy of increased productivity and per capita income to achieve global competitiveness. Our work includes efforts to decrease business costs and increase productivity; build a highly-skilled, capable workforce; nurture entrepreneurial development; foster a favorable climate among our members and their employees; and Improve quality of life for all South Carolinians. For more, go to: www.scchamber.net.
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Dilly-dallying at the StatehouseTo Statehouse Report:
This fine commentary by Andy Brack (Statehouse Report, 3/19) relates an obvious problem, but it does not delve into irony. The leaders of the State Senate and the General Assembly are manifestly competent, but they dance around the deficit and dally with tax breaks for special interests rather than deal directly with the persistent needs of the people. Clearly, this is their world, but it is not mine. The reality of this economic downturn magnifies the consequences of coasting through the last decade and ignoring the burgeoning problems in health care, education, public works, criminal justice and so forth. Maybe it's time for them to move on. Want to send us a letter? Letters to the editor are published weekly. We reserve the right to edit for length and clarity. We generally publish all comments about South Carolina politics or policy issues, unless they are libelous or unnecessarily inflammatory. One submission is allowed per month. Submission of a comment grants permission to us to reprint. Comments are limited to 250 words or less.
Please send to: feedback@statehousereport.com.
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Up, down and in the middleLegislature. Despite limited funds, work on important bills like restructuring ESC, bolstering the environment and sentencing reform is moving ahead. It’s a respite from the do-nothing sessions of recent years. Well done on everything but perhaps the decision to delay the Tax Realignment Commission. ESC. It may be a couple years late, but the legislature’s plan to revamp the Employment Security Commission should clean up inefficiencies, get more people jobs and cut down on costs. Eventually. More. Unemployment. The state’s unemployment rate may be 12.5 percent, but at least it didn’t go up from last month. More. Taxes. South Carolina collected the second lowest rate of income taxes in the country in the last fiscal year, showing a nearly 30-percent drop. More.
Senate. Caving on a mandatory 24-hour waiting period for an abortion may have cleared the calendar for other bills, but it shows this chamber will put politics over common sense. More. Ed $. The Pickens County School District announced this week that it will cut 100 jobs for next year in the face of decreasing state education funding. More. USC. Black lawmakers are reaching out to black football signees, asking them to reconsider their commitments to play football at the state’s flagship school in the face of a perceived threat to remove the only black member of the schools board of trustees. People, it’s hard enough beating Florida as it is. Diversity. State Rep. Annette Young (R-Summerville) announced this week she would not seek reelection, further dropping South Carolina’s number of women political leaders (hint: we’re already last). More. Porn. Former state legislator Bubba Cromer was supposed to see a film he directed, “The Hills Have Thighs, make its pay-cable debut last week on Cinemax. Instead, the network apparently aired another film with the same title with a more … adult rating. He’s suing. More.
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