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Insurance News in South CarolinaIn Efforts to Cut Medicaid Spending, Some States Try to Make Recipients More Responsible Source(s): Kevin Freking, Associated Press (August 15); Julie Rovner, NPR's Morning Edition (August 17). Aiming to make major changes in its Medicaid program that it claims will "redefine health care in the United States," South Carolina is trying to establish personal health accounts for most of its 850,000 Medicaid beneficiaries. The amounts allocated to the accounts would vary according to the recipient's age, sex and physical condition, and would include caps. If low-income people exceed the cap, they would have to make up the difference or go without coverage. The change is "based on the belief that Medicaid has created little incentive for frugality." The state now spends nearly 19 percent of its budget on Medicaid, but the percentage is expected to increase to 24 percent in five years and 29 percent in a decade. If South Carolina's waiver request is approved by the federal government, many believe other states will attempt similar reforms, which will then lead to changes in national policy. (August 15, 2005) Think tanks blast S.C. Medicaid plan Source: Roddie Burris, The State (Aug 10). Two new analyses say South Carolina’s proposed Medicaid changes will reduce health coverage and significantly raise costs to beneficiaries. According to the studies by the Center on Budget and Policy Priorities and Georgetown University’s Public Policy Institute, if the waiver requested by South Carolina is granted, the state is unlikely to provide adequate dollars to cover long-term, chronic illnesses such as heart disease, cancer and diabetes, or to cover people with disabilities. The proposal sent to Washington in June would allow for cuts in medical services to all children, the study concludes — not just 19- and 20-year-olds, as the state acknowledges. That’s because none of the plans the state is using as a model for its new children’s benefits package offers unlimited, preventive and diagnostic medical care for children, as Medicaid does, the analyses found. Since South Carolina submitted its waiver in June, state Health and Human Services director Robbie Kerr has said he doesn’t intend to cut children’s medical services. Medicaid, the 40-year-old medical safety net for the nation’s poor, is under pressure from the Bush administration to cut $10 billion from the ever-expanding program over the next five years. Governor Mark Sanford has been pushing for cuts to the program for more than a year. More than 52 million people get Medicaid in America, and about 850,000 residents get the nearly-free medical services in South Carolina. Of those, more than half, 520,000, are children. "The proposal, as written, is the most radical and far-reaching waiver in the country submitted to date," said Joan Alker, senior researcher at Georgetown’s Public Policy Institute. "It is based on untested concepts that have the potential to unravel the health care safety net in South Carolina." The waiver asks to install co-pays of $100 for inpatient hospital visits and $25 for outpatient surgery. Critics say Medicaid beneficiaries, who must make less than $2,000 a month for a family of three, can least afford co-pays as a percentage of their incomes. (August 10, 2005) Pregnant teens may lose free health care Source: Roddie Burris, The State (July 16). Pregnant teens from poor South Carolina families would lose free medical care under proposed changes in the state's Medicaid program. As part of a proposal by the Department of Health and Human Services, the state wants to take free medical care away from poor 18- to 21-year-olds now covered by Medicaid. Under South Carolina's waiver proposal, pregnant teens on the state's skyrocketing, $4.8-billion-a-year Medicaid program would lose access to regular medical checkups, dental care and eyeglasses, unless the proposal is changed. HHS has been working on a major Medicaid overhaul - the most fundamental change to the program in state history - for more than a year. If accepted by federal officials, several changes would occur: State Medicaid recipients would get personal health accounts that would allow them to choose a coverage plan and pay for it, much like the insured in the open marketplace. They also would get debit cards to pay hospital deductibles, doctor visits and for pharmacy needs. Frequent Medicaid users would be forced into managed care, designed to streamline and coordinate care, while hopefully lowering expenses. (July 16, 2005) Clinics redouble efforts to offer balm to uninsured Source: Liv Osby, Greenville News (May 22). The Greenville Free Medical Clinic is part of a network of health-care services available to low-income and uninsured residents. But with a variety of locations, different hours and diverse eligibility requirements, that network can be confusing and frustrating, providers say. So community agencies are working together to not only improve services, but spread the word about them in an attempt to link needy people with the appropriate provider. They particularly want to reach out to those who unnecessarily use the most costly care - emergency services - driving up the cost of health care for everyone and adding to the waits in already crowded ERs. A key element, Cook said, is an electronic system that allows health-care workers at all agencies to enter some general non-medical information about patients in a computer and get an automatic referral to the right provider. If someone at the ER has a condition determined not to be an emergency, she said, they can be channeled to the free clinic or New Horizon or MedWell Access. MedWell Access is a service of the Greenville County Medical Society that provides a primary care doctor or specialist to uninsured residents who work at least 30 hours a week. (May 22, 2005) Jenny Sanford Launches Health Challenges to Counties, Communities Source: Susanne M. Schafer, Associated Press (May 4). Supporters of first lady Jenny Sanford's new initiative to get people interested in power walking, raking leaves and other healthy activities gathered Wednesday at the Gov.'s Mansion to announce a statewide challenge. "Mark and I are both passionate about physical activity and staying well. ... We want people to compete on a statewide basis, to get schools and institutions to compete with one another. Our state will win as a whole if everyone works to make themselves healthier," Sanford said after the event, attended by local celebrities and sports mascots from South Carolina schools. The governor's wife said the "Healthy South Carolina Challenge" has a Web site to give people information about improving nutrition, increasing physical activity and quitting smoking. Sanford said a competition will be held to see which county in South Carolina is able to improve its health statistics over the 2005-2006 year. Also, groups in the state - such as schools, hospitals, government agencies, churches or corporations - are encouraged to join in the competition, she said. The winning residents of the most-improved county will be invited to visit with the governor and his wife at an Open House. The statistics are kept by the Department of Health and Environmental Control, rating each county's percentage change in smoking rates, physical activity and body mass index. In future years, fruit and vegetable consumption will also be added, according to the Web site. The efforts follow the governor's "family fitness challenge," during which the first family biked and canoed at sites across the state to focus on the importance of increasing a family's physical activity. (May 4, 2005) Group Puts Focus on Insuring Residents Source: Kathleen Vereen Dayton, The Sun News (May 3). Horry County leads the state in uninsured residents, with an estimate of more than 30 percent without any kind of insurance, according to a survey by the State Department of Insurance. Statewide, more than 19 percent of residents are uninsured, topping the nation's average of 15.2 percent uninsured. A couple of years ago, the problem prompted the Myrtle Beach Hospitality Association to launch a health-insurance program with coverages based on what small businesses can afford. About 50 companies are enrolled in the program, which caters primarily to tourism workers, according to the hospitality association. Since its inception in 2002, SharedCare has brought Horry County residents more than $1.2 million in donated medical services. The Rev. Joseph Washington, SharedCare's director, said the percentage of uninsured in the state has jumped from 14 percent to 19 percent in the past four years. SharedCare's goal is to provide a safety net for the self-employed and people who are working for small businesses that cannot afford to provide health insurance, he said. Through SharedCare, patients can qualify for medical services as long as their income falls within the program's guidelines: about $18,000 or less annually for an individual or $30,000 or less annually for a family. SharedCare members are asked to pay what they can for services, often at a discounted rate. "We have patients paying us $5 a month. Paying something, even if it is negligible, makes patients feel better," said Collins Wakefield, chief financial officer of Carolina Regional Cancer Center. Dr. Steve Bass, the center's medical director, said his patients' medical records are kept separate from their financial records and insurance information. "We're not going to treat them any differently because of compromised ability to pay," Bass said. (May 3, 2005) Novartis Donating Meds for S.C. Poor
Source: Linda H. Lamb, The State (Apr 29). Sixteen free medicines for ailments ranging from high blood pressure to foot fungus have been added to a program that serves low-income, uninsured South Carolinians. The Swiss-based pharmaceutical giant Novartis will become the 10th company to donate prescription drugs through Communicare, the Columbia nonprofit announced Friday. Ed Gajewski of Novartis called Communicare "the national model" for providing medications to the working poor. Gajewski said Novartis provided $270,000 million in free medicine to Americans last year, but this is the first time the company has made an arrangement with an organization like Communicare. State Rep. Ronnie Cromer, who is a pharmacist, said it's not just poor patients who benefit from such contributions. "I see people come into the store every day that cannot afford their medication," said Cromer, R-Newberry. When such patients need medical care, he said, the costs often are borne by hospitals and by people who do have insurance. For more information about Communicare's services, call (800) 763-0059 or visit www.commun-i-care.org. (April 29, 2005) Mental health bill debated Source: Jessica Flathmann, The Island Packet (Apr. 4). Most people with health insurance in South Carolina could get more mental health coverage under a bill working its way through the state House of Representatives. But mental health officials argue the bill doesn't go far enough to provide equal coverage for mental and physical illnesses, despite the increased coverage the legislation would require. Others representing businesses claim the coverage would increase premiums for all those with insurance unless the diseases and amount of treatment are restricted. The bill would require companies with more than 50 employees to provide insurance coverage for specific mental illnesses for up to 45 days of inpatient care and up to 60 outpatient visits a year. About 950,000 South Carolinians would get the increased coverage, according to the state Budget and Control Board. About one in five adults suffer from a mental disorder each year, said Mike Walsh, executive director of the Mental Health Association of Beaufort and Jasper Counties. David Almeida, executive director of the National Alliance of the Mentally Ill of South Carolina, said a four-year test run of mental health parity for state employees showed the average rate of increase in insurance costs for mental health coverage was less than 1 percent. "The cost concerns," he said, "are not real." Some private insurers already cover a portion of mental health care, but the coverage usually is significantly less than physical health care. Almeida said many health insurance companies cap mental health treatment expenditures at $10,000 a year - a level most seriously mentally ill patients far exceed. (April 4, 2005) Prescription for danger (Login Required) Source: Karen Cimino and Danica Coto, The Charlotte Observer (Mar. 20). Latinos across the Carolinas risk their lives daily because of a practice imported from their native countries: buying prescription drugs at Latino stores without a doctor's order. Latino marketplaces, called tiendas, are a lot like small-town general stores where neighbors buy goods and swap gossip. They're colorful slices of home, with bins full of fresh produce and dried chiles and shelves bulging with products ranging from dried milk to religious icons. Behind the counter, though, some are illegally selling antibiotics, contraceptives, steroids and other drugs that require a prescription. Despite the public health risk, no state agency in either North or South Carolina takes full responsibility for investigating, prosecuting and shutting down violators. That often leaves the job to local police, who aren't always aware of the problem or may not consider the misdemeanor cases a priority. There are no quality controls to keep expired or contaminated drugs from being sold. The drugs are often administered by injection in larger, more potent doses by shop workers who have no training, health and law enforcement officials say. Most people buying the drugs are newly arrived immigrants who often are poor, uneducated and don't know where to go when they're sick, health workers and Latino advocates say. It's unclear what proportion are here illegally. But many wrongly fear public health clinics, thinking they'll get deported. Carolinas officials say they aren't aware of any deaths from tienda drugs, but say it's only a matter of time. The problem is growing with the Latino population, which in the 1990s increased nearly fivefold to about 379,000 in North Carolina and more than tripled to about 95,000 in South Carolina, according to the 2000 Census. (March 20, 2005) Mental illness coverage proposed Source: Roddie Burris, The State (Mar. 3). Insurers would have to cover treatment for mental illness just as they do for cancer or diabetes under a bill that gets a hearing in the General Assembly today.South Carolina is one of 16 states that do not require insurers to cover treatment for mental illness. The bill also would forbid insurers from charging higher rates to cover mental illness than other diseases and would direct them to establish a set of conditions that qualify for coverage. About 800,000 South Carolinians - one in five - have some type of mental illness, according to the state Department of Mental Health. About 5 percent of the adult population has a serious mental illness. If the bill becomes law, proponents say, treatment of brain disease would be elevated to that of a failed kidney or clogged arteries; a person seized by schizophrenia or bipolar disorder could be as routinely medicated as someone with hypertension or prostate disease. Opponents say mandating coverage could raise insurance costs for everyone and could force employers, particularly small ones, to decide to stop offering insurance coverage."If the argument against passage is increased premiums, the debate is over," said former Attorney General Travis Medlock, an advocate for the S.C. chapter of the National Alliance for the Mentally Ill. "It seems to me the time has come to end discrimination against poor, sick people who have disorders of the brain." Mental health coverage raised the state plan's average annual costs by only about 1 percent, said Rob Tester, state health plan director. "In terms of costs, it was successful," he said, crediting a managed care approach for the state plan's success. Though the law requiring mental health coverage for state employees expired in December, the State Budget and Control Board extended the coverage for 2005, spokesman Michael Sponhour said. (March 3, 2005) Those in Need of Health Care Get Some Help Source: Anna Simon, Clemson Bureau (Mar. 2). Janet Greenlee wakes up at 5:30 a.m. and starts popping pills. Tiny tablets help her control diabetes, vertigo, thyroid, anemia, mini strokes and pain from a fractured left foot. At over 200 pounds, Greenlee, 48, of Pendleton, knows weight loss could help her shed some health problems as well, but it's hard to find time to exercise. "Once you get off work you have family to take care of," said Greenlee, who is a custodian at Clemson University. Clemson University and Voorhees College have created a national center aimed at helping Greenlee and others in her situation to close racial and ethnic health care gaps in rural communities and offer added help and hope for people suffering diseases including breast cancer, diabetes, heart disease and AIDS. The proposed South Carolina Center for Research on Minority Health Disparities "can empower" people with information to make informed decisions and appropriate health care choices, said Barbara Logan, a Clemson University nursing professor. "We are connecting people with information, education and peers who can support each other in changing lifestyle habits," Logan said. They want to help people communicate better with doctors and other health care providers and remove barriers, such as transportation, that discourage some from seeking health care. "We are supposed to have one of the best health care systems in the world and if we are not effective we need to know what we can do to improve," Davis said. "The goal is to have a keener understanding of why these health disparities persist and how to eliminate them," Logan said. Work already has started in Bamberg, Barnwell, Orangeburg and Calhoun counties, funded through a $5.26 million National Institutes of Health grant. Programs will start soon in Pickens, Anderson and Oconee counties. (March 2, 2005) Source: PRNewswire (Feb. 22). South Carolina's Jacksonboro Community Center and Bamberg Shalom Zone Mission Cottage, Inc. are two of 81 recipients of Nickelodeon grants designed to help foster healthy and active lifestyles within local communities. The network is distributing a total of $600,000 to schools and other organizations across the United States as part of its 2004 "Let's Just Play" program. The Community Center plans to use the "Let's Just Play" funds to initiate "The President's Challenge Active Lifestyle Program" in its after-school program, which provides tutoring, reading, enrichment, and recreational activities for children between the ages of five to 15. Shalom Zone Mission Cottage, whose mission is to provide kids in poor sections of Bamberg with opportunities to improve their lives, will purchase a playground and other recreational equipment for its residents. The broad spectrum of projects that the 2004 "Let's Just Play" Grants Program is funding includes nutrition and physical education programming, renovating facilities for play and exercise, providing athletic equipment, and establishing a variety of sports teams and athletic programs, among others. Selected organizations include elementary and middle schools, community centers, after-school programs, health centers, churches, youth at-risk programs, nonprofit organizations, charities and more. Grants were awarded to communities in every U.S. state, recipients ranged from cities such as Hickam Air Force Base, Hawaii, to Clearwater, Florida, to Nome, Alaska. A full list of awardees and grant plans is available upon request. (February 22, 2005) Uninsured now charged deposit in ER Source: Liv Osby, Greenville News (Feb. 6). Most people with insurance are charged a co-payment when they use the emergency room, and now uninsured patients at Greenville Hospital System are asked for a $50 deposit. The deposit is requested of all uninsured patients who don't qualify for Medicaid or any other kind of assistance as they prepare to leave the hospital. The charge was instituted at all GHS campuses as a hedge against the growing uncompensated care the hospital provides, said Susan Bichel, GHS's vice president for financial services. No one will be turned away because they can't pay, and those who can't pay the deposit then are asked to pay later, hospital officials said. Under federal law, hospitals are obligated to screen and stabilize all patients who come to the ER, regardless of their ability to pay. And last year, GHS provided $68 million in charity care and lost about $83 million to bad debt, Bichel said. Similar charges are being seen in a few places around the country, said Dr. Bruce Siegel, research professor at George Washington University Medical Center's School of Public Health. "The idea of charging people on the way out and collecting cash if they can is an unfortunate reality of what's happening today," Siegel said. "ERs are overwhelmed with patients, many of whom are uninsured, and they need to be paid for the services they're providing - nurses, doctors, tests. And I think you will see more and more of that." At AnMed Health, which wrote off $21 million in charity care last year, uninsured patients who don't qualify for Medicaid or another form of assistance are asked for a $100 deposit upon discharge, said spokeswoman Amanda Brasier. But the hospital will take whatever the patient can afford, she said. A similar policy exists at all Palmetto Health hospitals, said spokeswoman Tammie Epps. Insured patients are asked for their co-pay and uninsured patients meet with a financial counselor who determines whether they qualify for assistance. Ineligible patients are asked to pay $100, she said. Upon discharge from Bon Secours St. Francis Health System's ER, insured patients are asked for their co-pay, while uninsured patients are asked for some kind of deposit, though no amount is set, said spokeswoman Lee Turza. In cases where even a small deposit is a hardship, patients are offered information about financial assistance. Spartanburg Regional Healthcare System has no formal deposit policy, but it tries to collect co-pays from insured patients and other payment from those who are uninsured upon discharge, spokeswoman Betsy McMillan said. But Dr. Peter Lurie, deputy director of Public Citizen's Health Research Group, said health-care providers need to guard against discouraging people from seeking care. "They certainly make it more likely that people won't even be present at their emergency room door," he said. "And that could be very dangerous for the patients ... because they might put off going to the hospital even if their medical condition is severe." (February 6, 2005) Medicine program to help uninsured Source: Liv Osby, Greenville News (Jan. 24). A new nationwide program is aimed at helping people who have jobs that offer no health insurance or no prescription coverage. Established by a consortium of 10 pharmaceutical companies, the Together Rx Access Card program would offer discounts of between 25 percent and 40 percent on some 275 of their brand-name drugs to as many as 36 million uninsured Americans. Critics say that while the program may help some, those living hand to mouth will be left out in the cold. "There still will be folks in our community who will not be able to afford 25 to 40 percent off," said Eleanor Dunlap, director of Greenville County's Community Health Alliance. "There are still people out there who are having to choose whether to purchase needed medications or buy groceries or pay heating bills." At least one in 10 Greenville County residents is uninsured, and most of them work, according to Community Health Alliance, a coalition of 25 health-care, business and community leaders. The number of underinsured, those with coverage who went without care because of the cost, is estimated at 66,000. The savings offered by the new program may be especially out of reach for chronically ill patients who need more than one medication, said Suzie Foley, Greenville Free Clinic's executive director. "If they're taking three or four different medications, it can very easily total $300 to $400 a month. Even with the discount, that's largely unaffordable," she said. "It doesn't bring it down to a really affordable level for a lot of people who just barely get by. It's a little optimistic to think this will have much of an impact." But Roba Whiteley, executive director of Together Rx Access, said she believes about 80 percent of the 45 million uninsured Americans, most of whom are working, will be eligible. She added that all applicants will be assessed to see whether they are eligible for others programs, like Medicaid or pharmaceutical assistance programs offered by individual drug makers which provide additional savings. Whiteley said the Together Rx Access program is uncomplicated. The application process takes just a few minutes, she said, and then patients can take the card to participating pharmacies for direct savings. The savings apply only to medicines produced by the member companies. But Whiteley said they are 10 of the largest drug makers in the country and that she is in discussions with five others to include as many prescription products as possible. Dunlap said generic drugs might provide consumers greater savings than those offered under the Together Rx Access program. Whiteley said pharmacies participating in the program will offer discounts to cardholders for a variety of generics. (January 24, 2005) Chamber hopes to add health care alternatives Source: Peter Hull, The Island Packet (Jan. 21). The South Carolina Small Business Chamber of Commerce is inviting small businesses interested in securing affordable health care for their workers to a meeting in Bluffton next month. The chamber is partnering with the South Carolina Primary Health Care Association to develop an employee health care program for small businesses without traditional group health insurance. The meeting will be held at noon Feb. 1 to provide information to businesses with 100 or fewer employees that want to learn more about the plan. "We're looking for small businesses that are interested in affordable health care that don't offer health insurance," Knapp said. The program -- affordable health care, not health insurance -- will team a small business with a primary health care provider for medical services that would be available to the business's employees at that health care provider only. While services vary from one health center to another -- from obstetrics to dental care to discounted prescription drugs -- a business and the health center will negotiate a package of health care services, and how they are paid for, based on the needs of the business and what the center is able to provide. Under the pilot program, businesses will negotiate with one health care provider in each of the six counties participating in the program: Beaufort, Darlington, Greenville, Greenwood, Horry and Sumter. After the meeting in Bluffton, interested companies will attend private meetings with health care providers, coordinated by the chamber, to formulate a specific plan. As the program grows, and more providers are added, businesses may be able to negotiate with multiple providers to address more of their health care needs, Knapp said. The goal is to enable small businesses that can't afford health insurance to provide primary health care to their employees at a cost that's less than health insurance, he said. (January 21, 2005) South Carolina's Infant Death Rate Drops Source: Amy Geier Edgar, Associated Press (Jan. 14). Infant death rates in South Carolina dropped nearly 11 percent between 2002 and 2003, according to a report released Thursday by the state Department of Health and Environmental Control. The 2003 infant mortality rate was 8.3 deaths per 1,000 live births, representing a nearly 11 percent decrease from the previous year's rate of 9.3 deaths per 1,000 live births, DHEC Commission Earl Hunter said. The mortality rate for black and minority infants was 13.0 deaths per 1,000 live births - a 15 percent drop from the 15.4 deaths per 1,000 live births in 2002. While that is an improvement, the rate continues to be more than twice that of white babies at 5.9 deaths per 1,000 live births.The disparity is due to social issues including education and economics, said Karen Waldrop, a registered nurse and director of program services with the South Carolina March of Dimes. Many agencies and organizations have been working in South Carolina to close that gap, and it appears to be working, although more needs to be done, Waldrop said. "Eliminating this disparity gap between minority babies and white babies and the overall reduction of infant mortality must remain a top public health and community priority," said Lisa Waddell, DHEC deputy commissioner for health services. Disorders relating to premature births and low birth weight were the leading cause of infant deaths, Hunter said. Congenital malformations and deformations were the second leading cause of death, followed by pregnancy complications that affected the baby. There has been a drop in the number of birth defects, due to an active campaign promoting folic acid, Waldrop said. But there has been an increase in the number of premature and low birth weight babies, she said. Despite the overall improvement, South Carolina's infant mortality rate remains higher than the national average of 6.7 deaths per 1,000 live births. (January 14, 2005) Health care takes center stage Source: Johanna D. Wilson, The Sun News (Jan. 9). Folks fed up and fired up came together to share insight and stories concerning the need of every American to have health care. At the forum titled "Health Care For All" at Coastal Carolina University's Waccamaw Higher Education Center, about 70 health care advocates listened, learned and then left determined to help. Much of the event revolved around details given by Dr. Carol Kirschenbaum, founder and president of the N.C. Committee to Defend Health Care, and others educated about the downfalls of health care through personal experience and the intimate accounts of others. "The vast majority of the people who come to us don't have health insurance," said Gail Steinfield, executive director of the Conway-based charity called Churches Assisting People. "Some of their kids have Medicaid, but they are being bumped off on a regular basis." Steinfield told attendees that the charity, currently supported by 33 churches, serves 500 to 600 families a month. "A lot of them have nutritional needs, and nutrition is tough because we see a lot of diabetics and other people who are in need of special diets," Steinfield said. "They need certain types of food they can't afford to buy." When some of their clients do get health care, most of them cannot pay for their medication. A little more than 18,000 adult deaths annually are due to people being uninsured, according to an Institute of Medicine Study published in 2002. According to the S.C. Department of Insurance, there are 683,890 uninsured residents in the state. Nationally, Kirschenbaum said 45 million people are without insurance for the entire year. "Every year, that number goes up," she said. (January 9, 2005) More funds for cancer treatment urged Source: Liv Osby, Greenville News (Jan. 10). Gov. Mark Sanford's proposed 2005 state budget seeks to expand a breast and cervical cancer screening program for poor women in South Carolina that also permits their treatment to be covered by Medicaid. But other poor women can't get that treatment because they weren't diagnosed through the state screening program. That policy should be changed, Mary Lynn Faunda Donovan, president of the Upstate Affiliate of the Susan G. Komen Breast Cancer Foundation, told the Greenville County legislative delegation Monday night. "Expanding eligibility to all low-income, uninsured women ... will allow more South Carolina women to access Medicaid providers and hospitals for timely treatment of breast and cervical cancer," she said. "That will result in a significant reduction in mortality rates." Since 1995, the state's Best Chance Network has provided free screenings to uninsured women between 47 and 64 whose income is no greater than 200 percent of the federal poverty level. Treatment services followed in 2000 when Congress permitted Medicaid coverage for women diagnosed through the Network. In South Carolina, Medicaid covers treatment for women screened and diagnosed through the Network. And treatment is already covered for women diagnosed while on Medicaid. But women not on Medicaid when diagnosed who weren't diagnosed through the Network aren't eligible for Medicaid coverage of treatment. Under Sanford's proposed budget, South Carolina would provide $1 million to the Best Chance Network, and expand it to include screening for women between 18 and 64. (January 3, 2005) Study: Number of Insured Down in S.C. Source: Pauline Vu, Special to The Packet (Oct. 3). Nearly 250,000 South Carolinians have lost their health insurance over the past four years, following a trend that saw 12.7 million lose their insurance nationwide, a health care advocacy group announced this past week. Ron Pollack, executive director of Families USA, said America's workers are being hit with a "triple whammy" of rising premiums, fewer benefits and diminishing wages, resulting in a huge increase of uninsured people since 2000. Nationwide, Families USA says there are 85.2 million people under 65 who were uninsured at some point in 2003 and 2004. This is up from 72.5 million in 1999 and 2000. Families USA's numbers are much higher than the U.S. Census Bureau, which reported last month that from 2002 to 2003 the number of uninsured people rose by 1.4 million to 45 million. The agencies calculate the uninsured differently. The census only counts those who have been uninsured for a full calendar year, while Families USA counts those who have been without insurance for at least a month. According to Families USA, in the past four years the number of uninsured South Carolinians under 65 rose by 240,000 to 1.16 million. The S.C. Department of Insurance sent a study Thursday to the U.S. Department of Health and Human Services, as well as to Gov. Mark Sanford and the state General Assembly, about how to expand coverage and stabilize rates in South Carolina's small-group market, which includes small businesses. The report issued three recommendations: to expand Medicaid to small business workers; to create community-based health care programs that raise funds through prepayment fees; and to develop educational programs to inform South Carolinians of their health care options. (October 3, 2004) Report Finds Premiums in S.C. Increased 4.6 Times Faster Than Wages in Last Four Years Source: Jonathan Maze, Post and Courier (Sept. 28). The average cost for health insurance premiums in South Carolina rose 4.6 times faster than wages over the last four years, according to a report to be released today by the S.C. Appleseed Legal Justice Center and Families USA. "Health care is going to become unaffordable for most South Carolinians, especially for low- or moderate-wage workers, unless we in South Carolina do more to help lessen the burden," said Sue Berkowitz, director of S.C. Appleseed. The insurance affordability problem has been worsening for most of this decade. It's been fed in part by the higher number of uninsured patients, which in turn forces hospitals to charge insurance companies higher prices. Those insurers make up for the higher costs by raising premiums. State workers, for example, have seen huge increases in health insurance premiums year after year. Their salaries, meanwhile, have stayed stagnant for three years because of state budget problems. They finally received a 3-percent hike in July. Exacerbating matters, health insurance nowadays comes with higher deductibles and co-payments that put more of the burden on workers' shoulders. Average in-network annual deductibles in preferred provider organization plans, the most common type of health insurance plan, have gone from $175 to $287 between 2000 and 2004, according to Kaiser. Out-of-network PPO deductibles now average $558. (September 28, 2004) 3 More Hospitals Face Lawsuits (Registration Required) Source: Associated Press, The Charlotte Observer (Sept. 22). Three more South Carolina hospitals have been sued by patients who say they were charged more for services than people with insurance. Three law firms have filed lawsuits involving about a dozen hospitals in the state and are seeking class-action status for the cases. The latest were filed against Greenville Hospital Systems and two Charleston hospitals -- Roper St. Francis Healthcare and East Cooper Regional Medical Center. "We'll continue to file them around the state," said English McCutchen, a Columbia attorney involved in the case. "All the larger hospitals around the state are doing this. It's a fairly uniform practice." Similar lawsuits have been filed in other states as well. "I think it's outrageous," said Peter Campbell, vice president at Roper St. Francis, which was sued last week. "I think it's a shame that it's going to waste the assets of a nonprofit, charitable organization." Greenville Hospital Systems spokeswoman Robyn Zimmerman said it is anticipated that most hospitals will be sued eventually. "GHS charges are the same for all patients and payers," Zimmerman said in a prepared statement. "However, the amount actually received by GHS may vary depending on agreements with GHS and the patients, insurance companies, and federal and state government mandates." Last year, Campbell said, his company provided $17.8 million in free care and had to write off $36.9 million in care it was never paid for. Uninsured patients may get a higher bill, Campbell said, "but the uninsured rarely ever pay it." (September 22, 2004) A New Way to Help Pay for Health Care Source: Jonathan Maze, Post and Courier (Sept. 19). Facing a huge increase in its health insurance premiums, Pratt-Thomas Gumb & Co. decided four years ago to do something few other employers had considered. The Charleston accounting firm bought a bare-bones health insurance plan with a $2,500 deductible for each employee. Then it gave workers $1,000 apiece to place into an account to pay for all health care expenses below that amount. Workers also were given the option of setting aside a portion of their paychecks to put into their accounts. Today, this sort of insurance plan is known as a health savings account. With health care costs skyrocketing, experts believe HSAs are about to take off, as employers in Charleston and around the country seek relief from year upon year of skyrocketing premiums. Since putting its plan in place, Pratt-Thomas has been able to keep its annual premium increases to an average of 2 percent. "I don't know how you can get your health care costs controlled unless you do something like this," said Rudy Thomas, a partner at the firm. "There's no other way. It's an absolute success financially." Backers, most notably the Bush administration, see HSAs as an answer to the nation's health care cost problem. They say one of the biggest benefits of HSAs may be their savings feature. The money in an HSA can be rolled over from year to year. And the funds are portable, so a person can keep the account when he or she changes jobs. Critics have doubts. They worry the plans will help only those who are healthy, wealthy and childless, leaving poorer and sicker people with higher medical bills. They point out that those who tap into the account frequently could be left to shoulder bigger medical expenses if their health plan offers too little coverage. "It is ludicrous to think that HSAs are going to solve the problem of the uninsured," said Kathleen Stoll, health policy director at Families USA, a consumer advocacy group. Instead, she said, people wanting to save money will put off attending to their health care needs, which could lead to higher costs down the line after their illnesses become more serious. (September 19, 2004) State, Individuals Need to Invest More in Communicare Source: The State (Sep 15, 2004). Communicare, a small public-private partnership based in Columbia, has become a national model thanks to its impressive work to address one of the most daunting, and critically important, problems facing our state and our nation: how to provide medical care for the working poor. What Communicare does is so extraordinary that it nearly defies belief: It provides free medical care to 12,000 South Carolinians who make too much money to qualify for Medicaid but who don't have employer-provided insurance and are too poor to buy it themselves, let alone pay for their medical care directly. And Communicare doesn't just provide doctors' care, which is provided by several programs. It also provides a full array of prescription drugs - more than $15 million worth last year, and a projected $25 million this year - which increasingly are a crucial component of good health. It has been recognized multiple times by the federal government for its work and is the only program in the nation that has been able to so fully marry these two elements in a statewide program. (September 15, 2004) More People Than Ever Lack Health Insurance Source: Liv Osby, The Greenville News (Aug 29, 2004). According to the U.S. Census Bureau, 45 million Americans are currently without health insurance. The number of uninsured people increased by 15.6 percent in 2003. Public health advocates say the situation is reaching critical proportions. According to Karen Davis, president of The Commonwealth Fund, 5.2 million people lost health insurance between 2000 and 2003. Uninsured full-time workers now number 26.6 million, up from 25.7 million. In South Carolina, the Greenville Free Clinic reported a 20 percent increase in patient visits between 2002 and 2003. A recent survey of patients of the Free Clinic reported that if the clinic was not available, 63 percent would seek care at a hospital emergency room and 31 percent would seek no care at all. Suzi Foley, executive director of the clinic, said, "They recognize they can't afford health care. Unfortunately, the two primary options they most frequently use are not very good options." (August 29, 2004) Annual Increases in Health Care Costs a Big Concern for Many Employers, Employees Source: Ben Werner, The State (Aug 2, 2004). As employers prepare for this fall's health insurance open season, the outlook in South Carolina appears slightly better than during recent years. Officials with the state's largest insurer, BlueCross BlueShield of South Carolina, predict average increases in premiums nationwide will be about 10 to 12 percent. The S.C. Department of Insurance is more cautious, predicting increases of up to 14 percent. That's good news considering workers in some parts of the Southeast were hit with increases of up to 18 percent this year. In 2003, premiums on average rose by 13 percent. "The rate increases are not as high as past years," said William R. Shrader vice president and chief actuary for BlueCross BlueShield of South Carolina. "The only thing that worries me is we're seeing price pressure from hospitals and doctors." But for many employers and employees, trying to account for an annual increase in health care costs of 10 percent or more doesn't fit inside tight corporate or household budgets. (August 2, 2004) Growing Number of Uninsured Face Health-Care Crisis Source: David Dykes and Liv Osby, Greenville News (May 10, 2004). Despite an estimated 800,000 people lacking basic health-care coverage, the plight of the uninsured is not shaping up to be a dominant political issue in South Carolina. The bottom line, health experts say, is that the cost of treating the uninsured ultimately is borne by consumers through higher insurance premiums and co-payments. "It's a problem that's pressing because when they're not insured, they still go to the hospitals and we're still trying to take care of them," said Sen. Darrell Jackson, D-Hopkins, a member of the Senate's Medical Affairs Committee. "Part of the frustration is that we (state lawmakers) pass a resolution that says it's a pressing issue and we need to do something about it. But we don't do anything about it." With the problem showing no signs of abating, a coalition of business, political and medical community leaders is trying to establish a foothold to stem the tide of the uninsured. Greenville Hospital System, for example, spent about $55 million on charity care last year and expects to pay about $65 million this year, said Gregory J. Rusnak, vice president for hospitals and health services. Collaborations such as MedWell Access, the Greenville Free Medical Clinic and New Horizons Family Health Service also help, Rusnak said. But more emphasis needs to be on fully funding Medicaid statewide, he said, and on setting policies to help nationally. (May 10, 2004)
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Palmetto Project |
S.C. Budget & Control Board |
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This web site is intended solely for the purpose of electronically providing South Carolinians with general health and insurance-related information, and convenient access to resources. This website does not provide health insurance advice, referrals, or counseling.
