Republicans on the Senate Finance Committee sent the $6.3 billion spending plan for state taxes to the full Senate. Democrats voted “present” to protest Republicans’ refusal to expand Medicaid eligibility to hundreds of thousands of additional poor adults.
GOP lawmakers and Gov. Nikki Haley have remained steadfast in their opposition to expanding Medicaid under the federal health care law.
Finance Chairman Hugh Leatherman said he struggled with the issue but decided the state can’t afford the eventual costs. The federal government pledges to cover all but some administrative costs for the next three years. After that, Leatherman said, he’s not sure where the extra hundreds of millions of dollars would come from.
“I know the need, but I also face the reality that we’ve got to have money,” said Leatherman, R-Florence.
The Senate committee added to the House budget’s Medicaid initiatives that are aimed at improving residents’ health while driving long-term costs down. The committee put an additional $2 million toward health clinics for the uninsured and underinsured, and $3 million more to community residential care facilities.
Other key differences from the House plan include a 1 percent pay raise for state workers and money to hire 40 troopers.
The Senate committee’s plan puts more money toward public workers’ health insurance, in hopes of reducing an anticipated 20 percent increase for doctor and prescription co-payments. A figure on the reduction is not yet known.
The plan also provides for up to 8,200 additional 4-year-olds living in poverty to attend full-day kindergarten.
The state has funded a half-school-day for at-risk 4-year-olds since 1984. Some districts use local taxes to provide more slots and hours. But a full day paid by the state is available only in three dozen districts that sued the state over education funding 20 years ago. That full-day program was created in 2006 after a court required the state to do more in the early years to help children overcome the effects of poverty. It’s been considered a pilot program ever since.
This could be the year lawmakers approve extending access statewide.
The $22 million in the Senate plan would expand the full-day program to non-plaintiff districts where more than 75 percent of students qualify for free- and reduced-price meals. That first of a multi-year phase-in would pick up 17 districts with poverty rates up to 94.5 percent, leaving 30 districts still without the state-paid program.
The Republicans’ Medicaid initiative puts a total of $90 million – $48 million of that from state taxes – into programs designed to increase access to health care in rural areas.
It would steer people away from hospital emergency rooms, where care is expensive, to primary care in free or low-cost health clinics. Reform efforts include giving incentives to hospitals and doctors’ offices for innovative, cost-cutting programs, reimbursing rural hospitals 100 percent of their costs for treating patients without health care, and expanding access to specialists in rural areas.
The programs are largely funded through Medicaid savings realized over the past year.
Democratic senators blasted Medicaid director Tony Keck this week for opposing the federal law’s Medicaid expansion. Sen. Darrell Jackson, D-Columbia, said it made no sense to deny coverage to more than 200,000 people, especially while the federal government is picking up the tab.
Jackson drew a numbers comparison to the 10,000 uninsured, frequent ER visitors Keck estimates one of the initiatives will focus on.
Keck said his Medicaid reform efforts are not to be considered an alternative for the federal law’s expansion and contends insurance doesn’t necessarily result in better health.
“Just giving someone a Medicaid card doesn’t do it,” Keck said. “It’s a strategy to ID the people with the greatest needs, to give them money to treat these people and improve their health. Thinking outside the walls of health care providers is the solution.”