Health Care

“Nullifying” Obamacare

H.3101 seems to have been written with the purpose of blocking implementation of Obamacare in South Carolina. Our analysis of the legislation concludes that the bill, while comparable in some respects to bills passed in Arizona, Missouri, Oklahoma, and elsewhere, could be strengthened by the addition of several provisions found here.

Expanding Medicaid Per Obamacare

H.4095 would in effect opt the state into the expansion of Medicaid under the Affordable Care Act. The bill expressly states that the Department of Health and Human Services would create a new program – the Responsible Consumer Health Care Program – funded “through Medicaid expansion funds provided pursuant to the Patient Protection and Affordable Care Act.”

Under the proposal, the state would draw down federal dollars tied to Medicaid expansion for the three years the federal government has said it would fund 100 percent of the expansion. The money would be used to set up a state-run managed care program. Individuals not currently eligible for Medicaid or Medicare, who are aged 18 or older, and whose income is 138 percent of the federal poverty level or less, can be enrolled in this new program. These individuals would receive up to $500 in qualifying preventative care services each year and would be required to contribute to a medical savings account.

The proposal makes clear that the health care program is conditioned on the drawdown of Obamacare’s Medicaid expansion dollars. In fact, if at any point during the course of the “three year” Responsible Consumer Health Care program the state doesn’t receive 100 percent of the funds from the federal government, the program will shut down.

The state would have to request a waiver from the federal government in order to take the money and not spend it in accordance with Obamacare. That’s unlikely to happen, but not out of the realm of possibility. What’s far more unlikely to happen, however, is the state ending the program after three years. In effect – if the waiver is approved – the program would open the state up to a permanent expansion of Medicaid.

It’s hard to see how this program differs substantively from a straightforward embrace of Obamacare and Medicaid expansion. It’s even harder to understand how lawmakers who trumpet the fact that they favor “nullifying” Obamacare can then sign on to a bill that implements it.

Rejecting State Healthcare Exchange
(Passed by the House)

H.3096 would mandate that the state not establish or operate an American Health Benefit Exchange as provided in the federal Affordable Care Act, popularly known as Obamacare. Creating an exchange would not give our state any real flexibility in health care. Furthermore, since South Carolina’s biggest insurer already controls 65 percent of the entire market, more regulation will only hurt other competing insurance companies, giving patients fewer choices and, therefore, higher prices. The governor has indicated that she will not pursue the option of using state resources on an exchange, but a law to solidify that decision seems wise.

Protecting SC Citizens from Obamacare Penalties

In addition to prohibiting the state from establishing a state health care exchange per the Affordable Care Act (ACA) and allowing the Attorney General to bring an action against anyone causing harm when implementing the ACA, H.3473 would provide tax credits in the amount of the federal penalties imposed for not having health insurance. South Carolinians should not be penalized for choosing not to have health insurance, and these penalties imposed by the federal government hurt the lower-middle class the most since people in this category make too much money to qualify for Medicaid, but don’t make enough money to pay for the ever-increasing health insurance costs that ACA has helped perpetuate. As long as the costs of these tax credits are offset by cuts in government waste elsewhere, (and trust us, the waste is plentiful) this bill would go a long way toward protecting South Carolinians from the harmful provisions of Obamacare. However, further steps would also need to be made, which can be found here.

Prohibiting Medicaid Expansion under the Affordable Care Act

H.3355 would prohibit the South Carolina Department of Health and Human Services from implementing or otherwise participating in expansion of the state’s Medicaid program under the Affordable Care Act. As we have written before, while the federal dollars that come with Medicaid Expansion may be tempting to some, the benefits of expansion are questionable and South Carolina will be hard pressed to come up with its required share of spending for the program. This bill represents an important attempt to keep state spending in check.

Loosening Employer HMO Regulations

H.3818 would remove a requirement that employers with over 50 employees who provide health coverage through a health maintenance organization (HMO) also provide a point of service option (POS). Requiring companies offer coverage from a larger selection of programs pushes up employer business costs, and part of this increase is undoubtedly pushed on to employees. Ideally, individuals should purchase insurance independent of their employer. Absent this, employers should be able to offer the insurance coverage they deem best suited for their company and its employees. This bill would move the state insurance regulations a step closer to that particular freedom of choice.

Requiring Health Insurance Plans to Cover the Cost of Hearing Aids

S.65 would require group health insurance plans in South Carolina to cover the cost of providing and replacing hearing aids for individuals under the age of 21. It’s exactly this kind of intervention — requiring all health insurance plans to cover certain conditions — that has driven up the cost of health insurance for everyone over recent decades.

Requiring Insurers Cover Telemedicine

S.290 would require that insurers in the state of South Carolina cover the cost of telemedicine services from healthcare providers. Telemedicine is defined as the delivery of health care, including diagnosis, treatment, or transfer of medical data, by means of interactive audio, video, or data communications by a consulting health care provider to a patient at a referring site. It is precisely this kind of interference in the health insurance market (requiring that every plan cover so many different treatments and methods of healthcare delivery) that has caused premiums to rise for the entire population. Insurers should be able to determine what services their plans cover and consumers should be free to choose among these plans.