Proposed in 2014 Legislative Session
Creating Health Enterprise Zones (Filed 4/02/2014)
H.5026 would allow the Director of the Department of Health and Environmental Control (DHEC) to designate select areas in the state as “health enterprise zones”. Medical practitioners in health enterprise zones would be eligible for income tax credits, and loan repayment assistance. Non-profits and local government agencies who apply for an area to qualify as a health enterprise zone would be eligible to receive grants from DHEC.
Evidently the state believes the market is completely incapable of determining the need or demand for medical services and facilities. The state already prohibits the creation of new healthcare facilities in select locations under the Certificate of Need law, and now it wants to encourage the creation of health care facilities in other areas. Markets respond to demand with products and services, the sooner legislators realize this, the better off healthcare consumers will be.
New Anti-Commandeering Bills (Filed 3/26/14)
Since Senator Tom Davis’ (R- Beaufort) amendments to H.3101 (the anti-Obamacare bill) were ruled not germane, and H.3101 was voted down in the Senate, two new bills have been introduced modeled on some of Senator Davis’ former amendments.
S.1164 sponsored by Senator Davis himself is near identical to the first H.3101 amendment introduced by the Senator earlier this session. Clarifying language was added, and the critical budget process for ACA funds remains in the bill.
In the house Representative Bill Chumley (R- Spartanburg) has introduced a companion bill, H.4979. This bill however omits the most significant part of Davis’ amendment, the ACA budget process language.
Another Health Insurance Mandate (Filed 3/27/14)
H.4996 would require that health insurance offered in South Carolina cover amino acid-based elemental formulas used to treat food protein allergies and other digestive disorders. What’s offered in a health insurance plan should be left up to the insurer, and consumers should be free to purchase a plan that has the coverage they want and omits the coverage they don’t. While this free market interaction is obviously being disturbed on the federal level, there is no need for the state to further pile on. South Carolina already has 30 different coverage mandates that help to drive up the price of plans offered by large insurance companies. The mandates also keep smaller insurers from entering the market as they can’t afford to offer plans that cover all the mandated conditions. South Carolina should be seeking to remove insurance mandates not increase them.
Forcing People into Government-Sponsored Wellness Programs and Expanding Medicaid per Obamacare (Filed 2/20/14)
Perhaps the most peculiar bill we’ve seen during this session, H.4752 would require persons with “poor health behaviors” such as smoking or excessive body mass indexes to participate in wellness programs sponsored by the Department of Health and Environmental Control. If no improvement in health behaviors is made after one year, an insured person is required to participate in the cost of the premium not to exceed.05 percent of annual income. As worded, this first section of the bill seems to imply that every South Carolinian is insured and that the insured don’t already pay premiums. At the very least, this part of the bill is a severe intrusion on liberty by actually forcing people with “poor health behaviors”—which is nowhere defined and thus can be interpreted by DHEC as it pleases— to participate in government-sponsored wellness programs.
The next two sections of the bill, while oddly worded, seem to attempt to put South Carolina in the state health care exchange and expand Medicaid to those making 138 percent of the poverty line per Obamacare. South Carolina Dept. of Health and Human Services (SCDHHS) would be required to submit a waiver to the federal government requesting the establishment of a market where those making between 100-138 percent of the federal poverty line could purchase insurance coverage (which is odd, because these people can still purchase insurance). Lastly, the bill explicitly requires SCDHHS to establish relationships with qualified health plans to provide access utilizing federal funds provided by Obamacare.
Establishing the Medical Cannabis Therapeutic Treatment Research Program (Filed 2/19/14)
S.1035 would amend a program already in the state code but never utilized, the Controlled Substances Therapeutic Research Act, to make it more specific to medical cannabis therapeutic treatment research. The program would be put under the Department of Health and Environmental Control (DHEC). The bill specifies who would be eligible to participate in the program, the instances in which medical cannabis can be administered, and the reporting requirements by academic medical centers that supervise or administer these treatments. Moreover, the bill would provide criminal and civil immunity from state actions or suits arising from the proper implementation of the program, and require the state to defend state employees who carry out the provisions of this bill.
In giving an explanation of the bill, Tom Davis (the bill’s sponsor) said this bill was prompted by one of his constituents telling him the situation of a 6-year-old epileptic child in Charleston who has, at times, over 100 seizures in an hour. A drug that her doctor’s believe might help, cannabidiol—a non-psychoactive chemical in cannabis, is currently illegal in South Carolina but would be legal if this bill were to pass. There is no rational argument why this girl and countless others in similar situations shouldn’t have access to medical treatment that could benefit their health. South Carolina has too many state-imposed barriers to healthcare freedom as it is, so there’s no reason to maintain an unnecessary restriction.
Air Ambulance Permit and Health Insurance Mandate to Cover Air Transportation (Filed 1/15/14)
S.936 would require the owner of an air ambulance to obtain a permit from the Department of Health and Human Services to operate the aircraft as an air ambulance. Moreover, the bill mandates that health insurance providers must provide coverage for air ambulance transportation to a hospital or medical facility when air transport is deemed necessary by a physician. More regulation and licensing requirements create barriers to entry into provision of services creating higher costs for the provider resulting in higher costs for the consumer. And this is exactly the kind of intervention in health insurance practices – requiring all health insurance plans to cover certain services – that is driving up the cost of health care for everyone. Insurers should be free to determine what services their plans cover and consumers should be free to choose among these plans.
Unfortunately, while many lawmakers are vocal in opposition to the regulations and mandates imposed by Obamacare, lawmakers instead propose even more state-created mandates while making little to no effort to eliminate mandates the state imposes on itself already. And there has certainly been no effort to stop taking the federal money that triggers Obamacare mandates.
Allowing out of state insurers to offer health insurance in South Carolina (Pre-filed 12/17/13)
S.886 would allow the Department of Insurance to authorize out-of-state insurers to offer health insurance plans in South Carolina. These plans would not be subject to the rules and regulations for health insurance in South Carolina but would continue to be subject to the regulations from the insurer’s home state. While far from a be all and end all fix to the state’s healthcare problems (more on that here), this reform would inject some much needed competition into the insurance market and thereby help to drive down costs.
Refunding the Certificate of Need Program (Pre-filed 12/10/13)
S.845 would refund the state’s Certificate of Need program (CON), which was vetoed by Governor Haley in the last legislative session. The CON program is a program in which people in the health care industry must get permission from government bureaucrats in order to build health care facilities, expand existing ones, purchase certain medical equipment or even add a certain number of beds. The CON program is another unnecessary government intrusion on our state’s health care system, and as we explain here, has done nothing to significantly make health care cheaper or more effective.
State Funding for Dental Care (Pre-filed 12/10/13)
H.4411 would create the Dentally Indigent Children Preventative Dental Care Assistance Program in the Department of Health and Human Services to provide dental care to children under 18 whose family’s gross income and size falls at or below the federal Community Service Administration guidelines. The bill further specifies that the program is intended to provide payments to dentists who do not accept Medicaid patients since some low income families are already able to receive dental care using Medicaid. It is not the state’s job to provide for every possible want and need of the populace. To the extent that the state tries to do so it worsens its own finances while destroying the ability of civil society to meet these needs. The provision of Dental care for low-income families should left to existing social programs and private charity.
Proposed in 2013 Legislative Session
“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.
Health Care
Proposed in 2014 Legislative Session
Creating Health Enterprise Zones (Filed 4/02/2014)
H.5026 would allow the Director of the Department of Health and Environmental Control (DHEC) to designate select areas in the state as “health enterprise zones”. Medical practitioners in health enterprise zones would be eligible for income tax credits, and loan repayment assistance. Non-profits and local government agencies who apply for an area to qualify as a health enterprise zone would be eligible to receive grants from DHEC.
Evidently the state believes the market is completely incapable of determining the need or demand for medical services and facilities. The state already prohibits the creation of new healthcare facilities in select locations under the Certificate of Need law, and now it wants to encourage the creation of health care facilities in other areas. Markets respond to demand with products and services, the sooner legislators realize this, the better off healthcare consumers will be.
New Anti-Commandeering Bills (Filed 3/26/14)
Since Senator Tom Davis’ (R- Beaufort) amendments to H.3101 (the anti-Obamacare bill) were ruled not germane, and H.3101 was voted down in the Senate, two new bills have been introduced modeled on some of Senator Davis’ former amendments.
S.1164 sponsored by Senator Davis himself is near identical to the first H.3101 amendment introduced by the Senator earlier this session. Clarifying language was added, and the critical budget process for ACA funds remains in the bill.
In the house Representative Bill Chumley (R- Spartanburg) has introduced a companion bill, H.4979. This bill however omits the most significant part of Davis’ amendment, the ACA budget process language.
Another Health Insurance Mandate (Filed 3/27/14)
H.4996 would require that health insurance offered in South Carolina cover amino acid-based elemental formulas used to treat food protein allergies and other digestive disorders. What’s offered in a health insurance plan should be left up to the insurer, and consumers should be free to purchase a plan that has the coverage they want and omits the coverage they don’t. While this free market interaction is obviously being disturbed on the federal level, there is no need for the state to further pile on. South Carolina already has 30 different coverage mandates that help to drive up the price of plans offered by large insurance companies. The mandates also keep smaller insurers from entering the market as they can’t afford to offer plans that cover all the mandated conditions. South Carolina should be seeking to remove insurance mandates not increase them.
Forcing People into Government-Sponsored Wellness Programs and Expanding Medicaid per Obamacare (Filed 2/20/14)
Perhaps the most peculiar bill we’ve seen during this session, H.4752 would require persons with “poor health behaviors” such as smoking or excessive body mass indexes to participate in wellness programs sponsored by the Department of Health and Environmental Control. If no improvement in health behaviors is made after one year, an insured person is required to participate in the cost of the premium not to exceed.05 percent of annual income. As worded, this first section of the bill seems to imply that every South Carolinian is insured and that the insured don’t already pay premiums. At the very least, this part of the bill is a severe intrusion on liberty by actually forcing people with “poor health behaviors”—which is nowhere defined and thus can be interpreted by DHEC as it pleases— to participate in government-sponsored wellness programs.
The next two sections of the bill, while oddly worded, seem to attempt to put South Carolina in the state health care exchange and expand Medicaid to those making 138 percent of the poverty line per Obamacare. South Carolina Dept. of Health and Human Services (SCDHHS) would be required to submit a waiver to the federal government requesting the establishment of a market where those making between 100-138 percent of the federal poverty line could purchase insurance coverage (which is odd, because these people can still purchase insurance). Lastly, the bill explicitly requires SCDHHS to establish relationships with qualified health plans to provide access utilizing federal funds provided by Obamacare.
Establishing the Medical Cannabis Therapeutic Treatment Research Program (Filed 2/19/14)
S.1035 would amend a program already in the state code but never utilized, the Controlled Substances Therapeutic Research Act, to make it more specific to medical cannabis therapeutic treatment research. The program would be put under the Department of Health and Environmental Control (DHEC). The bill specifies who would be eligible to participate in the program, the instances in which medical cannabis can be administered, and the reporting requirements by academic medical centers that supervise or administer these treatments. Moreover, the bill would provide criminal and civil immunity from state actions or suits arising from the proper implementation of the program, and require the state to defend state employees who carry out the provisions of this bill.
In giving an explanation of the bill, Tom Davis (the bill’s sponsor) said this bill was prompted by one of his constituents telling him the situation of a 6-year-old epileptic child in Charleston who has, at times, over 100 seizures in an hour. A drug that her doctor’s believe might help, cannabidiol—a non-psychoactive chemical in cannabis, is currently illegal in South Carolina but would be legal if this bill were to pass. There is no rational argument why this girl and countless others in similar situations shouldn’t have access to medical treatment that could benefit their health. South Carolina has too many state-imposed barriers to healthcare freedom as it is, so there’s no reason to maintain an unnecessary restriction.
Air Ambulance Permit and Health Insurance Mandate to Cover Air Transportation (Filed 1/15/14)
S.936 would require the owner of an air ambulance to obtain a permit from the Department of Health and Human Services to operate the aircraft as an air ambulance. Moreover, the bill mandates that health insurance providers must provide coverage for air ambulance transportation to a hospital or medical facility when air transport is deemed necessary by a physician. More regulation and licensing requirements create barriers to entry into provision of services creating higher costs for the provider resulting in higher costs for the consumer. And this is exactly the kind of intervention in health insurance practices – requiring all health insurance plans to cover certain services – that is driving up the cost of health care for everyone. Insurers should be free to determine what services their plans cover and consumers should be free to choose among these plans.
Unfortunately, while many lawmakers are vocal in opposition to the regulations and mandates imposed by Obamacare, lawmakers instead propose even more state-created mandates while making little to no effort to eliminate mandates the state imposes on itself already. And there has certainly been no effort to stop taking the federal money that triggers Obamacare mandates.
Allowing out of state insurers to offer health insurance in South Carolina (Pre-filed 12/17/13)
S.886 would allow the Department of Insurance to authorize out-of-state insurers to offer health insurance plans in South Carolina. These plans would not be subject to the rules and regulations for health insurance in South Carolina but would continue to be subject to the regulations from the insurer’s home state. While far from a be all and end all fix to the state’s healthcare problems (more on that here), this reform would inject some much needed competition into the insurance market and thereby help to drive down costs.
Refunding the Certificate of Need Program (Pre-filed 12/10/13)
S.845 would refund the state’s Certificate of Need program (CON), which was vetoed by Governor Haley in the last legislative session. The CON program is a program in which people in the health care industry must get permission from government bureaucrats in order to build health care facilities, expand existing ones, purchase certain medical equipment or even add a certain number of beds. The CON program is another unnecessary government intrusion on our state’s health care system, and as we explain here, has done nothing to significantly make health care cheaper or more effective.
State Funding for Dental Care (Pre-filed 12/10/13)
H.4411 would create the Dentally Indigent Children Preventative Dental Care Assistance Program in the Department of Health and Human Services to provide dental care to children under 18 whose family’s gross income and size falls at or below the federal Community Service Administration guidelines. The bill further specifies that the program is intended to provide payments to dentists who do not accept Medicaid patients since some low income families are already able to receive dental care using Medicaid. It is not the state’s job to provide for every possible want and need of the populace. To the extent that the state tries to do so it worsens its own finances while destroying the ability of civil society to meet these needs. The provision of Dental care for low-income families should left to existing social programs and private charity.
Proposed in 2013 Legislative Session
“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.