October 1, 2005
Jonathan Maze
 
South Carolina small businesses would be able to buy into the state's health insurance plan and some individuals could buy into Medicaid under proposals being pushed by advocates seeking ways to control health care costs and reduce the number of state residents without health coverage.

Those two ideas were among four proposals discussed in detail at a forum held Thursday in Charleston by the Appleseed Legal Justice Center, South Carolina Fair Share, the South Carolina Association of Non-Profit Organizations and the South Carolina Small Business Chamber of Commerce.

The plans will be discussed again at upcoming forums in Florence and Greenville.

One of the programs they discussed, in which small businesses buy health care for workers directly from clinics, has already been started by the small business chamber and the South Carolina Primary Health Care Association.

Another would establish a reinsurance program that would pay for the most costly health problems, such as heart attacks or strokes. That program, said Lynn Bailey, a health care economist, would lower costs for all health plans, making coverage more affordable. But it would also require state or federal government funding.

None of the plans would guarantee health insurance coverage to all South Carolinians who currently have none, a number estimated at anywhere from 609,000 to 850,000. Some observers say the problem ultimately will require a solution at the federal level.

Advocates, however, say dealing with the issue will take many smaller solutions rather than an all-encompassing fix.

"Unless we get national health insurance, then there are a lot of ways to put this together," said Sue Berkowitz, executive director of the legal justice center.

The group may push the Medicaid expansion proposal hardest, even though the state is proposing a broad overhaul of that program that would encourage recipients to get their Medicaid coverage through private insurers.

The expansion would increase the income limit for the Children's Health Insurance Program, allowing children to enroll if their household has an annual income up to 200 percent of the federal poverty level, currently $37,770 for a family of four. Right now, the limit is 150 percent of poverty, or $28,275.

"I think it's sinful that we have never increased Medicaid to 200 percent of poverty" for children, Berkowitz said.

Advocates believe there is growing sentiment in the General Assembly for such a move, depending on the state's financial picture.

Berkowitz said this approach would allow the state to form a plan enabling those children's parents, most of whom would not otherwise qualify for Medicaid, to buy into the government insurance program for the poor.

Depending on how the plan is structured, either the parents or their employers could pay all or part of the state's contribution for the parents' coverage. The federal government pays for most of Medicaid's costs in South Carolina.

The expansion could add 60,000 to 150,000 people to Medicaid's rolls. Less certain is whether many small businesses would buy into the state's health plan, should the state follow through on advocates' recommendation.

The insurance plan, which covers 415,000 public workers, their families and retirees, is about 10 percent cheaper than the typical health insurance plan, said John Ruoff, research director for South Carolina Fair Share.

With an annual premium of $3,780 for an employee, the state health plan still isn't cheap. Many small businesses would still struggle to pay for that. But it could help some, Ruoff said.

"You'd find some folks," Ruoff said. "But it's not for everybody."