HEALTH CARE REFORMS IN SOUTH CAROLINA

May 5, 2010: David Dunlap, CEO of the Roper St Frances Hospital, spoke about Health Care Reform. The Roper system has 5000 employees in 90 locations in 7 counties. Locally, the company includes Roper Hospital, St. Frances in West Ashley and the soon to be completed hospital in Mt. Pleasant.

While no one ever asks for the cheapest services when faced with a cancer operation, those same people will dub the hospital bill “outrageous”. The system is broken, but the opinions on how to fix it are varied. Currently, health care in SC is provided in three ways: 2.2 million people receive it by employer based plans, which came into being during WWII when employers could not raise wages so they offered health benefits instead; 1.2 million get government sponsored plans through Medicare, Medicaid, Tri-Care or VA [military retirees]; 178,000 people buy private plans in the market. This leaves 760,000 in SC with no coverage: 557,000 are working taxpayers who have no job benefits and cannot afford plans, 357,000 people at the poverty level and the remainder who are poor single folks without children who are not eligible for anything.

The final group are covered by the EMTALA act of 1986 by the Federal government which forbids hospitals to deny medical services to those in need. In the last year SC hospitals spent 1 billion dollars on those people who paid nothing for their care. This cost is simply passed on to the bills of those who do pay. In 1999 the premiums for those with work related plans cost about $1500, with the employer share being $4200. In 2009 the employee share had gone to $3500 with the employer now paying $9800 per policy. This astronomical escalation of costs in simply not sustainable. The system as we know it, though medically superior, is broken.

This brings us to the new Federal Health Care Law of 2010. First David discussed the myths, which are false: there will be no choice in providers, there will be death panels, illegal immigrants will get free health care, there will be federal funds for abortion, health care will be rationed, according to Mr. Dunlap the above statements are simply not correct. Here are the facts:
coverage will not be denied due to pre-existing conditions; children can stay on parents’ policy until age 26; no higher premiums based upon gender or past medical history; no annual or lifetime limits to coverage; ability to shop among private carriers for policies [no public option]; there is an individual mandate, i.e. all must participate and not just wait until sick to start paying for medical costs; tax credits for employers with small businesses; state’s share of Medicaid paid for by the Federal government starting in 2014, with a declining assistance after 2016. There are other changes associated with the new plan for employers, physicians and patients. Employers will pay less for their share of an employees coverage, hospitals should have less debt, doctors will be paid for performance not volume of tests, see an increase in volume, and receive less compensation on specialty care. Patients and tax payers should see an increase in the populations coverage and perhaps a tax increase down the road.

Mr. Dunlap’s predictions – There will be continuing evolving changes. Many people will still delay getting medical care when they need it. Mental Health care is still not receiving improvements in coverage. Doctors may receive less reimbursement per patient. Intermediate medical service personnel such as nurse practitioners and physicians assistants will increase in number.

Reported by Fred Sales, Keyway Committee