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In a state without Medicaid expansion, uninsured South Carolinians mind the gap

February 3, 2014 at 6:21 PM EDT
After the Supreme Court ruled that states were not obligated to expand their Medicaid programs under the Affordable Care Act, South Carolina was one of the first to opt out. PBS NewsHour’s Mary Jo Brooks reports on the effects for residents who are still uninsured, plus a small alternative program designed to reach some of them.
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GWEN IFILL: Now a look at new efforts in South Carolina to provide health care for those in need, but who don’t qualify for Medicaid.

The NewsHour’s Mary Jo Brooks has our report.

MARY JO BROOKS: Sixty-year-old Walter Durst had hoped the Affordable Care Act meant he could finally get health insurance. Laid off from a retail job six years ago, he now makes less $1,000 a month working odd jobs.

WALTER DURST, South Carolina resident: Its like stepping on eggshells. You’re just afraid all the time of catching something. There are a few things that I know I need done, like a colonoscopy, that I can’t — I can’t do.

MARY JO BROOKS: But Durst isn’t getting coverage any time soon, since he falls into a gap: He can’t afford plans on the health exchange, but also isn’t eligible for Medicaid in South Carolina. Under the Affordable Care Act, Medicaid was to be expanded to include anyone under 65 who made up to 133 percent of the poverty level. That’s basically $15,000 a year for an individual.

However, the Supreme Court ruled that states could opt out. And South Carolina Governor Nikki Haley was among the first to announce that her state would do just that.

WOMAN: We’re fighting for justice and rights.

MARY JO BROOKS: It’s a decision that has stirred up political activity on both ends of the political spectrum. Activists on the left recently rallied at the state capitol, urging lawmakers to reverse the decision. They say some 250,000 people don’t have health coverage because Medicaid wasn’t expanded.

They brought forward a coffin to symbolize the lives that will be lost if people don’t have access to preventive care.

ANITRA JOHNSON, U.S. Air Force Veteran: I’m a student at South Carolina State University. I’m doing my — I’m doing my thing. But, yet, I don’t have coverage.

MARY JO BROOKS: Forty-six-year old Anitra Johnson can’t get coverage since she isn’t disabled and doesn’t have young children, the two main criteria for qualifying for Medicaid in South Carolina. An Air Force veteran who’s gone back to college, she’s currently unemployed.

ANITRA JOHNSON: Not to be able to go to the doctor and take advantage of the preventative care that they have for a woman my age is pretty bad.

MAN: We’re showing the rest of the country that South Carolina knows what is right.

MARY JO BROOKS: But just hours before Johnson rallied at the Capitol, activists from the Tea Party were on the other side of the building rallying against Medicaid expansion.

Rally organizer Jesse Granston says it’s very simple.

JESSE GRANSTON, tea party activist: Every time we take a federal dollar that is attached to the Affordable Care Act or attached to our Medicaid rolls, were giving up our sovereignty, and we’re giving up our own ability to take care of ourselves.

MARY JO BROOKS: The federal government would have paid the states’ costs for Medicaid expansion for the first three years and paid 90 percent after that. Twenty-six states so far have signed on. But South Carolina, led by a Republican governor and legislature, has stood firm in opposition.

Still, Granston worries that, long-term, lawmakers in his state may find that kind of money difficult to refuse.

JESSE GRANSTON: We understand that that’s going to be a tremendous battle to win, because when we have a legislature that has been addicted to sucking at the federal teat, if you will, for their entire life, it’s the equivalent of taking away crack cocaine from somebody that smoked it their entire life.

MARY JO BROOKS: While the political debate continues, the current Medicaid program has seen tremendous growth over the last few years, even without expanding the definition of who qualifies.

TONY KECK, South Carolina Director of Health and Human Services: I think our biggest success has been with children.

MARY JO BROOKS: Tony Keck is the state’s director of health and human services.

TONY KECK: We have invested in getting everybody who’s currently eligible but unenrolled in the system.

MARY JO BROOKS: Thanks to an aggressive outreach program, his department has enrolled 100,000 children who were previously eligible for Medicaid, but didn’t take advantage of it. That increase has earned the state a bonus of $17 million from the federal government.

Keck is happy to take that money, but he doesn’t want the state to expand Medicaid any more, since he thinks the system is flawed.

TONY KECK: My fear is, in the states where there’s Medicaid expansion that hospitals and doctors and other health care providers take the path of least resistance, which is instead of going and finding the people who need the most help, they take the healthy folks who just come on into their door, easy dollars, easy to treat. And it’s not really solving the big problems that a state like South Carolina needs to focus on.

MARY JO BROOKS: Keck has launched a pilot program that he thinks could do just that. It’s called the Healthy Outcomes Plan, and it’s really a series of 40 different experiments, each one developed by hospitals in the state to reach out to uninsured people who are chronic users of their emergency rooms.

The aim is to connect them with primary care physicians and social services, including mental health counseling and even access to food banks, all to keep people healthier.

Dr. Jamee Steen is a family practice physician with the program devised by Palmetto Hospital in Columbia.

DR. JAMEE STEEN, Palmetto Cares: Palmetto Cares really looks at more than just the physician visit. It’s, what can we get from social work? What can we get from pharmacy as well? Oftentimes, we do a tremendous amount around transportation. It sounds crazy. I’m not a bus driver. I’m not a cab, but that’s what patients need in order to get to the visits, because they walk.

So if I don’t have a provider around where they are, how am I going to get them consistently to their visits?

WOMAN: Hi. I’m here to see nurse Bridget.

MARY JO BROOKS: The primary care visits are free of charge. The hospitals are paid from a pot of money totaling nearly a half-billion dollars, mostly federal money allocated for indigent health care.

WOMAN: OK. Thank you.

BRIDGET EDWARDS, Palmetto Cares: Hey, Mrs. William. How are you?

MARY JO BROOKS: Right now, the program is small. The aim was to reach 8,500 patients in this first year. But three months into it, only about 1,500 have enrolled.

BRIDGET EDWARDS: When was your last time you saw your primary care doctor?

MARY JO BROOKS: Bridget Edwards, a nurse and care coordinator, says it’s often difficult to track these patients down and engage in a system that previously all but excluded them.

BRIDGET EDWARDS: The problem with a lot of them is, they don’t feel they have that person to connect with. They don’t have anyone that’s there to guide them and lead them and help them in managing their care. So it’s a matter of building their trust, reaching out to them.

MARY JO BROOKS: That was exactly the case of uninsured 46-year-old Tammy Moody, who suffers from hypertension and depression and frequently used the emergency room. Three months ago, she began participating in the pilot program and she says her health has already improved.

TAMMY MOODY, South Carolina resident: I’m encouraged to get up, take my meds. To be honest, they have actually gave me the will to want to live. They have given the mental ability to get up and move and help yourself, because we have given you the tools to do this.

MARY JO BROOKS: Although Moody is a big fan, she still wishes her state had expanded Medicaid, since this isn’t the same as insurance, and there’s no guarantee how long it will last.

Dr. Steen agrees, but she’s hopeful the pilot program will convince policy-makers of the need for preventive care.

DR. JAMEE STEEN: If looking at healthy outcomes programs, Palmetto Cares, is a way that they can glean some of that data, and say, wow, there really are people — they changed. They were using the E.R. 25 times. They have now they have used the E.R. once in the last six months because they’re now hooked into the system.

If that then allows the next discussion to be how can we expand services, I’m all right there, which is why I’m right here.

MARY JO BROOKS: Secretary Keck, of course, believes the program will deliver results more cheaply and effectively than Medicaid ever could.

TONY KECK: We think, with very little money, relatively speaking, to a $7 billion Medicaid budget, we can actually get that type of access to those 250,000 people, 200,000 people, so that we can identify, you’re somebody who might have a problem in the future, let’s get you connected to a health system now.

MARY JO BROOKS: While health care advocates wait to see what kind of results the program will bring, political activists in South Carolina will continue to argue it’s a matter of money, either more…

MAN: The unchecked power of Washington, D.C.

MARY JO BROOKS: … or less federal spending on people without health insurance.