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Published: Saturday, Aug. 04, 2012 / Updated: Monday, Sep. 10, 2012 12:55 PM

The Herald: Health care severely lacking

State should engage in a spirited debate about expanding Medicaid

A recent assessment of health care in York County indicates that many residents who lack insurance aren’t getting basic or preventive care. If the state decides not to expand Medicaid, as specified in the federal Patient Protection and Affordable Care Act, it still will face the problem of thousands of uninsured residents without access to health care.

A variety of state leaders, including Gov. Nikki Haley, are adamantly opposed to expanding Medicaid coverage in the state under so-called “Obamacare.” The law originally had required states to expand Medicaid coverage to all adults who make up to 138 percent of the poverty level or risk losing all federal support for Medicaid.

But in its ruling on the overall constitutionality of the law, the U.S. Supreme Court said the federal government had overstepped its authority in attempting to coerce states to expand coverage beyond current levels. That ruling essentially allows states to go their own way.

South Carolina provides Medicaid to parents who make up to 50 percent of poverty, pregnant women who make up to 185 percent and children whose parents make up to 200 percent. Even so, nearly 900,000 South Carolinians don’t have coverage, including 109,000 children.

Many of those are young people without health care problems who are gambling that they will stay healthy. But thousands more are the indigent and working poor who can’t afford insurance.

The Duke Center for Health Policy and Inequalities Research recently conducted a survey of health care delivery in York County. The assessment was commissioned by Catawba Care, the agency that provides AIDS testing and medical care in York, Chester and Lancaster counties.

The study concluded that there the health care network in York County is “insufficient” to meet the needs of residents. But the study also found that, for a variety of reasons, many residents simply are incapable of availing themselves of primary and preventive care.

Language barriers are a problem. Undocumented residents are reluctant to seek care.

Many poor residents lack transportation to a clinic or primary care doctor. That is particularly true in downtown Rock Hill, where there are high levels of poverty and unemployment.

Among the key findings of the survey, 41 percent reported they do not have a primary doctor. Just over a third of respondents said their primary source of care was a “crisis service,” with 18 percent going to urgent care centers and 18 percent to the emergency room. And 42 percent said they needed care last year but did not go to a doctor.

Dr. Susan Reif of the Duke Center for Health Policy, who presented the results of the survey, said that the lack of health care in Rock Hill is not that unusual in the state. But, she added, the state as a whole has higher levels of heart disease, diabetes, obesity and overall mortality rates than much of the rest of the nation.

So, she said, “it is not good enough to be as good as South Carolina.”

When considering the public cost of health care in the state, these problems have to be factored in. All residents help pay for the problems that arise from inadequate preventive care, lack of access to specialty care and use of emergency rooms for primary care.

Under the Affordable Care Act, the federal government initially would cover the entire cost of expanding Medicaid enrollment. The federal match then would drop to 90 percent.

Under that arrangement, the state could add more than half a million low-income residents to its Medicaid rolls with the federal government picking up 90 percent of the cost. In all, this could provide health care to nearly a third of the state’s population.

There are, no doubt, inefficiencies and fraud within the Medicaid system and among those who provide care to Medicaid patients. Nonetheless, it is hard to see how the state, acting alone, could fully address the issue of inadequate access to health care for hundreds of thousands of needy residents.

The decision will not be up to Gov. Haley alone. It will be decided in the Legislature.

Last week, Tony Keck, South Carolina’s director of Health and Human Services, predicted the state would have an impassioned debate about how and whether it would respond to the new health care act. We think such as debate is crucial.

It also seems likely that, once the facts are clear and the misinformation corrected, the prospect of expanding Medicaid to bring needed care to residents living at or near the poverty level will begin to look more attractive to many South Carolinians.