Send your feedback:
feedback@statehousereport.com

ISSUE 13.16
Apr. 18, 2014

RECENT ISSUES:
4/11 | 4/04 | 3/28 | 3/21

Index

News :
The high cost of saying no
Photo :
Rocking horse, Williamsburg County, S.C.
Legislative Agenda :
More work on budget, voting
Radar Screen :
Health reasons?
Commentary :
United Ways help South Carolina in a million ways
Spotlight :
Electric Cooperatives of South Carolina
Feedback :
Rant. Rave. Drop us a line.
Scorecard :
Three up, three down
Megaphone :
Just saying no
Tally Sheet :
Not much to report
Encyclopedia :
Robert E. Marvin

© 2002 - 2014, Statehouse Report LLC. All Rights Reserved. South Carolina Statehouse Report is published weekly.

News tips or calendar info?
E-mail
the editor.

Phone: 843.670.3996

Send
General e-mail

Credits.

UNDERWRITERS

SEARCH THE ARCHIVES

powered by

NUMBER OF THE WEEK

5.5

That’s the state’s new monthly unemployment rate, according to the state Department of Employment and Workforce today. It’s a drop of 0.2 percent from February and the lowest since March 2008. “South Carolina has seen 10 consecutive months of a declining unemployment rate. The state’s economy is on the right track,” said DEW Executive Director Cheryl M. Stanton. More.

MEGAPHONE

Just saying no

“If I thought that my resignation would save the life of even one child, the governor would have my resignation.  So I respectfully decline to resign.”

-- DSS Director Lillian Koller to state senators questioning her about the agency's performance.  More.

TALLY SHEET

Not much to report

With the S.C. House on furlough this week, the only new bills introduced came from state senators. Most were congratulatory or resolutions to memorialize people.

The only new bill of note was S. 1230 (Bennett), which would change state law to make it easier for brewpubs to be opened, particularly by non-residents.

ENCYCLOPEDIA

Robert E. Marvin

Landscape architect Robert E. Marvin was born in Colleton County on February 10, 1920, the son of W. R. Marvin and Alta E. Marvin. The grandson of a rice plantation farmer, he was raised on the 15,000-acre Bonnie Doone Plantation, where his father was overseer.


Marvin

As a child, Marvin explored the Lowcountry marshlands and forests, developing an appreciation for the land and the natural environment. After observing the work of the New York landscape architects Innocenti and Webel on the plantation gardens, Marvin pursued a degree in horticulture at Clemson College. Following graduation in 1941, he served as a captain in the U.S. Army during World War II. He returned to study landscape architecture in the graduate program at the University of Georgia (both of his alma maters would later honor him with distinguished alumni awards). He married Anna Lou Carrington in 1947, and they had two children.

In 1947 Marvin established a private practice in landscape architecture in the town of Walterboro, the county seat of his native Colleton County but far from urbanized areas where most landscape architects tended to congregate. Early in his career he developed a guiding philosophy, "to create and design an environment in which each individual can grow and develop to be a full human being as God intended him to be." Despite the scarcity of work for a landscape architect in Walterboro, Marvin, supported by Anna Lou, set his standards high, determining that he would not be involved in a project without control over "everything outside the walls of the building." Sensitivity to the natural environment was essential to his work. "We need to knock the walls down and let nature in again," he stated. "[M]an needs to get out of his box that technology has created. He needs to wrap his arms around nature."

Because he structured his practice to be responsive to the natural environment of his native Southeast, Marvin focused his energy on regional projects. Some of his notable projects within South Carolina include Harbor Town at Sea Pines Plantation, Hilton Head Island (1969); Henry C. Chambers Park, Beaufort (1976); and the Governor's Mansion and Finlay Park in Columbia.

Marvin was noted for his sensitive design responses to the fragile Lowcountry natural environment in which he worked. Uncompromising in his approach to his work, he influenced the next generation of landscape architects profoundly. Marvin was honored with numerous national, regional, and local awards, including induction into the Fellows of the American Society of Landscape Architects, the South Carolina Order of the Palmetto, and the South Carolina Hall of Fame. Records of his professional work and awards have been selected for inclusion in the South Caroliniana Library. Marvin was one of the first landscape architects in South Carolina, and his career spanned six decades. He died on June 25, 2001, and was buried in Live Oak Cemetery in Walterboro.

-- Excerpted from the entry by Sarah Georgia Harrison. To read more about this or 2,000 other entries about South Carolina, check out The South Carolina Encyclopedia by USC Press. (Information used by permission.)

PALMETTO PRIORITIES

Palmetto Priorities Statehouse Report encourages state leaders to develop and implement Palmetto Priorities involving several issues to make the state better a better place. Click the link to learn more about our suggestions for bipartisan policy objectives.

Here is a summary of our Palmetto Priorities:

CORRECTIONS: Reduce the prison population by 25 percent by 2020.

EDUCATION: Cut the state's dropout rate in half by 2020.

ELECTIONS: Increase voter registration to 75 percent by 2015.

ENVIRONMENT: Adopt a state energy policy that requires energy producers to generate 20 percent of energy from renewable sources by 2020.

ETHICS: Overhaul state ethics laws.

HEALTH CARE: Ensure affordable and accessible health care.

JOBS: Develop a Cabinet-level post to add, retain 10,000 small business jobs per year.

POLITICS: Have a vigorous two- or multi-party political system of governance.

ROADS: Strengthen all bridges and upgrade state roads by 2015.

SAFETY: Cut the state's violent crime rate by one-third by 2016.

TAX REFORM: Remove outdated special interest sales tax exemptions as part of an overall reform of the state's tax structure to be completed by 2014.

SUBSCRIBE FOR FREE

Subscriptions to Statehouse Report are now free. Click here to subscribe.

YOUR COMMENTARY SOUGHT

Every week in our new My Turn section, we seek guest commentaries on issues of public and policy importance to South Carolina. If you're interested, click here to learn more.

OPPORTUNITY

Become an underwriter

Statehouse Report is an underwriter-supported legislative forecast with new added features that provide more information about what’s going to happen at the SC General Assembly and in state government.

Organizations and companies that underwrite the publication receive a host of exciting benefits through branding, information spotlights and more.

To learn more about our exciting transformation and how your organization or business can benefit, click here. Or give us a holler on the phone at: 843.670.3996.

Statehouse Report -- making it easier to learn more about state politics and policy.

News

The high cost of saying no

Rejecting Medicaid expansion dollars will hurt, experts say

By Andy Brack, editor and publisher

APRIL 18, 2014 -- Up to eight rural hospitals across the Palmetto State are threatened with closure or outside takeover because the state is not accepting billions of federal money to expand Medicaid to almost 200,000 of the state’s neediest, according to health policy experts.

The head of the state agency that runs Medicaid, however, disagrees.

Experts say rural hospitals that face possible closure or loss of local control due to purchases by outsiders are in Abbeville, Allendale, Barnwell, Dillon, Edgefield, Fairfield, Florence, Hampton and Union counties. 

“There will be some hospitals that will sustain such significant financial harm that they will be purchased by for-profit health systems or out-of-state, not-for-profit systems,” said health economist Lynn Bailey.   “There will be a shift to more for-profit health care and out-of-state controlled facilities.”

But Tony Keck, head of the state Department of Health and Human Services, points to the  $20 million-a-year state Healthy Outcomes initiative. Started in October, it is paying for free care given by 19 rural hospitals across the state as a lifeline for those hospitals, most of which have bed occupancy rates of less than 30 percent.

“Since South Carolina Medicaid has agreed to cover the uncompensated care cost of rural hospitals, we are in fact paying for the full cost of care for the uninsured that use these hospitals,” Keck told Statehouse Report. “The primary reason rural hospitals are struggling are the significant decreases in volume they are experiencing that is  (a) part of a larger national trend of decreasing admissions and (b)  the result of shifting referral patterns where local residents use larger hospitals.”

Battle over Obamacare

During the 2013 legislative session, hospitals fought hard to get the General Assembly to accept billions of federal money to expand Medicaid to about 200,000 of the state’s poorest residents.  Advocates came up short. This year, they focused their efforts on fixing a state Certificate of Need program for which Gov. Nikki Haley vetoed funding last year. Earlier in the week, the S.C. Supreme Court overturned the governor’s veto.

Caught in the middle in the battle over Obamacare are two groups: the poor and hospitals.

Because of the way the complicated Affordable Care Act (ACA) is constructed, adults who are not elderly and who are at the federal poverty level or below generally don’t qualify for any federal health insurance subsidies if a state does not accept Medicaid expansion money, projected to be $11.2 billion between 2014 and 2020. Oddly, those who are above the poverty level do qualify for subsidies up to a certain point. Since October, almost 100,000 South Carolinians have signed up for Obamacare through a federal exchange, since the state hasn’t started its own due to rejecting Medicaid expansion dollars.

Also left in the lurch are hospitals. In the past, they’ve received “disproportionate share” payments from the federal government through the state for free care, such as emergency room visits by the poor for routine health needs. As a lure to encourage states to expand Medicaid, those payments are to be cut off under the presumption that the funding would be covered through new health insurance provided through Medicaid. In states that didn’t expand, the payments will to end, although the cutoff has been delayed in recent months.

For and against

 MEDICAID FACTS

In FY 2013, Medicaid assistance equaled about $4.4 billion in S.C. Another $810 went to other state agencies and $164 million went to contracts and operating, according to SCDHHS.

In the current state budget, lawmakers added $549 million to expand services to uninsured citizens in a variety of ways.
Those who believe it is in the state’s best interest to expand Medicaid point to a number of benefits associated with the Affordable Care Act:

  • Jobs. An estimated 44,000 new jobs would be created in South Carolina with a third of them outside the health care sector, according to a 2012 report by USC’s Moore School of Business for the association.

  • Return on investment. For a state that invests millions in luring big industries like BMW and Boeing, investing in the state’s poor would have a dramatic economic statewide benefit, according to the S.C. Hospital Association. Expansion would generate $3.3 billion in economic output in the state by 2020 and enough tax revenue to cover the state’s 10 percent share of expanding Medicaid, according to the Moore study.

  • Keeps tax dollars here. Proponents say if South Carolina continues to reject the money, it will be used to pay for insurance coverage in other states. Expanding Medicaid keeps tax dollars here that are already being paid by South Carolina taxpayers.

  • Higher business costs. Businesses and individuals will pay higher premiums because the state won’t get the cost savings available through Obamacare. A 2013 Jackson Hewitt study showed failure to expand Medicaid could expose employers to extra payments of $30 million to $46 million.

  • Competitiveness. Experts also say if South Carolina doesn’t accept Medicaid money and another state in the region does, then it will be more competitive to businesses interested in relocating. In other words, regardless of any tax incentives, the state’s failure to embrace Obamacare will make it less competitive and it won’t achieve the economic growth it could.

  • Increased productivity. Bailey, the economist, added the state would become more productive if more people had health insurance. She quoted from a soon-to-be-published study that says: “In addition to the economic activity associated with Medicaid expansion, about 500,000 South Carolinians would gain health insurance coverage, leading to improvement in their health status and improved labor productivity.” 

Those who don’t want to accept Medicaid expansion money offer several reasons:

  • Mandate. They don’t like the program being thrust down their throats as a kind of federal mandate. The first half of this year’s session in the state Senate found many conservative senators trying to figure out a way to nullify or bypass Obamacare.

  • We can handle it. Opponents also say the state can handle its own health insurance needs without a state-run exchange. They point to the Health Outcomes initiative as a response.

  • Federal exchange is there. They also say the federal exchange remains an option for those who want insurance. Keck has said that about half of 433,000 eligible for subsidized health insurance would sign up within three years, but that number actually might cripple hospitals because they were sicker and had expensive pre-existing conditions.

  • Match is too much. Opponents also say they worry the long-term costs to the state will be too much because there’s no guarantee of the level of the required state match, which will be 10 percent level in 2020. Expansion calls for no match until 2017, when it will phase in over four years to 10 percent, which is a third of what the match is for all other federal Medicaid funds administered by the state.

The cost of saying no

In all of the hubbub about whether to take billions of federal money to expand Medicaid, there’s been relatively little attention about the costs -- particularly to taxpayers -- of not expanding the program. In other words, if the state doesn’t take the federal money, will it incur other costs that could actually be more than the 10 percent match required by expansion?

Here are some of those costs:

  • State health plan. Almost 450,000 state residents get their health insurance through the state health plan administered by the Public Employee Benefit Authority. Because the state isn’t accepting expansion dollars, it is not expected to get the cost-savings generated through Obamacare, which means that insurance costs will continue to rise for the state. In 2015, costs are projected to rise 4.5 percent, which means that state will have to spend $83 million to meet increase costs, or $61 million if it makes those on the health plan pay more, according to PEBA figures.

  • Rural hospital spending. The Healthy Outcomes program costs $20 million in the current year and is projected to cost $25 million next year. This money likely wouldn’t have to be spent if Medicaid expansion dollars were accepted.

  • Uncompensated costs. A June 2013 RAND study in the Health Affairs journal estimates the 14 states that do not expand will have to pay $1 billion more to health care providers who treat uninsured patients. A basic extrapolation for South Carolina reveals the uncompensated costs would be about $56 million. Subtracting the rural hospital spending above leaves about $36 million in more uncompensated costs that the state would have to pay. A July 2013 study by the Urban Institute suggests a similar annual overall amount of $61.2 million averaged over 10 years in net spending to pay for indigent care.

  • Lost tax revenue.  The Moore study suggested the state would lose $45.6 million in income, sales and other tax revenue from not generating expansion’s new jobs in 2014. By 2020, that loss would grow to $105.7 million.

  • Hospital funding. Not only will disproportionate share funding be cut off in two years but hospitals in states that don’t expand Medicaid face losses of future Medicare fee-for-service rate increases, according to the Urban Institute study. In South Carolina, that translates to a whopping $6.7 billion in federal and state Medicaid payments from 2013-2022.

What’s next?

In the 2015 legislative session, Medicaid expansion advocates are expected to ramp up efforts to pressure the state legislature to accept the federal dollars to cover the South Carolina’s poorest.

But if Haley remains governor, she is not expected to change her position of being against Obamacare, despite some who wonder whether there will be a “January surprise” -- a sudden post-election deal that will find the state in a position to accept the money.

“We've said that we can and should get care to people in need, but we don't need ACA Medicaid expansion to do that,” Keck said. “We are rearranging our current financing for the uninsured ($500+ million) to cover people in need more effectively than currently and will be applying for ACA waivers which begin in 2017.

“There will be no January surprise.”

Andy Brack is editor and publisher of Statehouse Report.  He can be reached at: brack@statehousereport.com.

RECENT NEWS STORIES
Photo

Rocking horse, Williamsburg County, S.C.


This rocking horse sits in front of an old store and across the street from a refurbished Williamsburg County farmhouse in the Workman Crossroads community. Photo by Linda W. Brown.  More.
Legislative Agenda

More work on budget, voting

With the House off again next week, the state Senate will be about the only game at the Statehouse as senators continue to craft the state budget in the Finance Committee. On the floor, senators are expected to debate H. 3198, a measure to put county boards of registration and election under the State Election Commission. Also up for possible debate is statewide third reading of  a bill to make superintendent an appointed position.

Also next week, the Constitutional Laws subcommittee of the House Judiciary Committee is scheduled to meet 10 a.m. Wednesday in 516 Blatt to discuss H. 3945, an ethics reform measure that has passed the House and Senate. The bill calls for several ethics law changes involving investigations, lobbyists, public disclosure, campaigns and more with provisions that have changed significantly since it was first introduced last year.

Radar Screen

Health reasons?

GOP Gov. Nikki Haley has dug in her heels to support her head of the state Department of Social Services, Lillian Koller, who was grilled by state senators over child deaths and other happenings involving the agency. Haley even got into a much-publicized Facebook spat with a good friend, Sen. Katrina Shealy, over Koller. 

Despite Haley’s current support, it may be thin because if the governor, who doesn’t want problems with another cabinet appointment, determines Koller is a political liability, she’ll probably cut her loose.   The probable excuse: Health reasons. (Koller suffered a stroke in December, which she said kept her from testifying before senators until this week.)

Commentary

United Ways help South Carolina in a million ways

By Andy Brack, editor and publisher

APRIL 18, 2014 -- If you ever wanted proof that South Carolinians have a lot of basic, unmet needs, just look at what the state’s United Ways are doing.

This year, the United Way Association of South Carolina and two affiliates that run the free statewide 2-1-1 helpline are expected to handle a million calls from people. Yep. A million calls for help.

Through the calls, United Ways link people to help with health care needs, food, clothing and shelter -- areas that directly meet the organization’s mission, said UWASC director Tim Ervolina of Columbia.

The state association has built a powerful statewide help database that includes 17,000 services offered by more than 4,000 public, private and non-profit organizations. Through three call centers -- one in Columbia that handles 2-1-1 calls from 40 counties, one in Aiken (three counties) and one in Charleston (three counties) -- more than 80 paid staff members and volunteers field calls from people who need everything from a warm bed for the night to a meal to help with rent.

It’s a daunting task, Ervolina said, but one that allows the United Way to focus on individuals while breaking down silos of help typical at many agencies and organizations. Furthermore, the association applies private-sector entrepreneurial lessons to manage three basic kinds of help calls:
  • Medicaid. The state Department of Health and Human Services has contracted with UWASC to field calls related to people seeking Medicaid services, including those trying to get federal health. The contract pays for a staff of about 50 people to start eligibility applications and deal with specific problems related to benefits or service providers. The group handles about 30,000 calls per month. Some 94 percent of callers wait less than a minute before they speak to someone.

  • Food stamps. The state Department of Social Services also contracts with the United Ways to consolidate its calls for food assistance, including applications for the Supplemental Nutrition Assistance Program. The SNAP team handles about 50,000 calls a month. Almost 900,000 people in the Palmetto State get food stamps, but that doesn’t mean people are not still hungry, Ervolina said. “The fact that all of these people are calling us tells us that we do still have hunger.”

  • Other problems. Another smaller team takes all of the other calls -- about 10,000 a month -- ranging from homeless people needing a place to bed down for the night to a young mother dealing with domestic abuse to a parent trying to pay a power bill. 

Petra Lilly of Blythewood, a licensed master social worker who handles some of the more difficult cases, remembers one call in particular. A woman with obsessive-compulsive disorder hardly ever left her home. She called to say she was going to end her life by eating all of her pills. It was quickly clear she was very lonely, Lilly said.

She recalled how she told the woman that she wanted to provide assistance, but wouldn’t do so until the woman got her pills out of the room. The woman, who didn’t identify herself so that Lilly could send help from authorities, put away the pills and talked for 20 minutes. She promised she would call again if she felt suicidal.

“I didn’t know if she would keep her promise,” Lilly said. “When she called back, I felt really relieved,” adding that the woman called two or three times a week to deal with her loneliness. 

“Active listening is a skill that we all need to have here.”

As a state, we’re lucky our United Ways provide much-needed support to so many people who have nowhere else to go. After spending time at a call center, it’s clear more work is needed to increase capacity by state government and nonprofits to meet the basic needs of South Carolinians. 

“We have more need than availability of services,” Ervolina said.

Our high-poverty state prides itself on being charitable. But what’s so frustrating -- and challenging -- is how much more work we all have to do.

Andy Brack is editor and publisher of Statehouse ReportYou can reach Brack at: brack@statehousereport.com.

Spotlight

Electric Cooperatives of South Carolina

The public spiritedness of our underwriters allows us to bring Statehouse Report to you at no cost. This week's spotlighted underwriter is the Electric Cooperatives of South Carolina. More South Carolinians use power from electric cooperatives than from any other power source. South Carolina’s 20 independent, consumer-owned cooperatives deliver electricity in all 46 counties to more than 1.5 million citizens. As member-owned organizations, cooperatives recognize their responsibility to provide power that is affordable, reliably delivered and responsibly produced.
Feedback

Rant. Rave. Drop us a line.

We love hearing from our readers and encourage you to share your opinions.  But you've got to provide us with contact information so we can verify your letters. Letters to the editor are published weekly. We reserve the right to edit for length and clarity.We generally publish all comments about South Carolina politics or policy issues, unless they are libelous or unnecessarily inflammatory. One submission is allowed per month. Submission of a comment grants permission to us to reprint. Comments are limited to 250 words or less.  Please include your name and contact information.  Send your letters to:

Scorecard

Three up, three down

Haley. Gov. Nikki Haley got good news this week from two polls that should encourage her campaign. One showed her approval rating at just below 50 percent and another, disputed by her gubernatorial opponent, showed she had a double-digit lead. 

Fowler. Hats off to former DNC Chair and USC professor Don Fowler for 50 years of teaching about politics and communications.

Supreme Court. Congratulations on doing the right thing to finding Haley’s veto of money for the state Certificate of Need program to be wrong. More.

2016. They -- aspiring presidential candidates -- are already making their way through South Carolina. This week found Texas Sen. Ted Cruz in Charleston, where former Penn. Sen. Rick Santorum also made a stop. Already? Sheesh.

Koller. While DSS Director Lillian Koller says she won’t resign, it might be time to do just that.

Not so. State. Sen. Lee Bright is one of several Republicans who are giving away AR-15 assault rifles as campaign stunts. More.

Biking. The state is near the top in bike and pedestrian fatalities, but near the bottom in money spent to ensure safety through bike lanes and sidewalks. Misplaced priorities? More.
credits

Statehouse Report

Editor and Publisher: Andy Brack
Senior Editor: Bill Davis
Contributing Photographer: Michael Kaynard

Phone: 843.670.3996

© 2002 - 2014 , Statehouse Report LLC. Statehouse Report is published every Friday by Statehouse Report LLC, PO Box 22261, Charleston, SC 29413.
Excerpts from The South Carolina Encyclopedia are published with permission and copyrighted 2006 by the Humanities Council SC. Excerpts were edited by Walter Edgar and published by the University of South Carolina Press. Statehouse Report has partnered with USC Press to provide readers with this interesting weekly historical excerpt about the state. Republication is not allowed. For additional information about Statehouse Report, including information on underwriting, go to http://www.statehousereport.com/.