Is Obamacare turning the corner?

The Washington Post

By Ezra Klein and Evan Soltas, November 26, 2013

Welcome to Wonkbook, Ezra Klein and Evan Soltas's morning policy news primer. To subscribe by e-mail, click here. Send comments, criticism, or ideas to Wonkbook at Gmail dot com. To read more by Ezra and his team, go to Wonkblog.

A spin through HealthCare.Gov this morning went smoothly. The site loaded quickly. The process progressed easily. There were no error messages or endless hangs. I didn't complete the final step of purchasing insurance but, until then, the site worked -- or at least appeared to work -- exactly as intended.

My experience isn't rare. There are increasing reports that HealthCare.Gov is working better -- perhaps much better -- for consumers than it was a few short weeks ago. "Consumer advocates say it is becoming easier for people to sign up for coverage," report Sandhya Somashekhar and Amy Goldstein in the Washington Post. "The truth is, the system is getting stronger as it recovers from its disastrous launch," writes Sam Baker in the National Journal. Applying "was no problem at all, with no delays," says Paul Krugman.

Reports from inside the health care bureaucracy are also turning towards optimism. People who knew the Web site was going to be a mess on Oct. 1st are, for the first time, beginning to think HealthCare.Gov might work. Data backs them up: By mid-November, the pace of enrollment in the federal exchanges had doubled from what it was in October.

The Obama administration is certainly acting like they believe the site has turned the corner. Somashekhar and Goldstein report that they're "moving on to the outreach phase, which had taken a back seat as they grappled with the faulty Web site. Next week, the White House will host an insurance-oriented 'youth summit' aimed at people ages 18 to 35, an age group whose participation in the health-care law will be critical to its success."

The White House had held off on this kind of outreach because they believed it would simply drive people to a useless Web site. If they're restarting the outreach, it's because they believe, rightly or wrongly, that HealthCare.Gov will be able to convert the interest into enrollments.

The worry, at this point, is that the site is working in ways that are visible but broken in ways that are harder to see. The Obama administration won't answer direct questions on the percentage of "834s" -- the forms insurers need to sign people up for the correct policies at the correct prices -- that are coming through with errors. Robert Laszewski, a health-industry consultant with deep contacts among the insurers, told the National Journal the problem is getting better, but that his clients are still seeing a five percent error rate. That's still too high.

The systems that determine whether applicants are eligible for insurance are also improving. But inside the administration there's a recognition that it was error-ridden in the first six weeks of Obamacare -- and so the question is how to handle the many people who unknowingly received an eligibility determination that can't be trusted.

Still, it's clear that HealthCare.Gov is improving -- and, at this point, it's improving reasonably quickly. It won't work perfectly by the end of November but it might well work tolerably early in December. A political system that's become overwhelmingly oriented towards pessimism on Obamacare will have to adjust as the system's technological infrastructure improves.

The next challenge for the law, as the White House knows, will be the outreach challenge of signing up enough young-and-healthy people to balance out its risk pools. That's a challenge the White House spent quite a lot of time thinking about before this IT nightmare. The question is whether they still have enough time, and enough clout, to get it right.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/26/wonkbook-is-obamacare-turning-the-corner/?print=1

This chart is amazing news for our health cost problem

The Washington Post
By Sarah Kliff, Published: November 20 at 3:55 pm

This just might be my favorite chart about health care costs as of late. And it's one that contains billions of dollars' worth of good news!

The chart, from the Council of Economic Advisers, shows the Congressional Budget Office constantly revising downward how much it thinks the federal government will need to spend on health care costs over the next decade. That's because health care costs have been growing a lot more slowly over the past few years than they typically do. You can see that below, with a breakdown of health care cost growth by source of coverage.

In private insurance, the average spending growth rate per person has slowed a lot over the last few years. In Medicare, there was no spending growth between 2010 and 2013 and, in Medicaid, per person costs actually decreased some.

All told, health care costs have been growing more slowly over the last three years than any other time period since 1965. More recently, yearly health cost growth slowed from an average rate of 3.9 percent between 2000 and 2007 to 1.3 percent between 2011 and 2013.

The big health policy parlor game for the past few years has been to ask: How much of this change is cyclical, owing to the recession, or structural, partially due to the health law's payment reforms?

The White House has long argued that the changes are structural, and it made that case again Wednesday in a briefing with reporters.

"The slowdown is indisputable," Council of Economics Advisers chairman Jason Furman said. "A very important part of that is structure, and a very important part of the structural story is the Affordable Care Act."

Most health care economists now agree, at least to some extent, with this more structural view.  Even those who argue that the current slowdown is unlikely to last, such as Harvard's Amitabh Chandra and Dartmouth's Jonathan Skinner, still expect slower health care cost growth in the next decade compared with the previous one.

And in some cases, that translates into better health care, too. This chart from the council's report shows a significant drop in preventable readmissions to hospitals (when  treatment goes wrong the first time and the patient must return to the hospital). That happened right around the time Medicare began penalizing such return trips to the hospitals.

Cost savings aside, that's great news for patients, suggesting that the quality of care hospitals are delivering is improving at the same time that spending on that care is slowing down.

Original Article

Fallout for states rejecting Medicaid expansion

By RICARDO ALONSO-ZALDIVAR

Associated Press

  

WASHINGTON (AP) -- Rejecting the Medicaid expansion in the federal health care law could have unexpected consequences for states where Republican lawmakers remain steadfastly opposed to what they scorn as "Obamacare."

It could mean exposing businesses to Internal Revenue Service penalties and leaving low-income citizens unable to afford coverage even as legal immigrants get financial aid for their premiums. For the poorest people, it could virtually guarantee they remain uninsured and dependent on the emergency room at local hospitals that already face federal cutbacks.

Concern about such consequences helped forge a deal in Arkansas last week. The Republican-controlled Legislature endorsed a plan by Democratic Gov. Mike Beebe to accept additional Medicaid money under the federal law, but use the new dollars to buy private insurance for eligible residents.

One of the main arguments for the private option was that it would help businesses avoid tax penalties.

The Obama administration hasn't signed off on the Arkansas deal, and it's unclear how many other states will use it as a model. But it reflects a pragmatic streak in American politics that's still the exception in the polarized health care debate.

"The biggest lesson out of Arkansas is not so much the exact structure of what they are doing," said Alan Weil, executive director of the nonpartisan National Academy for State Health Policy. "Part of it is just a message of creativity, that they can look at it and say, `How can we do this in a way that works for us?'"

About half the nearly 30 million uninsured people expected to gain coverage under President Barack Obama's health care overhaul would do so through Medicaid. Its expansion would cover low-income people making up to 138 percent of the federal poverty level, about $15,860 for an individual.

Middle-class people who don't have coverage at their jobs will be able to purchase private insurance in new state markets, helped by new federal tax credits. The big push to sign up the uninsured starts this fall, and coverage takes effect Jan. 1.

As originally written, the Affordable Care Act required states to accept the Medicaid expansion as a condition of staying in the program. Last summer's Supreme Court decision gave each state the right to decide. While that pleased many governors, it also created complications by opening the door to unintended consequences.

So far, 20 mostly blue states, plus the District of Columbia, have accepted the expansion.

Thirteen GOP-led states have declined. They say Medicaid already is too costly, and they don't trust Washington to keep its promise of generous funding for the expansion, which would mainly help low-income adults with no children at home.

Concerns about unintended consequences could make the most difference in 17 states still weighing options.

A look at some potential side effects:

-The Employer Glitch

States that don't expand Medicaid leave more businesses exposed to tax penalties, according to a recent study by Brian Haile, Jackson Hewitt's senior vice president for tax policy. He estimates the fines could top $1 billion a year in states refusing.

Under the law, employers with 50 or more workers that don't offer coverage face penalties if just one of their workers gets subsidized private insurance through the new state markets. But employers generally do not face fines under the law for workers who enroll in Medicaid.

In states that don't expand Medicaid, some low-income workers who would otherwise have been eligible have a fallback option. They can instead get subsidized private insurance in the law's new markets. But that would trigger a penalty for their employer.

"It highlights how complicated the Affordable Care Act is," said Haile.

-The Immigrant Quirk

Arizona Gov. Jan Brewer, a Republican, called attention this year to this politically awkward problem when she proposed that her state accept the Medicaid expansion.

Under the health law, U.S. citizens below the poverty line - $11,490 for an individual, $23,550 for a family of four - can only get coverage through the Medicaid expansion. But lawfully present immigrants who are also below the poverty level are eligible for subsidized private insurance.

Congress wrote the legislation that way to avoid controversy associated with trying to change previous laws that require legal immigrants to wait five years before they can qualify for Medicaid. Instead of dragging immigration politics into the health care debate, lawmakers devised a detour.

Before the Supreme Court ruling, it was a legislative patch.

Now it could turn into an issue in states with lots of immigrants, such as Texas and Florida, creating the perception that citizens are being disadvantaged versus immigrants.

-The Fairness Argument

Under the law, U.S. citizens below the poverty line can only get taxpayer-subsidized coverage by going into Medicaid. But other low-income people making just enough to put them over the poverty line can get subsidized private insurance through the new state markets.

An individual making $11,700 a year would be able to get a policy. But someone making $300 less would be out of luck, dependent on charity care.

"Americans have very strong feelings about fairness," said Weil.

Medicare and Medicaid chief Marilyn Tavenner, also overseeing the health overhaul, told the Senate recently that cost is a key question as the administration considers the Arkansas deal. Private insurance is more expensive than Medicaid.

But Tavenner said the Arkansas approach may be cost-effective if it reduces the number of low-income people cycling back and forth between Medicaid and private coverage, saving administrative expenses. "We are willing to look at it," she said.

---  Associated Press reporter Andrew DeMillo in Little Rock, Ark., contributed to this report.

Original Article 

Nearly 418,000 South Carolinians Will Be Eligible for New Health Insurance Premium Tax Credits in 2014

New Report Provides County-Specific Breakdown of Tax Credit Eligibility by Income, Age, Race and Ethnicity, Employment Status

Press Release: Families USA

Washington, D.C.— A report released today says that in 2014 nearly 418,000 South Carolinians will be eligible for premium tax credits that will help them pay for health coverage—a doorway to quality health care for individuals and families of all ages and of all racial and ethnic backgrounds across the state.

The report from the national health consumer organization Families USA includes county-by-county data, which reveal how many South Carolina families in different income brackets (ranging as high as $94,200 for a family of four) will soon be protected from having to spend more than a set percentage of their income for health coverage.

Under the terms of the Affordable Care Act, these premium tax credits take effect in January 2014, following an enrollment process that begins in October of this year. The tax credits will be determined on a sliding scale based on income. Those with the lowest incomes will receive the largest tax credits, ensuring that those who need it most will get the greatest financial assistance.

The tax credits will help South Carolinians purchase health insurance that meets their specific needs in the new health insurance marketplace, sometimes called the “exchange,” which is being set up in the state. The tax credits will flow directly to the health plans in which families or individuals enroll, offsetting the total cost of plan premiums.

In terms of statewide eligibility for South Carolinians, the report, “Help Is at Hand: New Health Insurance Tax Credits in South Carolina,” says:

• Nearly 418,000 South Carolinians will be eligible for new premium tax credits in 2014.
• People with annual incomes between $47,100 and $94,200 for a family of four (incomes between 200 and 400 percent of the federal poverty level), will make up about 55 percent of the South Carolinians eligible for the tax credits.
• About 63 percent of the South Carolinians who will be eligible for the premium tax credits will be white and non-Hispanic, while about a quarter (about 26 percent) of the eligible South Carolinians will be black and non-Hispanic, and about 6.5 percent of the eligible South Carolinians will be Hispanic.

The report provides the same data on eligibility for counties or county groupings, based on how data are presented by the U.S. Census Bureau, across the entire state of South Carolina. For example:

• In Charleston County, which includes the city of Charleston, approximately 32,380 South Carolinians will be eligible for the premium tax credit, and about 55 percent of those residents will be families with incomes between 200 and 400 percent of the federal poverty level. Approximately 60 percent of the eligible residents will be white, non-Hispanic, about 31 percent will be black, non-Hispanic, and about 5 percent will be Hispanic.

• In Richland County, which includes the city of Columbia, 29,080 people will be eligible, and about 57 percent of those residents will be families with incomes between 200 and 400 percent of the federal poverty level. Approximately 44 percent of the eligible residents will be white, non-Hispanic, about 43 percent will be black, non-Hispanic, and about 7 percent will be Hispanic.

• In York County, which includes Rock Hill, 19,800 South Carolinians will be eligible for the premium tax credit, and about 57 percent of those residents will be families with incomes between 200 and 400 percent of the federal poverty level. Approximately 71 percent of the eligible residents will be white, non-Hispanic, about 17 percent will be black, non-Hispanic, and about 6 percent will be Hispanic.

The report also provides specific data on the employment status and age of eligible South Carolinians, showing that an overwhelming number of those who will be eligible for tax credits will be in working families, and that young South Carolinians (ages 18-34) make up a large proportion of those who will be eligible for assistance.

“The tax credit subsidies are a game-changer: They will make health coverage affordable for huge numbers of uninsured families who would have been priced out of the health coverage and care they need,” said Ron Pollack, Executive Director of Families USA.

The full report, “Help Is at Hand: New Health Insurance Tax Credits in South Carolina,” is available online at http://familiesusa2.org/assets/pdfs/premium-tax-credits/South-Carolina.pdf

Families USA is the national organization for health care consumers. It is nonprofit and nonpartisan, and its mission is to secure high-quality, affordable health coverage and care for all Americans.

Tidal wave of lies

There are three main things holding the small businesses back in North Carolina, says Gregg Thompson the National Federation of Independent Business (NFIB) in that state.  “One is regulations, one is health care and one is taxes.”

Mr. Thompson’s comments were part of a nine-state “Stop the Tidal Wave” anti-regulations campaign recently launched by the NFIB and its new national project, Small Businesses for Sensible Regulations (created one year ago and now with an unimpressive 1,333 members).  The effort will include paid advertising and, of course, a lot of fear mongering about how we’re all going to be washed away in a tsunami of federal regulations.  Not present regulations mind you.  But future, mostly unspecified regulations.  Are you scared yet?

To buttress their argument that regulations are the number one problem for small businesses the NFIB cites a February Gallup poll as one demonstrating that “regulatory burdens are a top reason why small businesses are not hiring at pace with previous years.”

But as most polls have shown, regulations are not the reason small businesses are not hiring.  It’s the lack of demand. 

Even the Gallup poll the NFIB references says that. 76% of the small-business owners Gallop polled who were not hiring said that they do not need any additional employees and 71% said they were worried that sales won’t justify adding employees.  “Companies typically hold back on hiring when the economy is weak and when their operating environment is not providing sufficient revenues or cash flows.  This appears to be the case right now,” said Dennis Jacobe, chief economist for Gallup.

However, 48% of the business owners not hiring did say they were worried about the potential cost of healthcare and 46% were worried about new government regulations.  But these were concerns about something potentially happening in the future, worries ginned up by the NFIB’s relentless politically motivated PR campaign against the Obama Administration.  Mr. Jacobe refers to these concerns as “exacerbating an already uncertain and difficult situation.”

In other words, lack of demand is the driver of lack of new jobs, not concern about regulations and healthcare.  If it were the latter, no small businesses would be hiring but the truth is that small businesses are leading the new job creation in this country. 

When Gallup asked small-business owners why they were hiring new employees, 64% cited increased consumer or business demand and 55% said that sales and revenues justify adding more employees. 7% even cited government tax incentives as the reason (you won’t hear the NFIB talking about that). 

So while the NFIB misrepresents the Gallup poll findings, Mr. Jacobe throws cold water on the NFIB bogus claim that small-businesses owners are shaking in their boots over future new regulations.  “Right now,” he says, “economic confidence is approaching its highest levels in the last four years.  U.S. small-business owners are also about as optimistic about their business and their future hiring as they’ve been at any point during that time.” 

This is exactly what the NFIB political machine is afraid of—small business optimism.  It must be stopped.  Thus their 9-state anti-regulation campaign built on distortion and lies.

Small Business & the Next Governor

The South Carolina Small Business Chamber of Commerce (SCSBCC) today released an assessment of the three candidates running for Governor—Rep. Nikki Haley, Sen. Vincent Sheheen and Dr. Morgan Reeves. The assessment was based both on specific critical legislative votes and a questionnaire sent to each candidate on July 7, 2010. The questionnaire can be found at http://www.scsbc.org/issues.aspx?article_id=883.

While the SCSBCC does not endorse candidates for any office, it is educating the small business owners in the state as to how small business-friendly each candidate has been to date and might be in the future if elected.

“It is important that small businesses have a good understanding of how the election of the next Governor might affect them,” said Frank Knapp, Jr, president and CEO of the SCSBCC. “In 2002 we were in our infancy as an organization and thus not in a good position to evaluate Gubernatorial candidates. As a result, what many small business owners thought they were getting with Mark Sanford did not pan out.” Mr. Knapp’s blog on this issue can be read at http://www.unconflictedsc.com/2010/06/sheheen-haley-sanford-endorsement.html.

Summary and Assessment

Below are the detailed results of our questionnaire and review of critical legislative votes.

Because both Rep. Haley and Dr. Reeves failed to respond to our questionnaire, they have deprived small businesses the opportunity to compare the candidate’s positions on extremely important small business issues. Dr. Reeves, the candidate of the Green and United Citizens Parties, might receive a pass on this matter due to lack of resources. However, there is no excuse for Rep. Haley’s unresponsiveness to a questionnaire from a statewide small business advocacy organization with thousands of members that has successfully represented the interests of small business in the Legislature and in regulatory matters for over 10 years.

Sheheen @ Wateree River Sweep

Sen. Sheheen should be applauded not only for responding but also because his comments reflected an appreciation for not increasing health care costs to small business, projecting leadership in creating alternative energy jobs, and promoting comprehensive tax reform and reducing small business property taxes. Most importantly, Sen. Sheheen recognizes the importance of small business growth and development and proposes a Division of Small Business and Entrepreneurship within the Department of Commerce.

A review of critical small business votes indicates that both Rep. Haley and Sen. Sheheen have casts numerous votes in support of matters strongly favored by the SCSBCC.

However, Rep. Haley has demonstrated that she has been willing to forgo supporting small business in the case of affordable health care insurance when it was tied to a tax increase on cigarettes. Since 2006 she has voted multiple times against such legislation that was specifically targeted to help small businesses. Confusing the understanding of her votes is Rep. Haley’s apparent recent endorsement of increasing the sales tax on groceries thus indicating that she is not universally opposed to raising taxes.

One of the most important questions Rep. Haley did not respond to was our inquiry of her support for establishing a small business division within the Department of Commerce not only to give Commerce a small business development focus it has never had but also to provide assistance to local communities to help make them more small business friendly.

Sen. Sheheen strongly endorsed such an initiative. Rep. Haley’s silence causes great concern given her public statements about economic development. These statements appear to completely ignore the important role of small business and possibly demonstrate a lack of knowledge about small business.

Rep. Haley’s primary economic development campaign promise is to eliminate the corporate income tax. She no longer talks about her earlier promise to reduce small business income taxes.

Image: Haley's Facebook page

Growing our small businesses and encouraging entrepreneurship apparently are no longer an important part of Rep. Haley’s economic development plan, even though over 60% of all new jobs come from small businesses. Instead, she promises only more of the traditional, and not very successful, economic development strategy of recruiting big business.

That is the essence of her “elimination of corporate income tax” pledge. For the uniformed, and possibly this might apply to Rep. Haley, very few small businesses pay corporate income taxes because they are not C-corporations. The elimination of corporate income taxes will not help our small businesses. Instead, it would create an unlevel playing field between big and small businesses on income taxes.

In 2005, after a major legislative battle with Governor Sanford, the SCSBCC scored one of its most significant victories in having the income tax paid by small businesses reduced from 7% to 5% primarily to achieve parity with big business C-corporations.

There is an underlying problem with Rep. Haley’s unresponsiveness to the questionnaire and her campaign’s lack of courtesy in failing to even notify the SCSBCC that they would not be responding. In the past, Rep. Haley has demonstrated this same lack of respect for the SCSBCC in her refusal to meet with the SCSBCC to discuss legislation. This is the same path Mark Sanford took with the SCSBCC, refusing every request for a personal meeting.

It is possible that Governor Sanford and Rep. Haley both believed that they already had the answers to all the state’s problems and didn’t need to listen to alternative opinions. Unfortunately, we know that this gubernatorial attitude failed our state over and over during the last 8 years.

Questionnaire Response

Haley: Unfortunately, Rep. Haley did not return the questionnaire. To insure that her campaign received it, the questionnaire was hand delivered to her campaign communication director, Mr. Rob Godfrey, on July 27, 2010. The SCSBCC did not receive a response by the due date of August 2, 2010, or a request for an extension. No contact from the Haley campaign has been received by the date of this release.

Sheheen: Senator Sheheen did respond to the questionnaire but requested an extension to do so. His response was received on August 17, 2010. Senator Sheheen addressed each of the areas of interest—healthcare, energy, taxation, and economic development. Although some specific questions within these areas might not have been addressed, his answers did sufficiently address the issues to allow for analysis.

Senator Sheheen’s response can be read at http://www.scsbc.org/issues.aspx?article_id=882.

Image: Reeves' website

Reeves: Dr. Reeves called our office immediately upon receiving the questionnaire promising to provide a response. A series of e-mails were received with responses but subsequently, Dr. Reeves contacted our office again to ask us to disregard those responses that were prepared by a volunteer consultant no longer with his campaign. No further communications or response to the questionnaire was received. Consequently, we must consider Dr. Reeves not to have responded.

Critical Legislative Votes

Since 2005, Rep. Haley and Sen. Sheheen haves taken votes on certain legislation of extreme importance to South Carolina small businesses. Dr. Reeves has not served in the South Carolina Legislature and thus is not included in this analysis. Below is an explanation of these critical votes and whether the candidates supported these bills.

2005—The SCSBCC supported job tax credits for small businesses so that the hiring of as few as two new employees would qualify many of the state’s small businesses for this economic development incentive. These job tax credits had never before been available to small business. Both Rep. Haley and Sen. Sheheen supported this bill that passed both chambers.

2006—The SCSBCC was the primary business organization supporting an amendment to the state budget that would have increased the cigarette tax from 7-cents per pack to 39-cents. The additional revenue would have been used as a Medicaid match to give premium assistance for small businesses providing health insurance to employees with family incomes of up to 200% of poverty. This effort to reduce the cost of small business health insurance failed. Rep. Haley voted against the budget amendment. Because the budget amendment failed in the House, it did not come up for a vote in the Senate.

2007—The SCSBCC was the primary business organization supporting the establishment of a $1000 tax credit per new employee in a Registered Apprenticeship program. Rep. Haley supported the bill. The Senate passed the bill on a voice vote.

2007—The SCSBCC proposed reform in the state’s workers’ compensation insurance law that would require the state to regulate how much an insurance company could build into the premium for profit, taxes and other expenses. The non-regulation of this Loss Cost Multiplier component of premiums had cost businesses over $200 million in excess premiums over several years. The bill that contained this reform passed with the support of both Rep. Haley and Sen. Sheheen.

2007—The SCSBCC was a strong supporter of increasing funding of the State Child Health Insurance Program to extend Medicaid to the children in families with incomes of up to 200% of poverty. This change would help make health care more affordable and reduce health insurance costs for small businesses by helping to stop health care cost shifting from the uninsured to the insured. The Legislature passed this bill but Governor Sanford vetoed it. Both Rep. Haley and Sen. Sheheen voted to override the Governor’s veto.

2007/2008—In 2007 the SCSBCC and a growing coalition of business organizations supporting an increase in the state’s cigarette tax to provide more affordable health insurance for individuals and employees. The House passed its version of the program in 2007 with Rep. Haley voting against the bill. In 2008 the Senate passed its version of the bill calling for a 50-cent increase in the cigarette tax to be used in a non-Medicaid premium assistance program for small employers offering health insurance to workers below 200% of poverty. The state’s Medicaid program would also be expanded to parents between 50% and 100% of the poverty level. Sen. Sheheen voted for this bill. Governor Sanford vetoed the bill and Rep. Haley voted not to override. The House sustained the Governor’s veto thus no Senate vote was held.

2008—The SCSBCC first identified in 2003 the problem with excessive amounts (approximately 42%) of our state procurement dollars going out of state to purchase goods, labor and services. As the primary advocate for procurement reform that would result in more procurement dollars staying in our state to benefit our small businesses, legislation was crafted for the SCSBCC by the Budget and Control Board and introduced by Republican leadership in the Senate (Leatherman) and in the House (Harrell). The Legislature passed the Senate bill but the Governor’s veto failed to be overridden in the House. Both Rep. Haley and Sen. Sheheen voted to override the Governor’s veto.

2009—The exact same procurement reform bill passed in 2008 but stopped by a gubernatorial veto was reintroduced in the Senate by Senators Knotts and McConnell and in the House by Speaker Harrell and Rep. Mac Toole. The Senate bill was passed by the Legislature and vetoed by the Governor. Both Sen. Sheheen and Rep. Haley voted to support the successful override of the veto.

2009/2010—The SCSBCC once again joined the even greater chorus of organizations supporting an increase in the cigarette tax. In 2009 the House passed a 50-cent increase in the cigarette tax with the new revenue used for a tax credit for small businesses providing health insurance to low income employees, a tax credit for low-income individuals purchasing health insurance directly and premium assistance for those wanting to enroll in the state’s high-risk health insurance pool. Rep. Haley voted against this bill. In 2010 and in recognition of the new national health care law which created a small business health insurance tax credit program, the Senate passed a 50-cent increase in the cigarette tax with most of the funds going into a Medicaid Trust Fund to make health insurance more affordable for low-income South Carolinians. Sen. Sheheen voted for the bill. Governor Sanford’s veto of the bill was overridden with Rep. Haley voting to sustain the veto and Sen. Sheheen voting to override.