Expanding healthcare to more childen....finally!

Congratulation to South Carolina Governor Nikki Haley and state Health and Human Services Director Tony Keck.  Their proposal to add an additional $29 million in the Medicaid budget for children’s healthcare appears to be a done deal both in the House and Senate.  This is a dramatic turnaround from the Mark Sanford administration.

Back in 2007 the South Carolina Small Business Chamber, S.C. Appleseed Legal Justice Center, S.C. Fair Share and AARP-SC were fighting to increase the cigarette tax in an effort to generate funding for a program to help make health insurance more affordable for small businesses and to expand the number of children eligible for Medicaid from those in families of  up to 150% of poverty to up to 200% of poverty.  The latter proposal survived and the General Assembly put about $29 million in the budget to provide healthcare services for an additional 70,000 to 100,000 children.

Governor Sanford then vetoed that part of the budget but we were successful in having that veto overridden.  The story should have ended there…but it didn’t.

The Sanford administration and his HHS director actively worked against adding these children to the Medicaid program by refusing obvious measure to let parents know about the program and throwing every roadblock they could in front of parents and organizations who tried to have the newly eligible children enrolled in the program.  Who knows where the millions set aside for the program went but it certainly wasn’t used as intended by the Legislature.

For 5 years these children went without the Medicaid for which by state law they were legally eligible. For 5 years the uncompensated healthcare these children did receive helped push insurance premiums up on individuals and small businesses.  For 5 years the working parents of these children were less productive on the job because of sick children whose illnesses could have been preventive with proper healthcare.  All of this because Governor Sanford and his Director of HHS knew better that the General Assembly and caring more about shrinking government instead of the health of our needy children and health insurance costs for the rest of us.

But while Governor Haley, Tony Keck and the Legislature appear to be all on board with funding and implementing this Medicaid expansion, they should drop their rhetoric that they are doing it because of the new federal health care law, the Affordable Care Act. 

There was no “ObamaCare” back in 2007.  This Medicaid expansion program for children was passed by a Republican House and Senate.  It is the law.  State officials need to stop blaming President Obama for a worthwhile healthcare program that we worked for and our South Carolina Legislature passed 5 years ago. 

"Good" morning

We made some good progress in the SC Legislature yesterday morning. 

A Senate subcommittee carried over a regulation to give the state’s Workers’ Compensation Commission a free hand at changing the methodology used to determine compensation for specific medical providers.   Two of the three Senators appeared to be leaning against the proposed regulatory change.  The South Carolina Small Business Chamber of Commerce (SCSBCC) opposes this change because the inevitable result will be certain well-heeled medical providers will use their influence to be paid more for services.  Workers’ compensation insurance premiums would then have to be raised.  We believe that the Legislature should maintain oversight of the current scientifically-based methodology where all medical providers are treated the same regardless of their deep pockets.  (See story below)

About 50 independent auto glass installers joined the SCSBCC in a press conference (see pic from yesterday’s blog below) in support of a House Bill to restrict an unfair trade practice used by Safelite Corporation to steer business in its direction.  Safelite, a foreign-owned multinational corporation, operates call-centers for about 150 auto insurance companies taking customer calls that include questions about replacing damaged auto glass.  The SC Auto Glass Installers Association with over 300 members correctly feels that Safelite should not be able to use its customer call centers for the insurance industry to increase its auto glass business (think how you would feel if your customers had to go through your competition to get to you).  Later that morning the Senate Committee hearing the bill approved an amendment to the legislation and voted it out to the full Senate.

It was a good morning for small business, not so good for some well-financed special interests.
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WorkCompCentral
February 16, 2012

Effort to Break Ties with RBRVS Likely Dead for the Session

By Michael Whiteley, Eastern Bureau Chief

An effort by the South Carolina Workers' Compensation Commission (WCC) for the authority to adopt a fee schedule that isn't tied to Medicare's pricing system appears to be dead for the 2012 legislative session because of fears over what future commissions might do, officials confirmed on Wednesday.

A special subcommittee of the Senate Judiciary Committee met on Wednesday morning and took no action on proposed Regulation 67-1302(A), which the commission voted to send to the South Carolina Legislature for approval last September.

Under South Carolina's Administrate Procedures Act, lawmakers must approve changes to state regulations, vote them down or allow them to take effect without action.

Senate Judiciary Subcommittee Chairman Larry Martin, R-Pickens, said in an interview following the committee meeting that the regulation has no chance of approval by the full Senate in its present form, and that he had no suggestions for changing the proposed regulation.

He said the subcommittee is planning a second hearing, during which it will probably pass a resolution recommending that the proposed rule be withdrawn.

"It looks like the business community is pretty unanimously opposed to the regulation and has expressed serious concerns about what the commission may or may not do in the future," Martin said.

He said he expects the full Senate to support a proposal to order the rule be withdrawn.

The South Carolina Small Business Chamber of Commerce and the South Carolina Small Business Regulatory Review Committee opposed the rule. The groups demanded last year that the commission provide an economic impact statement and regulatory flexibility analysis before going forward with the regulation.

WCC Executive Director Gary Cannon, who testified in favor of the rules change on Wednesday, said the proposed regulation would have no impact without further action by the commission at a later date.

The current regulation sets maximum reimbursements for physicians' fees based on the Resource-Based Relative Value Scale (RBRVS) used by Medicare, plus a single South Carolina conversion factor for services provided by all types of physicians except anesthesiologists, who are paid using a different method.

The state's orthopedic surgeons, pain management doctors and neurologists have called on the commission to create multiple conversion factors or scrap the Medicare-based schedule altogether. They argue the Medicare RBRVS system tends to penalize specialists.

The proposed regulation removes the requirement that maximum allowable payments be "based on a relative value scale and conversion factor set by the commission."

Frank Knapp, president of the South Carolina Small Business Chamber of Commerce, told the panel on Wednesday that the rules change will boost workers' compensation premiums in the state. He called on lawmakers to exercise their authority to deny the rule.

The National Council on Compensation Insurance (NCCI) earlier this week submitted a proposal to increase loss costs by 7.3%. That recommendation was not based on the fee schedule, but on increasing indemnity and medical claims costs.

"This ensures that special interest medical providers are not exerting undue influence over the commission as to compensation that would directly benefit only them, as opposed to all providers, and add significant cost to the system," Knapp said.

The South Carolina Orthopaedic Society did not return a telephone call from WorkCompCentral, but has warned lawmakers that some orthopedic surgeons may pull out of the workers' compensation system if payments aren't increased.

Cannon said the commission has no plans to come back to lawmakers with a revised rule.

"The biggest argument I came away with today was the unknown factor," Cannon said. "While they trust the current commission with regard to the fee schedule, there is fear about what future commissions may do."

South Carolina gives lawmakers 120 legislative days to approve a state regulatory change, vote it down or allow it to take effect without action.

The regulation would take effect automatically if the House and Senate don't vote to withdraw it by May 9.

The Senate meeting announcement and a link to the proposed regulation are here.

Amazon.com’s business plan revealed

Amazon.com is scared. Scared that if it is forced to follow the laws that apply to every other small business retailer, it can’t compete. Not only here in South Carolina, but across the country.

So the business plan of the company is to force states to make exceptions to tax laws. Amazon does this by waiving promises of lots of jobs and major investment to suck in public and private economic development folks with visions of professional achievement and personal financial gain. And if there is resistance, Amazon.com and their supporters start bullying officials and opponents with their deep-pocketed attacks and misinformation campaigns.

As I (here and here) and others have been saying, the sales tax exemption for Amazon.com is an unfair competitive advantage, which will harm the small business retailers across the state that have to collect the state sales tax.

Yesterday, I spoke with the co-founder of American Independent Business Alliance, Jeff Milchen, about Amazon. He has extensive knowledge of the company's operations around the country and pointed me to the 2008 Annual Report of the company.

In that report on page 14, Amazon.com lays out why it must have an exemption to collecting state sales tax.

A successful assertion by one or more states or foreign countries that we should collect sales or other taxes on the sale of merchandise or services could result in substantial tax liabilities for past sales, decrease our ability to compete with traditional retailers, and otherwise harm our business.

Free market be damned!

Amazon.com’s business plan is based on the company receiving an unfair competitive advantage over other businesses courtesy of the state taxpayers. The company is not run by business geniuses. It’s run by thugs that blackmail states into letting them not obey the laws that all other businesses must obey.

The South Carolina Legislature and its counterparts in every state must start standing up to Amazon.com and tell the company that they won’t throw small business retailers under the bus for a few pieces of gold.