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 1. What is the Covering Carolina Collaborative?
The
Collaborative is a group comprised of the South Carolina Hospital
Association, South Carolina Medical Association, the South Carolina
Chamber of Commerce, and the South Carolina Alliance of Health Plans.
These four entities have come together to help reduce the number of
uninsured individuals in the state and encourage universal coverage for
our citizens.
2. How many people are uninsured in South Carolina?
Estimates
vary widely, from 600,000 to as high as 900,000. The US Census Bureau’s
most recent estimate places the number of uninsured in South Carolina
close to 667,000 or about one in six South Carolinians.
3. What is the Federal Poverty Level?
The
Federal Poverty Level changes annually. The 2008 levels were recently
released. For a single individual, the annual income limit is $10,401
at 100% of the Federal Poverty Level while the annual income limit for
a family of three is $17,600.
The annual income limit for an
individual at 200% of the Federal Poverty Level is $20,802. For a
family of three, the annual income limit is $35,200.
2008
HHS Poverty Guideline
|
Persons in Family
or Household |
Income |
1
|
$10,400 |
2
|
$14,000
|
3
|
$17,600
|
4
|
$21,200
|
| 5 |
$24,800
|
6
|
$28,400 |
7
|
$32,000
|
8
|
$35,600
|
| For each additional person, add $3,600 |
4. How many uninsured adults in South Carolina live below 100% of the Federal Poverty Level?
According
to the US Census Bureau, American Community Survey, there are
approximately 98,000 uninsured adults whose incomes are below 100% of
the Federal Poverty Level.
 5. What about children living in poverty?
There
are almost 588,000 children in South Carolina whose family incomes are
below 250% of the Federal Poverty Level. This is almost half of the
entire population of children in the state. It is also estimated that
there are 105,391 uninsured children between the ages of 0-18 in South
Carolina. The State Children’s Health Insurance Program (SCHIP) is
currently being expanded to cover eligible children up to 200% of the
Federal Poverty Level. One of the initiative’s outlined in the
Collaborative’s proposal would provide health care coverage to eligible
uninsured children up to 250% of the Federal Poverty Level.
6. What is Covering Carolina Collaborative’s proposal to address the uninsured population in South Carolina?
Covering
Carolina Collaborative’s long-term goal is to make affordable, quality
health care available to every South Carolinian by the year 2010.
The
plan that the Collaborative is proposing is a first step toward
improving access to care while emphasizing the need for adequate health
care coverage. The proposal outlines four incremental initiatives that
would increase coverage for uninsured citizens of the state.
- Providing
refundable tax credits to uninsured individuals and small businesses
targeted at people between 100% and 250% of the Federal Poverty Level
to purchase health coverage in the private market;
- Creating a
high-risk comprehensive safety-net pool (Palmetto Health Safety Net)
for low income uninsured individuals who are otherwise uninsurable;
- Closing
existing coverage gaps by extending Medicaid coverage to parents of
low-income families living below the Federal Poverty Level.
- Providing coverage to uninsured children living between 200% and 250% of the Federal Poverty Level.
7. How many individuals will be impacted and what is the estimated costs of each of the Collaborative’s initiatives
a. The cost of this initiative is dependent upon the amount of the credit offered. To make a significant impact, we envisioned an annual credit of at
least $2,000. At this level, we estimate that between 36,000 to 50,000
individuals could receive a credit. This would result in a projected
total cost of $90 to $120 million.
b. In our proposal, we
envision funding the high risk pool for low income individuals with
residual amounts in the Health Care Trust Fund. Therefore, the cost
and number of individuals that could be served are dependent on
utilization of the tax credits. For example, if the Health Care Trust
Fund were initially funded with $140 million and only $90 million was
used to fund tax credits, then $50 million would be available to fund
the high risk pool.
c. Under initiative three, we estimated
that an additional 80,000 parents would qualify for Medicaid coverage
at an annual cost of $60 million.
d. It is estimated that 30,000 children would qualify for the fourth option at an annual cost of $45 million total dollars. If
the state were able to leverage federal Medicaid funding for this
segment of the population, the amount of state funds could be
significantly reduced to approximately $10 million annually. The
eligibility criteria for participation would need to be designed to
prevent individuals from dropping current coverage.
8. How does the Collaborative recommend funding this proposal?
There
has been considerable discussion about the possibility of increasing
the cigarette tax and using the revenue generated for health care
initiatives. The four components of the Collaborative’s proposal were
designed to be incremental initiatives that could be funded separately.
With that in mind, revenue generated from a cigarette tax increase
could be a potential funding source to provide tax credits for
uninsured individuals and small businesses to promote the purchase of
health care coverage. Funding for covering additional low-income
parents and to extend coverage for children up to 250% of the Federal
Poverty Level would be dependent upon the availability of state
appropriations.
 9. Is the Collaborative recommending a specific amount of cigarette tax increase?
While
the Collaborative members support an increase in the cigarette tax to
reduce smoking and smoking related illnesses and to generate revenue to
help cover the uninsured, the Collaborative has not taken an official
position about the specific amount of a cigarette tax increase.
However, the Collaborative strongly recommends that funds generated by
a cigarette tax increase should be put in a Health Care Trust Fund to
be used for health care initiatives.
10. Is the Collaborative’s proposal unfair to employers who have already been providing health insurance to their employees?
Equity
will almost always be an issue when implementing plans to address the
uninsured and small businesses when faced with limited funding. The
Collaborative discussed this potential issue at length and believes
that this proposal will help stabilize health insurance rates and keep
costs down for employers and workers who have health coverage but are
paying more to cover the cost of the uninsured. Tax credits will have
to be significant enough to encourage uninsured individuals to purchase
health care coverage. Funding constraints led the Collaborative to
focus only on the uninsured population.
11. There is already a high-risk pool in place. What is the thought behind the creation of another high-risk pool?The
existing high-risk pool is extremely expensive and currently covers
around 2,000 individuals. Low-income individuals do not have the
resources to participate in the existing pool. Since it has been shown
that a small percentage of beneficiaries are responsible for a large
percentage of health care costs, the Collaborative believes that
creating access to a high risk pool for low income individuals whereby
their medical care will be coordinated will not only improve health
outcomes but will be cost effective.
12. Why does the
Collaborative’s proposal require someone to be uninsured for twelve
months before taking advantage of the tax credits?
That
provision was put into the plan to keep persons who currently have
insurance from dropping coverage and applying for state-sponsored
coverage. If this requirement were not in place, it would be cost
prohibitive for to the state and would threaten the stability of
existing employer plans.
13. How will the Collaborative’s proposal help the small business health insurance problem?
The
plan provides an option that will allow businesses to receive tax
credits on a sliding scale for insurance provided to eligible employees
meeting the criteria outlined in the plan.
14. Will the Collaborative’s plan reduce insurance costs for others?
The
costs of insurance will not likely decrease in the short term; however,
as more employers provide health care coverage for their employees and
individuals purchase their own plans, the rates should stabilize and
not continue to escalate at unsustainable amounts.
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