To be fair, our system already provides a dysfunctional semblance of universal health care today. Currently, care for the uninsured is generally delivered by safety net hospitals and other providers, often long after the opportunity for basic and preventive medical care has passed. The result is often the most inefficient and expensive use of medical care resources.

The plan that the Covering Carolina Collaborative is proposing is a good first step toward improving access to care while emphasizing the need for adequate insurance coverage. Providing access to insurance coverage, rather than directly paying for delayed and uncoordinated treatment, means health care would become more efficient and effective.

The Collaborative’s plan is a revenue neutral proposal that would use cigarette tax increases to provide tax credits for employers that provide health care coverage for employees who do not have health insurance and to provide premium assistance for uninsured individuals who do not have access to health care. While the plan is not a magic solution to this daunting problem, it does present some logical first steps that address real needs and concerns of individuals, business, health care providers, insurance companies, and policy makers.

The Collaborative’s Plan outlines four distinct initiatives that can be enacted individually or together, depending on resources available.

Using revenue raised from an increase in the state cigarette tax, the Collaborative recommends:

• Providing tax credits to uninsured individuals and eligible small businesses to help purchase health insurance coverage for people earning between 100 and 250 percent of the federal poverty level and
• Creating a high-risk “safety net” insurance pool for low-income, uninsured South Carolinians who are uninsurable due to pre-existing conditions. Participants would be carefully managed to help them achieve better health outcomes and use health care services efficiently.

• Fill a gaping hole in South Carolina’s Medicaid program that excludes the parents of low-income families living below the federal poverty level and unable to afford basic necessities.
• Cover uninsured children living between 200 and 250 percent of the federal poverty level. These children live in families where incomes are not sufficient to purchase health insurance.

While the Collaborative’s initial proposal does not offer a fix to all the health problems that face South Carolina, it does offer an incremental first step toward improving access to care while emphasizing the need for adequate insurance coverage.

The proposal would result in several benefits.

• Individuals would have increased access to higher quality of care through early prevention programs. This would have a positive effect on South Carolina’s overall health status, on the cost of covering the uninsured, and on the productivity of workers.
• More small business owners could afford to purchase insurance for their employees who are not currently covered, making health coverage more accessible for many South Carolinians.