State Governments in Action

This has been a busy week in state governments.

In South Carolina, the Senate “approved a non-binding resolution that affirmed the state’s rights under the 2nd, 9th, 10th, and 14th amendments to the U.S. Constitution.”

In Idaho, “Gov. Butch Otter has announced his intention to sue if Congress passes a bill that increases the state’s Medicare commitments and requires people to buy health insurance.”

In addition, four state representatives introduced legislation that would declare Idahoans free “free from government compulsion in the selection of health insurance options.”

Also this week, the Missouri House of Representatives passed a similar measure, citing the Cornhusker Kickback and the cost to Missouri, among other concerns. Some Democrats who voted for the measure cited their pro-life concerns that federal health care reform would lead to taxpayer funding of abortion.

Two Constitutional Challenges to Health Bill

Henry McMaster, the attorney general for South Carolina, said he has the support of 14 other states’ attorneys general, as he challenges the constitutionality of the House and Senate health reform bills.

“The Constitution assigns broad spending authority to Congress, he said, but national spending may not be arbitrary and capricious.” That’s the Christian Science Monitor reporting on a press conference that McMaster held. At issue is the Cornhusker Kickback, which, McMaster said, puts a burden on his own state.

Meanwhile, Florida’s attorney general, Bill McCollum, is questioning the legality of the personal mandate that requires everyone to buy an insurance policy approved by government.

South Carolina Joins the List

South Carolina joins the list of states in which legislators have voiced their opposition to a federal takeover of health care.

Here’s a press release from the American Legislative Exchange Council, which is tracking and supporting such developments:

The American Legislative Exchange Council (ALEC), the nation’s largest individual membership association of state legislators, congratulates South Carolina State Representative Tim Scott for pre-filing a constitutional amendment to protect the right of individuals to make their own health care choices. South Carolina now becomes the 24th state where legislators have introduced, or will introduce, legislation modeled after ALEC’s Freedom of Choice in Health Care Act.“Congress should not expect the states to blindly accept a federal health care reform bill that just keeps getting longer and more complicated at every turn. We know that creating new mandates for individuals and employers will not reduce costs or increase competition, it will trample on the rights of individuals to make their own health care choices and hurt our economy,” said Iowa Representative Linda Upmeyer, minority whip, family nurse practitioner, and chair of ALEC’s Health and Human Services Task Force.

The proposed South Carolina constitutional amendment preserves the rights of individuals to pay directly for medical care—something not allowed in single-payer countries like Canada—and prohibits any individual from being penalized for not purchasing government-defined insurance. Any state attempt to require an individual to purchase health insurance—or forbid an individual from purchasing services outside of the required health care system—would be rendered unconstitutional. The measure may also cause a federalism clash if Congress passes a law with either of these provisions.

“This is not a battle that hasn’t been fought before or won before,” said Christie Herrera, health policy director for the American Legislative Exchange Council, a state legislator group coordinating the effort.

“States are allowed to give greater constitutional protection than what is provided for in the U.S. Constitution.  The U.S. Constitution provides a floor, not a ceiling, for the preservation of individual rights,” Herrera added.

Similar constitutional amendments have been filed or pre-filed in twelve states—Arizona, Florida, Indiana, Michigan, Minnesota, New Mexico, North Dakota, Ohio, Pennsylvania, South Carolina, West Virginia, and Wyoming. An additional twelve states have indicated their intent to introduce this legislation—Alabama, Alaska, Georgia, Kansas, Louisiana, Missouri, Mississippi, New Hampshire, Oklahoma, Montana, Tennessee, and Utah. Arizona’s measure, which passed the legislature in June, will be put before voters on the 2010 ballot.

Higher Costs, Lower Quality Ahead

Rather than fix the insurance market, the majority party in Congress wants to throw even more people into Medicaid. In some states, that means turning Medicaid from a program for children and the blind and disabled into one for single, childless adults.

The South Carolina Policy Council says that already Medicaid is a dominant player in the state. It pays for more than half of all births, and consumes 20 percent of the budget.

Under the first House proposal (HR 3200), the state budget would face even more demands from Medicaid, which could crowd out spending on education and other key priorities. In the last 10 years, Medicaid spending in the state has doubled, and the council projects that under HR3200, spending would more than double in the next 10. Among the results could be that patients have a hard time finding a doctor, given the low rates that Medicaid pays.

Subway at a School Near You

Something about this just doesn't seem right: The South Carolina Department of Education and Subway restaurants are teaming up an anti-childhood obesity effort.

Subway, the official fast-food restaurant of public schools?

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

South Carolina Squabbles over Government Health Care

South Carolina politicians want to expand government's involvement in health care – they just can't agree on how to do it. A proposal to raise the state's seven-cents-a-pack cigarette tax has stalled because of objections to creating a fund to subsidize health insurance premiums: 

The House-passed version of the bill now before the Senate would generate about $145 million.

Amendments adopted in the subcommittee Tuesday as it approved the bill with a 3-1 vote would use about $135 million for health care programs.

About $100 million of that would create a fund to cover 75 percent of health care policies for individuals who make up to roughly $21,600. The maximum credit would be $3,000. Employers with 25 or fewer low-income workers could get a 67 percent credit for each worker insured with the same limit.

The plan calls for the rest of the money to go into health care coverage for the people in high-risk health groups, cancer research, smoking cessation and agricultural marketing.

Senate Minority Leader John Land wants to use the money to expand Medicaid instead. As he points out, the $150 million would draw $450 million in federal funding.

I'm not enamored with insurance subsidies, but I think they are a better way to provide health care than Medicaid. But Sen. Land has a point — the feds are offering all this "free" money, so why not take it? It's another illustration into the unintended effects of the current Medicaid system. What may be a good idea may be defeated because there is a pot of federal money out there if the state expand Medicaid.

Contracting Out Gone Bad

With Medicaid, you may not be able to find a doctor, but if you have one, you may be able to get a ride to the office. That is, if the company the state has contracted with to do the job shows up.

South Carolina contracted with a firm to get Medicaid patients from A to B. (Medicaid in the transportation business? I guess so.) But there have been complaints that some companies hired by the state have not been doing a good job.

A legislator would like the state to rebid the contracts.

South Carolina Ramps Up SCHIP Notifications

Opponents of SCHIP expansion have argued that states should be required to max out enrollment in the target population before they raise the income limits.

The Post and Courier says that the state of South Carolina will be spending more to market its version of SCHIP, S.C. Healthy Connection Kids. Of the 130,000 or so children without insurance in the state, only 12,000 have signed up.

Federal Stimulus Money: Government Health Care by Stealth

Mark Sanford, governor of South Carolina, has in the past expressed his dissatisfaction with the stings attached to federal handouts. It looks like his critique has been valid–and that the federal bailouts are yet another step in the march towards a government takeover of health care, directly or otherwise.

The Obama Administration has said that South Carolina can't get some of the stimulus money because it recently made some cuts to the program as a part of the response to a budget deficit.

From a long-term perspective, South Carolina is on to something. If it uses one-time money to expand Medicaid, it gets some help from the people manning the printing presses in the basement of the Bureau of Engraving.

But then it will have to reverse recent cuts–and maintain that reversal, for years to come, putting greater fiscal pressure on the state and undermining private ways of paying for health care. In other words, "free" money isn't.