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Last week, I covered the first portion of my interview with South Carolina Governor Nikki Haley. In the next part of our discussion, Governor Haley relayed the efforts by South Carolina to improve health care in the state.
"We are taking the lead in the country on payment reform. We had $40 million alone in payments and we tied it to performance. Which meant that we have to actually produce better health, but more than that, we’re getting our Medicaid beneficiaries to be more engaged in their health."
Like many government programs, follow up, or the lack thereof has been a factor in producing positive results.
"If a doctor tells you to stop smoking and you don’t, we can’t continue to work with you. If a doctor tells you to take prescriptions and you don’t, we can’t continue to work with you. So to try and improve that patient engagement, to get them to care or else they will lose their benefits and to get us a better quality outcome will be an amazing improvement for healthcare. Then all of a sudden we’ve gone from talking about cost to talking about outcome...our focus is, is what can we do in terms of measurables? How do we go about doing that and what do we have to show for it?
I asked Governor Haley to clarify her point on what exactly the state could do should a patient not follow their doctor's directions.
"Well what we’ve already done is, like I said, $40 million of the payments are tied to performance so what we are doing is we’re getting them engaged. What we’re saying is they have to get involved with what their doctors are saying, they have to get engaged in that. From a federal standpoint, we have not clarified whether we can actually take that money away. What we are saying is we’re going to start to engage you in this process because you should want to be healthy. You know a lot of times the doctor will tell a patient to do something and then there’s no follow-up. This is more of making sure that the doctors and the patients are more engaged, follow-up is involved and then we’re seeing exactly who is and who is not following the directions that they are supposed to. You know when you talk about payment reform or performance, doctors love it because that’s the most frustrating part that they have with Medicaid patients is they come in and they go and they get a prescription and then they either don’t take it or they either don’t do what they’re supposed to and the doctors see them again and the doctor’s already taking a cut from what he’s supposed to get, the taxpayer’s already paying more for it, and here you have an unengaged patient. So we’re demanding accountability that they have to start doing what is expected of them; and they should want to start doing what is expected of them. We are now studying what can we do when they don’t do what is expected of them."
Governor Haley elaborated on the importance of letting people know what they are doing, instead of just saying no to this "free money."
Many of the states, I mean in the next 3 or 4 years we have to be very careful, and what they are all focusing on is, 'Are you accepting ObamaCare?' or 'Are you expanding Medicaid?' We can’t just say no we’re not, we have to say what we are doing. These are the things South Carolina is doing to show that we are a state that is a can-do state; that we don’t need Washington telling us what to do, we will actually lead in the country on how we can better perform, giving every citizen in our state quality healthcare."
Next, the governor tackled the question of what not setting up a state exchange means for South Carolina. According to Obamacare, if a state refuses to set up the exchange, the federal government will set one up for them; the concern then becomes the potential increase in power the federal government might have in the state. Governor Haley remained firm, however, stating,
"I think that this was the biggest magic trick in the world, which was to say, “If you don’t set this up we’re going to do it for you,” because what we found out is they have no plan. When you go back and you throw it back in their face and say look, “You’re telling us what to do, you’re telling us how to do it and you’re telling us to pay for it when we don’t have the money to pay for it. No, if you think you can do this better, then you can do it.” Well the answer that we get back is they don’t have a plan, nor do they have the money to pay for it. So what my federal delegation has said is, and when I’ve spoke with Senator DeMint and Senator Graham and all of our Congressional members, they basically said, “Thank you, you just bought us two more years,” because we know they don’t have a plan for what they would do in these states. We also know the money is not there because they’re dealing with money problems now. So, you know, we cant’ let them bully their way into our state to tell us how we need to do things. We need to throw it back at them and say, “Look, you think you can do it better, fine you do it, but you’re going to pay for it.”
Since South Carolina has joined 9 other states in refusing to expand Medicaid, the state newspaper, The State, has claimed that those making less than $11,000 will fall through the cracks. I asked Governor Haley if the newspaper was correct and, if so, what should be done about the situation. In her response she noted that she is working closely with her director of Health and Human Services, Tony Keck to focus on expansion but with accountability.
"What we’re not going to be told is that we have to expand a certain number without making sure there is accountability tied to it. You can’t go and buy a product without knowing how you are going to pay for it two and three years down the road."
She explained further,
"We did this with the stimulus and we saw what happened to all those states that took it and all those states that basically had to go and pick themselves up, two and three years later; this is no different when you do that. We will expand based on what the needs of South Carolina are, not on the needs of Connecticut, not on the needs of Massachusetts, not on the needs of California, that is not our job. If you look at Connecticut and you look at California, I mean do you need any more examples of exactly why this isn’t going to work? So what we are saying is we have to stand up, we have to have a backbone and say, 'Look, you think you can make life better for the people of South Carolina, you try.' When they look at it, they know they can’t because they don’t know the people of South Carolina, they don’t know what our demographics are, they don’t know what our cultural and education issues are. The truth is these are cultural issues within our state where we have to go and engage with the public on how we can get them more informed and more engaged on how they wan’t to be healthy and why they want better outcomes, and then reward them for it. The rewards come in both ways, one - the taxpayers pay less for things like obesity and prostate cancer and two - they get healthier lives and become more productive; it’s a win-win."
In the final part of my interview with Governor Haley, she states her views on the gun control debate finding its way into healthcare law and the fight against Obamacare going forward.