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  • 19 Feb 2024 4:18 PM | Addie Thompson (Administrator)
    More than 16 million Americans have lost Medicaid coverage in recent months, according to data from the Kaiser Family Foundation. Two million Texans have rolled off Medicaid, newly released state data show. That’s good news, despite what the Biden administration would have us believe.

    For decades, Medicaid has burdened taxpayers with billions of dollars in wrongly allocated payments while providing beneficiaries substandard care. Taxpayers and beneficiaries themselves would be well served by a swift process of redetermining whether those currently enrolled in the program are actually eligible — and reforms that make private insurance more affordable.

    The size of Medicaid has swelled in recent years. During the pandemic, the federal government restricted states’ ability to “disenroll” people who no longer qualified, often because they’d moved up to a higher income level.

    As a result, Medicaid enrollment increased by more than 23 million people between February 2020 and April 2023. Total enrollment was nearly 95 million at its peak.

    Even in Texas, which did not expand Medicaid under the terms of the Affordable Care Act and has some of the tightest criteria for eligibility in the country, enrollment surged during the pandemic. Nearly 6 million people — about one in five Texans — had coverage through Medicaid and the state Children’s Health Insurance Program in May 2023.

    After the COVID public health emergency ended last spring, states resumed “redetermination” procedures to establish Medicaid eligibility. Progressives are warning that millions of low-income Americans could end up losing Medicaid by mistake — say, by failing to respond to a letter requesting that they prove they’re eligible.

    Such scaremongering is unwarranted. Anyone wrongfully disenrolled can sign up again. And in most states, including Texas, those folks can also get several months’ worth of retroactive coverage.

    It’s far likelier that those being disenrolled shouldn’t be on the program at all.

    According to the Congressional Budget Office, nearly 13 million Medicaid enrollees in 2022 weren’t eligible and had simply been kept on due to pandemic rules. Payments for these extra enrollees amount to waste.

    And Medicaid’s issues with waste, fraud, and abuse run deep. In 2023, it distributed more than $50 billion in “improper payments” — expenditures for the wrong people or at the wrong amount.

    Things were worse before redetermination. In 2021, Medicaid’s improper payments reached nearly $100 billion. That year, the program spent a staggering one in every five dollars incorrectly.

    Even Medicaid’s proper payments are inefficient. The program, which now costs taxpayers north of $800 billion annually, spends nearly three times more per patient than employer-sponsored plans.

    Many state officials are rightly trying to stop this waste through redetermination. Government shouldn’t squander money earmarked for the vulnerable on those who qualify for cheaper care elsewhere.

    The Urban Institute estimates that most of the 18 million Americans projected to lose Medicaid during redetermination will get comparable coverage through the Children’s Health Insurance Program, the individual market, or some kind of employer-sponsored insurance.

    Of the 3.8 million projected to become temporarily uninsured, roughly half will “have access to subsidized coverage, principally a subsidized exchange plan,” according to Brian Blase of the Paragon Health Institute.

    There’s plenty the government could do to help disenrolled beneficiaries obtain quality coverage.

    To start, the federal government could give low-income Americans vouchers to spend on employer-sponsored or other private health plans in lieu of the federal subsidies they’re already entitled to. Those funds could go into health savings accounts, or HSAs, where people can stow money tax-free for future health needs. Patients could access the money using a bank-issued debit card reserved for medical bills, as a paper published by the Paragon Health Institute recently proposed.

    Incentivizing people to use HSAs would save money for virtually all taxpayers and prove especially valuable for lower-income Americans. According to one estimate, nearly seven in 10 Obamacare enrollees below 200% of the federal poverty line would benefit from an HSA option, with the average beneficiary saving around $1,500 per year.

    Lawmakers should also expand ways for employers to offer coverage. That means loosening regulations so it’s easier for companies to purchase association health plans. These group plans cover multiple businesses, making insurance more affordable for startups and entrepreneurs with tight budgets.

    Congress should also enshrine a Trump-era executive order that lets employers reimburse their employees for qualified health expenses, including Obamacare premiums. That way, employers can offer health benefits without purchasing a company-wide plan.

    Medicaid should not be the largest health insurer in the country. The program exists to serve those who truly can’t afford care. States are rightly pushing a return to that original purpose by disenrolling those who don’t qualify.

    ©2024 Fort Worth Star-Telegram. Visit star-telegram.com. Distributed by Tribune Content Agency, LLC.

  • 19 Feb 2024 4:17 PM | Addie Thompson (Administrator)

    By far the biggest thing about the great Medicaid unwinding of 2023 is the number of low-income people who have been disenrolled, and we have been tracking that relentlessly at KFF. More than 16 million people have been disenrolled so far, as continuous Medicaid coverage provided during the pandemic ended, based on the most current data from all 50 states and the District of Columbia. About 70% of the disenrollments were for procedural reasons. Many people dropped will get coverage elsewhere, through an employer or the Affordable Care Act marketplace, and some who are still eligible will make their way back to Medicaid. The big question is how many will end up uninsured. The picture will vary across states, as it always does when it comes to covering the low-income population.

    But there is another story in the data that goes with the unwinding that has mostly escaped notice. We are seeing a decline in federal Medicaid funding as fiscal relief to states in the form of higher matching funds is withdrawn, and an increase in state Medicaid spending, despite lower enrollment. And it’s happening when revenues in most states are weakening. That can be expected to put pressure on state budgets, rekindle on again off again conflict in states about the share of the budget consumed by Medicaid, and make it tougher for states to continue current efforts to strengthen their Medicaid programs.

    A few numbers:

    • The Congressional Budget Office projects that states will receive $58 billion less in federal Medicaid outlays in FY 2024 than they did in 2023. As a consequence, states report that their Medicaid spending will increase by 17.2% in FY 2024.
    • State revenue collections have started to slow down or decline, and some states may have to face budget gaps in the coming years.  States have recently experienced an overall 2% decline in inflation adjusted revenues.
    • Most of the state numbers are estimates and projections. They are often the product both of best estimates and political calculus, but over the years, they’ve generally been in the ballpark.
    • States are spending to address rising costs in Medicaid and health care, but also long overdue needs, such as increasing some providers payment rates or putting more resources into home and community-based services or mental health and behavioral health services. States like California and North Carolina are making big plays to address the social determinants of health outcomes for targeted populations. These are some of, if not the most innovative programs in health care.

    Medicaid will face blowback in state budget wars in many states as it eats up a larger share of the new funds available in state budgets that legislatures, cabinet agencies, and governors will want to direct to other priorities. When I was Human Services Commissioner in New Jersey, I had eight divisions and a third of the state budget and workforce in NJ HHS (the department has long since been reorganized and reduced in size). One division was Medicaid. The competition for new funds was fierce even within my own department when times were good. In state budget politics, only so much of the annual increase in a state budget will go to one department, no matter the need.

    As always there will be variation among states. Where governors have made Medicaid initiatives a personal priority, they may sustain them despite revenue and budget challenges, even cutting elsewhere in Medicaid and social services to continue favored projects.

    In our large survey of consumers, Medicaid generally competed well with Medicare, Marketplace and employer coverage, with each type of coverage presenting consumers with the kinds of barriers to care and frustrations common to health insurance today.  But Medicaid programs face their own challenges, including access to many specialists.

    The question for the next several years is whether states will be able to continue to make targeted new commitments to strengthen Medicaid and mount innovative new programs in an environment of declining federal matching funds, weakening state revenues and competing state priorities. Medicaid is a counter-cyclical program and these are far from the worst circumstance states have faced. The election obviously can have significant additional consequences for Medicaid, especially if Republicans control the White House and Congress, and return to proposals to block grant Medicaid and make significant cuts in federal funding. But that’s only a possibility, while these changes are already in the works, bringing with them shifting sands for Medicaid.

    View all of Drew’s Beyond the Data Columns

  • 15 Feb 2024 4:15 PM | Addie Thompson (Administrator)

    Nurses in Santa Cruz, Calif., make more money on average than nurses in any other metro area, a Vivian Health ranking found.

    Vivian Health used Bureau of Labor Statistics data to find the metro area in each state that paid nurses the highest wages. Rankings of metro areas were based on the dollar difference between a registered nurse's median annual salary and the median salary of all occupations in the area.

    The ranking showed that nurses earn some of the highest wages relative to other occupations in the area. California had the highest wage among all states, while Iowa had the lowest.

    Here is the top metro area in every state with the median annual wage for nurses:

    Alabama — Daphne: $64,700

    Alaska — Fairbanks: $107,880

    Arizona — Yuma: $82,290

    Arkansas — Little Rock: $71,460

    California — Santa Cruz: $175,350

    Colorado — Pueblo: $82,780

    Connecticut — Danbury: $105,370

    Delaware — Dover: $78,320

    Florida — Sebastian: $79,190

    Georgia — Rome: $81,320

    Hawaii — Urban Honolulu: $127,020

    Idaho — Coeur d'Alene: $83,730

    Illinois — Kankakee: $80,470

    Indiana — Michigan City: $72,720

    Iowa — Sioux City: $62,860

    Kansas — Lawrence: $67,150

    Kentucky — Owensboro: $78,040

    Louisiana — Shreveport: $77,790

    Maine — Bangor: $83,750

    Maryland — Salisbury: $79,210

    Massachusetts — Leominster: $96,410

    Michigan — Flint: $86,210

    Minnesota — St. Cloud: $85,730

    Mississippi — Hattiesburg: $59,910

    Missouri — St. Louis: $77,390

    Montana — Missoula: $76,550

    Nebraska — Grand Island: $74,290

    Nevada — Las Vegas: $95,770

    New Hampshire — Manchester: $80,560

    New Jersey — Ocean City: $85,490

    New Mexico — Las Cruces: $78,270

    New York — New York City: $103,540

    North Carolina — Fayetteville: $82,390

    North Dakota — Fargo: $75,710

    Ohio — Canton: $74,950

    Oklahoma — Lawton: $77,070

    Oregon — Bend: $108,310

    Pennsylvania — Chambersburg: $84,090 

    Rhode Island — Providence: $84,770 

    South Carolina — Spartanburg: $81,520 

    South Dakota — Rapid City: $62,920 

    Tennessee — Cleveland: $76,620 

    Texas — Wichita Falls: $79,800 

    Utah — Provo: $75,090 

    Vermont — Burlington: $77,230 

    Virginia — Winchester: $81,940 

    Washington — Spokane: $100,280 

    West Virginia — Huntington: $77,240 

    Wisconsin — Racine: $77,960 

    Wyoming — Cheyenne: $81,680 

  • 15 Feb 2024 4:14 PM | Addie Thompson (Administrator)

    Feb. 1 (UPI) -- A RAND Corporation report released Thursday found that U.S. prescription drug prices are much higher than in other nations.

    The report is out on the same day that Medicare sent initial price negotiating offers on 10 drugs for seniors.

    According to the study, U.S. drug prices average 2.78 times the prices charged in 33 other countries studied.

    For brand name drugs, it's even more pronounced, with U.S. prices for those kinds of drugs being 4.22 times higher than drug prices in other countries.

    For insulin, RAND found U.S. prices ranged from 457% higher than Mexico to 3,799% higher than prices in Turkey.

    "These findings provide further evidence that manufacturers' gross prices for prescription drugs are higher in the U.S. than in comparison countries," said report lead author Andrew Mulcahy in a statement. "We find that the gap is widening for name-brand drugs, while U.S. prices for generic drugs are now proportionally lower than our earlier analysis found."

    Medicare on Thursday sent initial pricing offers to U.S. drug manufacturers aiming to lower medicine costs for families.

    The White House said in a statement that Big Pharma is using nine lawsuits against the Medicare Drug Price Negotiation that was in the Biden Administration's Inflation Reduction Act.

    According to the RAND report, U.S. prescription drug prices are 1.72 times higher than in Mexico while they are 10.28 times more expensive than prescription drugs in Turkey.

    The U.S accounts for 62% of the total drug spending in the nations RAND studied while it accounts for just 24% the drug volume sold.

    The study was sponsored by the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services.

    The study looked at pricing in the Organization for Economic Cooperation and Development countries.

    According to RAND, estimates are that prescription drug spending in the United States accounts for more than 10% of all health care spending.

    Retail prices for prescription drugs in the United States rose by 91% between 2000 and 2020. It's expected to go up 5% a year annually through 2030.

    The RAND report "International Prescription Drug Price Comparisons Estimates: Using 2022 Data" is available at www.rand.org.

  • 15 Feb 2024 4:13 PM | Addie Thompson (Administrator)

    As readers of Say Ahhh! know, I have been tracking monthly data (hereherehereherehere and here) from the Centers for Medicare and Medicaid Services (CMS) on the number of people who were either previously enrolled in Medicaid or had experienced a denial or termination during unwinding who then selected a marketplace plan.  At the end of January, CMS issued new data for October 2023.  (For an overall status update on Medicaid unwinding, see this blog from my CCF colleague Joan Alker.)

    In September, another 1.62 million people lost their Medicaid coverage due to unwinding of the Medicaid continuous coverage protection, of which 68.9 percent were procedural disenrollments and 31.1 percent were due to a finding of ineligibility.  Separately, CMS reported that nearly 393,000 people who were either previously enrolled in Medicaid in federal marketplace states or had experienced a denial or termination in state-based marketplace states selected a marketplace plan in the same month.  That constituted about 24.3 percent.

    Compared to total marketplace enrollment among those losing Medicaid in September, October marketplace enrollment was nearly 77 percent higher.  (Virtually all of this marketplace enrollment increase occurred in federal marketplace states.)  As a result, the rate of marketplace enrollment among those disenrolled from Medicaid increased substantially, compared to only 13.4 percent in September. (In addition, another 36,000 or 2.2 percent enrolled in a Basic Health Plan in New York and Minnesota in September, with nearly all of that BHP enrollment occurring in New York.)  Cumulatively, through October 2023, compared to the 10.8 million people disenrolled from Medicaid, about 1.4 million or still only 13.3 percent enrolled in marketplace plans.  (The figure rises to 15.1 percent if including Basic Health Plan enrollment.)

    As each of the blogs about previous CMS data releases noted, to provide context to these figures, last year, federal researchers from the HHS Office of Assistant Secretary for Planning and Evaluation (ASPE) projected that of the 15 million people expected to lose Medicaid during the unwinding, nearly 2.7 million people — or about 18 percent —would be eligible for subsidized marketplace coverage.  While this data represents only the outcome of unwinding through October, it indicates that overall transitions to marketplace coverage is still falling short of the expected pace.  This is despite overall marketplace enrollment soaring to a historic high of 21.3 million during the 2024 Open Enrollment Period and the welcome surge in successful marketplace transitions for those disenrolled from Medicaid in October.

    Moreover, at the current pace of disenrollments, the total number of people disenrolled from Medicaid once unwinding is completed is highly likely to far exceed the original 15 million projection from ASPE, and even the 17 million projection from other analysts such as KFF.  And the share of total disenrollments that are procedural terminations — 71 percent according to our latest data — is well above the 45 percent estimate from the ASPE projections of the number of eligible people disenrolled for procedural reasons.  Finally, for children losing Medicaid, even with the enhanced marketplace subsidies, children accounted for only about 9 percent — or 1.55 million — of total marketplace enrollees during the 2023 Open Enrollment Period.  (Data on the child share of marketplace enrollees during the 2024 Open Enrollment Period is not yet available.)

    Marketplace plans will be a valuable source of affordable, comprehensive health coverage but only for a relatively modest number of people, especially children, who lose their Medicaid coverage during unwinding.  Instead, it’s critical for state Medicaid programs, as they complete the unwinding process in coming months, to reduce the persistently high rates of procedural terminations for children, parents and other adults, many of whom, especially children, are likely to remain eligible for Medicaid.  This includes states continuing to increase ex parte renewal rates, ensuring full compliance with all federal requirements for Medicaid renewals and taking up more of the renewal flexibilities provided by CMS, such as pausing all Medicaid renewals for children for one year as Kentucky and North Carolina have recently done.

    At the same time, to increase child Medicaid enrollment to offset these large coverage losses from unwinding, states should also take up various actionable strategies to promote continuous coverage for children and families, as recently reinforced in a CMS Informational Bulletin issued in December.  States should also take up multi-year continuous eligibility for children, which an increasing number of states are adopting, in addition to successfully implementing mandatory 12-months continuous eligibility for children which took effect on January 1, 2024.  Finally, states and the federal government will need to work together on robust outreach and enrollment efforts in 2024 to target eligible children, families and other adults who were disenrolled for procedural reasons so they can be reenrolled in Medicaid as quickly as possible.

  • 15 Feb 2024 4:12 PM | Addie Thompson (Administrator)

    We’re halfway through the Medicaid “unwinding,” in which states are dropping people from the government health insurance program for the first time since the pandemic began.

    Millions of people have been dumped from the rolls since April, often for procedural issues like failing to respond to notices or return paperwork. But at the same time, millions have been re-enrolled or signed up for the first time. 

    The net result: Enrollment has fallen by about 9.5 million people from the record high reached last April, according to the latest estimates by KFF, based on state data. That leaves Medicaid on track to look, by the end of the unwinding, a lot like it did at the start of the coronavirus pandemic: covering about 71 million people.

    • “What we are seeing is not dissimilar to what we saw before the pandemic — it is just happening on a bigger scale and more quickly,” said Larry Levitt, executive vice president for health policy at KFF.

    Enrollment churn has always been a feature of Medicaid, which covers low-income and disabled Americans. Even before the pandemic, about 1 million to 1.5 million people fell off the Medicaid rolls each month — including many who still qualified but failed to renew their coverage, Levitt said.

    In the unwinding, a lot of people have been disenrolled in a shorter period of time. In some ways — and in some states — it’s been worse than expected.

    The Biden administration predicted about 15 million people would lose coverage under Medicaid or the related Children’s Health Insurance Program during the unwinding period, nearly half due to procedural issues. Both predictions were low. Based on data reported so far, disenrollments are likely to exceed 17 million, according to the KFF report, 70 percent of them due to procedural reasons.

    But about two-thirds of the 48 million Medicaid beneficiaries who have had their eligibility reviewed so far got their coverage renewed. About one-third lost it.

    Timothy McBride, a health economist at Washington University in St. Louis, said the nation’s historically low unemployment rate means people who lose Medicaid coverage are more likely to find job-based coverage or better able to afford plans on Obamacare marketplaces. “That is one reason why the drop in Medicaid is not a lot worse,” he said.

    There are big differences between states. Oregon, for example, has disenrolled just 12 percent of its beneficiaries. Seventy-five percent were renewed, according to KFF. The rest are pending.

    At the other end of the spectrum, Oklahoma’s dumped 43 percent of its Medicaid beneficiaries in the unwinding, renewing coverage for just 34 percent. About 24 percent are pending.

    States have varying eligibility rules, and some make it easier to keep people enrolled. For instance, Oregon allows children to stay on Medicaid until age 6 without having to reapply. Everyone else gets up to two years of coverage regardless of changes in income.

    Joan Alker, executive director of the Georgetown University Center for Children and Families, said she remains worried the drop in Medicaid enrollment among children is steeper than typical. That’s particularly bothersome because children usually qualify for Medicaid at higher household income levels than their parents or other adults. 

    More than 3.7 million children have lost Medicaid coverage during the unwinding, according to the center’s latest data. “Many more kids are falling off now than prior to the pandemic,” Alker said.

    And when they’re dropped, many families struggle to get them back on, she said. “The whole system is backlogged and the ability of people to get back on in a timely fashion is more limited,” she said.

    The big question, Levitt said, is how many of the millions of people dropped from Medicaid are now uninsured.

    The only state to survey those disenrolled — Utah — discovered about 30 percent were uninsured. Many of the rest found employer health coverage or signed up for subsidized coverage through the Affordable Care Act marketplace.

    What’s happened nationwide remains unclear.

    This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

  • 15 Feb 2024 4:10 PM | Addie Thompson (Administrator)

    South Carolina’s Senate convened for an initial debate on Wednesday about a bill that would allow medical cannabis access for patients with certain health conditions. It’s a renewed push by lawmakers after the body passed an earlier version of the legislation in 2022 that went on to stall in the House over a procedural hiccup.

    During the floor debate on the measure from Sen. Tom Davis (R), members held a lengthy discussion on the merits of the reform proposal and also adopted an amendment on vaping. It’s expected to receive an initial vote on second reading, possibly as soon as Thursday, before a third and final reading that could send it over to the House.

    Senators last week had failed to advance the measure to floor debate, falling short on a vote that required two-thirds support. But on Tuesday, lawmakers voted again and came up 23–13 to give the bill a special order slot and keep it in play for the 2024 session.

    South Carolina’s Senate convened for an initial debate on Wednesday about a bill that would allow medical cannabis access for patients with certain health conditions. It’s a renewed push by lawmakers after the body passed an earlier version of the legislation in 2022 that went on to stall in the House over a procedural hiccup.

    During the floor debate on the measure from Sen. Tom Davis (R), members held a lengthy discussion on the merits of the reform proposal and also adopted an amendment on vaping. It’s expected to receive an initial vote on second reading, possibly as soon as Thursday, before a third and final reading that could send it over to the House.

    Senators last week had failed to advance the measure to floor debate, falling short on a vote that required two-thirds support. But on Tuesday, lawmakers voted again and came up 23–13 to give the bill a special order slot and keep it in play for the 2024 session.

    Davis said during Wednesday’s floor session that his goal has always been to “come up with the most conservative medical cannabis bill in the country that empowered doctors to help patients—but at the same time tied itself to science, to addressing conditions for which there’s empirically based data saying that cannabis can be of medical benefit.”

    “I think when this bill passes—and I hope it does pass—it’s going to be the template for any state that truly simply wants to empower doctors and power patients and doesn’t want to go down the slippery slope” to adult-use legalization, he said. “I think it can actually be used by several states that maybe regret their decision to allow recreational use, or they may be looking to tighten up their medical laws so that it becomes something more stringent.”

    Overall, the bill would allow patients to access cannabis from licensed dispensaries if they receive a doctor’s recommendation for the treatment of qualifying conditions, which include several specific ailments as well as terminal illnesses and chronic diseases where opioids are the standard of care.

    On Wednesday, members adopted an amendment that clarifies the bill does not require landlords or people who control property to allow vaporization of cannabis products.

    Certain lawmakers raised concerns during the hearing that medical cannabis legalization would lend to broader reform to allow adult-use marijuana, that it could put pharmacists with roles in dispensing cannabis in jeopardy and that federal law could preempt the state’s program, among other worries.

    Here are the main provisions of the proposal

    • “Debilitating medical conditions” for which patients could receive a medical cannabis recommendation include cancer, multiple sclerosis, epilepsy, post-traumatic stress disorder (PTSD), Crohn’s disease, autism, a terminal illness where the patient is expected to live for less than one year and a chronic illness where opioids are the standard of care, among others.
    • The state Department of Health and Environmental Control (DHEC) and Board of Pharmacy would be responsible for promulgating rules and licensing cannabis businesses, including dispensaries that would need to have a pharmacist on-site at all times of operation.
    • In an effort to prevent excess market consolidation, the bill has been revised to include language requiring regulators to set limits on the number of businesses a person or entity could hold more than five percent interest in, at the state-level and regionally.
    • A “Medical Cannabis Advisory Board” would be established, tasked with adding or removing qualifying conditions for the program. The legislation was revised from its earlier form to make it so legislative leaders, in addition to the governor, would be making appointments for the board.
    • Importantly, the bill omits language prescribing a tax on medical cannabis sales, unlike the last version. The inclusion of tax provisions resulted in the House rejecting the earlier bill because of procedural rules in the South Carolina legislature that require legislation containing tax-related measures to originate in that body rather than the Senate.
    • Smoking marijuana and cultivating the plant for personal use would be prohibited.
    • The legislation would sunset eight years after the first legal sale of medical cannabis by a licensed facility in order to allow lawmakers to revisit the efficacy of the regulations.
    • Doctors would be able to specify the amount of cannabis that a patient could purchase in a 14-day window, or they could recommend the default standard of 1,600 milligrams of THC for edibles, 8,200 milligrams for oils for vaporization and 4,000 milligrams for topics like lotions.
    • Edibles couldn’t contain more than 10 milligrams of THC per serving.
    • There would also be packaging and labeling requirements to provide consumers with warnings about possible health risks. Products couldn’t be packaged in a way that might appeal to children.
    • Patients could not use medical marijuana or receive a cannabis card if they work in public safety, commercial transportation or commercial machinery positions. That would include law enforcement, pilots and commercial drivers, for example.
    • Local governments would be able to ban marijuana businesses from operating in their area, or set rules on policies like the number of cannabis businesses that may be licensed and hours of operation. DHEC would need to take steps to prevent over-concentration of such businesses in a given area of the state.
    • Lawmakers and their immediate family members could not work for, or have a financial stake in, the marijuana industry until July 2029, unless they recuse themselves from voting on the reform legislation.
    • DHEC would be required to produce annual reports on the medical cannabis program, including information about the number of registered patients, types of conditions that qualified patients and the products they’re purchasing and an analysis of how independent businesses are serving patients compared to vertically integrated companies.

    Kevin Caldwell, southeast legislative manager for the Marijuana Policy Project, praised Davis’s multi-year effort to advance medical cannabis legislation.

    “He has listened to patients as well as fellow senators who have opposed this type of legislation in the past. He has been masterful in making strategic compromises to satisfy both groups,” Caldwell told Marijuana Moment. “We certainly hope that this is the year that his colleagues in the Senate and the House pass this legislation. The long-suffering patients of the Palmetto State deserve the same safe access that residents of 38 other states and the District of Columbia currently have. ”

    After Davis’s Senate-passed medical cannabis bill was blocked in the House in 2022, he tried another avenue for the reform proposal, but that similarly failed on procedural grounds.

    The lawmaker has called the stance of his own party, particularly as it concerns medical marijuana, “an intellectually lazy position that doesn’t even try to present medical facts as they currently exist.”

    Meanwhile, a poll released last year found that a strong majority of South Carolina adults support legalizing marijuana for both medical (76 percent) and recreational (56 percent) use—a finding that U.S. Rep. Nancy Mace (R-SC) has promoted.

  • 14 Feb 2024 11:56 AM | Addie Thompson (Administrator)

    Neel Ghoshal was 13 years old when his life changed. 

    Born in 1978 to Sam and Pritha Ghoshal, who immigrated from India eight years prior in pursuit of the American dream, Neel grew up in the Northeast.

    There were moments of struggle but life was good in the New York City area, where his father worked at the World Trade Center. 

    In November 1991, Ghoshal’s mother went back to India to visit her father. She never made it home. 

    His mother had been managing a kidney issue, Ghoshal said, but a disconnect between doctors and a lack of access to health care led to a misdiagnosis. For reasons unbeknownst to him, the family and doctors in India did not contact medical professionals back in the United States. She died a few weeks later in 1992. 

    Ghoshal recalls feeling angry at the systems that were designed to protect people like his mother. 

    “There was no reason she had to pass,” he said. “She did because of this lack of access.” 

    Though he has worked in multiple industries during his professional career, Ghoshal’s desire to help fill the gaps in the health care system has always stuck with him. That, plus a family connection to the hospitality industry, is driving his new business venture, Healthpitality

    The memory of his mother is directly tied to the “why” behind Healthpitality, Ghoshal said. Many U.S. citizens, including the majority of hospitality workers, struggle to access affordable health care. For those who do have traditional health care, long wait times and pricey copays can make it hard to see a primary care physician regularly. 

    Set to launch in January, Healthpitality is being marketed as a membership-based alternative to traditional health insurance. It will rely heavily on telehealth services to treat the many hospitality employees — more than 50 percent nationally — who do not receive health insurance from the restaurant or hotel that employs them. At Healthpitality, Ghoshal wants to create an environment where members of the hospitality industry “are partners in their care and are treated with the same VIP treatment that they provide for their guests night after night.” 

    Hospitality industry workers can become Healthpitality members individually, but Ghoshal envisions restaurants making this membership an employee benefit. The monthly subscription will cost employers $38 to $55 dollars per month per employee, plus a $250 onboarding fee, and includes unlimited telehealth visits. 

    Restaurants will be billed monthly per employee, meaning restaurants will not be left with footing the bill of someone who leaves the staff, Ghoshal said. On the flip side, workers will not be dropped when they switch jobs. 

    Subscriptions for individual employees purchasing their own Healthpitality package are $65 per month. Hospitality workers who want to sign up individually will be asked to provide proof of employment, such as a recent paycheck. 

    ‘Telehealth first’ 

    Ghoshal, who moved to Charleston in 2018, describes Healthpitality as a “virtual-first” health care provider. His experience with telehealth includes working as a consultant for Doxy.me, a telemedicine business that got its start as a tool for health care providers to bring prenatal care to women who normally would have to travel long distances for well-checks and weigh-ins. 

    Though he understands the benefits of telehealth, Ghoshal also recognizes that it cannot cover every health care need. It simply is not possible to do every type of visit remotely, meaning Healthpitality members will still have to schedule appointments for imaging tests, blood work and other visits that require in-person interaction. 

    In-person visits, recommended by the doctors and nurse practitioners employed by Healthpitality, will incur an out-of-pocket expense for either the restaurant or the employee. 

    “Our providers are adept at leveraging telehealth’s best practices to serve our members. However, when necessary, they are also skilled at identifying situations where in-person care is essential, and will accordingly refer members to external providers,” Ghoshal said.

    Telemedicine has been more widely adopted since the pandemic, said Medical University of South Carolina Director of Primary Care Telemedicine Dr. Marty Player. It has been especially effective in treating mental health disorders, Player said. 

    Telemedicine’s limitations include the inability to conduct testing and exams that must be done in person. South Carolina law also prohibits doctors from prescribing certain “controlled” medications without establishing care with a patient in person. 

    Early research prior to the pandemic suggested that telemedicine provided more access to people who already had access to health care, Player said. Developments in the field suggest that, moving forward, telemedicine could increase access for more vulnerable populations, he said. 

    “Access to primary care is still limited in this country in general,” Player said. “I think there’s a benefit to having the telehealth option.” 

    Healthpitality currently has six employees and plans to have three doctors and six to nine nurse practitioners by its January launch in South Carolina and Florida. The primary focus at the onset will be on acute care. As Healthpitality sees a growth in demand, the plan is to broaden services to encompass primary care and preventive medicine, said Ghoshal, whose brother is a certified master chef, a designation given by the American Culinary Federation. 

    The eventual goal is to create a “comprehensive health and wellness ecosystem” where members can manage most of their health needs. They will do so by working with Healthpitality’s concierge team, who will be trained to understand the realities of working in the restaurant industry. 

    “Their deep understanding of the unique challenges faced by those in hospitality ensures that every interaction is not only helpful, but also empathetic and tailored,” Ghoshal said. 

    Ambitious future goals include the creation of “healthpitals,” units that would bring health care services directly to members for seasonal needs like flu shots and physical exams. The overarching goal, Ghoshal said, is to make health care accessible and convenient for all Healthpitality members. 

    For more information, visit healthpitality.life

  • 14 Feb 2024 11:55 AM | Addie Thompson (Administrator)

    We have another Freedom Agenda healthcare win to report! Healthcare in South Carolina just got a little freer and more accessible for South Carolinians on January 31 with the passage of H. 4159, the Telehealth and Telemedicine Modernization Act!

    The bill was first filed last year and passed by the House in May 2023. At the beginning of the 2024 legislative session, the Senate fast-tracked the bill unanimously with an expansive amendment, and on January 31,  the House concurred with the amendment, officially sending the Telehealth and Telemedicine Modernization Act to the Governor’s desk! We urge Governor McMaster to sign this outstanding legislation as soon as possible.

    Palmetto Promise has supported the expansion of telemedicine for years. In fact, it was item #9 in our 2023 Palmetto Freedom Agenda. Telehealth allows patients to access medical care more efficiently, flexibly, and cost-effectively than going in-person for every appointment, and we fully support the reduction of regulations that allow consumers the ability to choose the best care for them. This is particularly beneficial for rural South Carolinians, where in-person medical providers are fewer and further between.

    Back in 2022, PPI Senior Fellow Dr. Oran Smith testified in support of S. 1179, which allowed social workers, professional counselors, and other mental health professionals to practice via telehealth. The bill was ultimately passed in both chambers and signed into law in May 2022. According to the South Carolina Telehealth Alliance, South Carolina’s telehealth scene has grown rapidly, with over 1.2 million telehealth interactions between patients and medical professionals in the year 2022. A few months ago, we discussed the next steps for telehealth and other essential healthcare reforms in our Beyond Policy podcast here.

    Now this session, we are pleased to see the General Assembly take that next step with the passage of H. 4159!

    Representative Sylleste Davis, chair of the House’s Medical Committee, put it best in her post on X (formerly known as Twitter):

    The repeal of Certificate of Need laws in South Carolina opened the door to greater advancements in healthcare freedom and a medical system that is free of burdensome, costly regulations. Now, that momentum continues with telehealth expansion, another Freedom Agenda win that every South Carolinian should celebrate.

  • 14 Feb 2024 11:48 AM | Addie Thompson (Administrator)

    The COVID-19 pandemic created a sudden need for virtual health care for patients and prompted regulators to drop stricter regulation of what could be provided.

    Now, four years later, giant retailers are offering consumers direct access to services while traditional providers adapt and partner to meet patient needs, particularly for rural patients like many across South Carolina.

    The future of health care for many patients and providers could be a mix of both virtual and face-to-face care, experts said.

    Telemedicine, providing an exam via an interactive video system, has been around for decades, but it was limited by acceptance, traditional regulation and reimbursement to limited uses, such as in a stroke. Hooking up a rural emergency room that lacked specialists to a larger medical center meant patients with a suspected stroke could be evaluated remotely, and after a neurologist read a CT scan of their brains, offered clot-busting drugs that improved outcomes and survival.

    Stroke was one of the first ways the technology showed it was better than the traditional approach, said Brandon Welch, CEO of telemedicine company Doxy.me and author of “Telehealth Success: How to Thrive in the New Age of Remote Care.

    “Telemedicine really proved itself in the stroke use case because it was a very clear path to success,” he said. But outside of that, and some limited use in psychiatry, the industry “was kind of treading water,” Welch said.

    That is until COVID-19 hit in early 2020. Suddenly, hospitals and clinics were limiting who could be seen, while many patients feared leaving the safety of their homes, even when sick. Federal regulators like the Centers for Medicare and Medicaid Services quickly loosened the reins on what care could be provided virtually and also reimbursed, and many others followed suit.

    Those flexibilities were meant to be temporary, and technically still are, with the latest expiration on Dec. 31. But most believe they will be made permanent soon. Congress has been trying in various bills, and the South Carolina Legislature recently passed new regulations codifying remote care standards.

    The changes are here to stay, Welch said.

    “They’ve been threatening to end it for the last four years, and every time the time comes, they extend it for another year or two,” he said. Members of Congress don’t agree on much, but “what they can agree on is telemedicine should be here to stay,” Welch said.

    Big companies already believe that. Amazon purchased virtual-care provider One Medical; Costco members in South Carolina can use its provider, Sesame; and other big retailers have followed suit or soon will.

    That kind of access is what many patients want, said Kaitlyn Torrence, executive director of MUSC Health Solutions. She gets it — she uses One Medical herself at times.

    “I demand access. I want it quickly,” Torrence said. “And yet, I still want that continuum of care when I need to go to a higher level (of treatment).”

    It poses a dilemma for MUSC Health and other providers in South Carolina and across the country: How do you compete with that? Or do you even try?

    It’s something MUSC Health is thinking a lot about, whether to continue building its own or partner with a provider like One Medical to provide care that it can’t, Torrence said. For instance, one of those quick-access providers might be the first to see a patient, but MUSC Health becomes the provider for more acute care or for patient management.

    One Medical is already a provider for 8,500 employers and partners with 18 health systems across the country, the American Hospital Association noted.

    Read more here.

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