<b>By Rick Toomey</b>

I have been a hospital administrator for most of my healthcare career, and I have been honored to serve as Beaufort Memorial’s President and CEO for the last five years.

Yet, every day I come face to face with the reality that there is a widening gap between those who can afford health care coverage and those who cannot, and it makes me concerned about the health of our residents and of our hospital.

Our elected officials have an opportunity to change the fates and health of our state’s uninsured as they debate the state budget and whether or not to broaden health coverage for low income adults and families — a move that would improve the health of our state and community.

The debate centers on whether or not the state will accept $11.2 billion in federal funds available through the Affordable Care Act — money our residents have contributed through federal withholdings — to expand Medicaid to those living below 138% of the Federal Poverty Level. The alternative is to reject these funds and allow them to be sent to another state to expand their healthcare coverage.

People on both sides of the debate are fairly well entrenched in their positions, and there is no doubt that we are working with a system that needs reform — reform that will take many years to implement.  But the issue at hand today is very simple: use our money to improve healthcare coverage and health in our state, or allow our money to be sent to another state to improve their healthcare.

While a number of Republican governors initially said “no” to Medicaid expansion, upon reflection many, including governors Chris Christie of New Jersey, Rick Scott of Florida, John Kasich of Ohio and Jan Brewer of Arizona, have reconsidered because they recognize that expansion puts people first and makes good economic sense.

There is virtually no expense to the state for expanding Medicaid to newly eligible enrollees during the first three years of expansion (2014-2016), as the Federal government pays 100% of the cost. So as debate about the state budget continues in the statehouse,  all our legislators have to do is direct DHHS to expand Medicaid to access over $11 billion of your federal tax dollars to cover South Carolina’s most vulnerable citizens.

Our state needs to reconsider its hard line against expansion and consider the devastating impact their choices will have on our state, our economy, and the health of our citizens.

Hospitals across the state, including ours, will face millions in annual Medicare cuts beginning next year. These cuts were to be offset by increased coverage for the uninsured provided through Medicaid expansion.

Meanwhile, hospitals are still forced to absorb the cost of providing care to the uninsured while forgoing billions of dollars in Medicare reimbursement.

What does this mean for our community?

Beaufort Memorial provides a lion’s share of the cost of caring for Medicaid patients and the uninsured, and those costs are only increasing.

The hospital has experienced a significant increase in charity care over the past several years, rising from $15.4 million in fiscal year 2008 to $22.3 million in fiscal year 2012.

Likewise, we’ve had to absorb bad debt increases driven by the poor economy, with provisions for bad debt rising from $13.3 million in fiscal year 2008 to $21.7 million in fiscal year 2012.

In order to meet the challenges of an annual $7 million cut in Medicare reimbursements and a rising number of uninsured patients, BMH will be forced to make the toughest choice of all: Whether or not we can continue providing critical, much-needed health services to our community.

As a hospital administrator and a member of this community, I believe that we should expand health coverage under the Affordable Care Act. It’s a better plan for our state, our health, and our money.

I urge you to learn more about this important issue that will affect us all for years to come.  Contact your local legislators, write to our governor, and implore them to do what is right for the people of South Carolina.

<i>Rick Toomey is President and CEO of Beaufort Memorial Hospital  and incoming president of the SCHA and chair of its legislative committee.</i>
<div><i> </i></div>