© Kim Kim Foster-Tobin/The StateDr. David Cull tried to get help from his hometown senator, but was rebuffed.
Dr. David Cull, a prominent vascular surgeon in Greenville, had invented a small valve system that, if it works, could spare 300,000 dialysis patients across the country enormous suffering and save U.S. taxpayers billions of dollars.
But Cull's hometown senator, Jim DeMint, would not write a letter supporting the surgeon's application for a federal grant under the landmark health care bill that President Barack Obama signed into law a year ago today.
A hard-core conservative with a growing national following, DeMint vowed in 2009 to make health care Obama's "Waterloo" and is leading Republican efforts in Congress to repeal or deny funding to the law, designed to provide medical coverage to 31 million uninsured Americans.
Backing a grant application under the law - even for a constituent who lives in the same Upstate town as DeMint - would leave the senator open to charges of hypocrisy, staffers say.
"Senator DeMint opposed President Obama's government takeover of health care because he believed it would lead to higher insurance premiums, less choices for patients, and that it was unconstitutional," said DeMint spokesman Wesley Denton. "And that's exactly what has happened."
A year after the controversial Patient Protection and Affordable Care Act took effect, political warfare between the law's proponents and opponents is trumping the search for better, more affordable health care.
And Cull and DeMint are not the only ones feuding.
S.C. Gov. Nikki Haley has shared DeMint's national spotlight in opposing health care reform, challenging President Obama, first, to repeal the legislation and, later, to speed up a judicial review of its constitutionality.
Outside the spotlight, Haley also is using a $1 million federal grant to see how South Carolina might enact the law if it has to.
'Money ... well spent?'
To Cull, who is about to start clinical trials with 12 subjects for his valve system, DeMint's stance on his fledgling device - and on health care more broadly - is pennywise and pound-foolish.
"It's a good sound bite on Fox News, but he's looking at it so simplistically," Cull said. "He's completely ignoring the huge (possible) savings."
Cull received a $249,479 grant without DeMint's help - though the senator's aides say they provided guidance on applying for it - under a little publicized part of the Affordable Care Act that is aimed at encouraging cutting-edge biomedical research.
Cull and 12 other S.C. doctors, all clustered around Charleston and Greenville, have received grants totaling $2.6 million for "translational research" - applied projects that are almost ready for the market, not simply on the drawing board. Nationwide, physicians and biomedical firms have obtained $1 billion in grants for such projects.
Cull's valve system would replace a plastic stent that's been used for a half-century for patients with acute kidney failure, often resulting in painful complications, including circulation impairment, gangrene, finger ulcers and severe arm swelling.
A typical dialysis patient will undergo 10 to 12 operations over a lifetime to treat complications from the stents, with 1 million performed each year - all paid for by Medicare. Such surgeries cost taxpayers a fifth - $15,000 - of the $75,000 a year the federal program pays per person with acute kidney failure.
Cull's valve system, by contrast, could cut or eliminate the costly and painful complications.
"This is money ... very well spent," he said of the federal grant. "If our valve doesn't work, the government will have lost $250,000. If it does work, they will have saved a gazillion dollars."
House Assistant Democratic Leader Jim Clyburn of Columbia wrote a letter of support for Cull's grant application.
"There are a number of diabetics living in South Carolina," Clyburn said. "Dr. Cull's device has the potential to save many of them from the often federally subsidized cost and the pain associated with frequent dialysis treatments."
'We have to be prepared'
Newly elected Gov. Haley has butted heads with Obama over the health care law at two recent White House meetings of governors.
Obama rejected Haley's request to repeal his signature legislative achievement, but he expressed willingness to let states opt out of some of its mandates - as long as its central goals are preserved, such as bans on denying coverage to patients with pre-existing conditions and enabling people to pool together into groups to get better insurance rates.
In response to another Haley request, Obama two weeks ago asked the Justice Department to expedite the federal courts' handling of lawsuits by GOP governors challenging the health care law.
Two Republican-appointed judges have deemed the law partially or wholly unconstitutional while three Democratic-appointed judges have upheld it.
The cases are expected to end up before the U.S. Supreme Court.
"I want to thank him for realizing the need and urgency to have this resolved so our states and our country can move forward," Haley said of Obama's move to expedite the case.
But even as she pushes against the health care law, Haley has instructed key agency heads to get ready for its implementation.
"We don't know what the outcome will be, but for the citizens of South Carolina, we have to be prepared for whatever happens," said Tony Keck, Haley's new director of the state Department of Health and Human Services.
"Right now, the law of the land is health care reform," Keck said. "Although we're fighting it and looking to produce our own alternatives, we also have to prepare to implement it to meet the deadlines. The risk of not preparing for any eventuality is simply too high in the form of penalties from the federal government and interruption to care."
The state is using a $1 million grant under the law to evaluate whether it will set up and run its own health insurance exchange or turn that function over to Washington, an option under the law.
Keck and new S.C. Insurance Commissioner David Black are heading up a task force, formed by a Haley executive order and to include members chosen by the General Assembly.
With its first meeting scheduled for April 15, the panel will call in experts from states that already have insurance exchanges, among them California, Massachusetts and Utah.
Massachusetts' exchange, set up under its 2006 first-in-the-nation mandatory health insurance law, buys private policies and then resells them to its residents.
Utah, by contrast, has a exchange that acts as a clearinghouse for insurers to sell their products in a transparent setting based on comparison shopping with uniform rules.
"In our view, the answer is probably somewhere in between Utah and Massachusetts in terms of what we're trying to accomplish with a health insurance exchange," Keck said.
A problem for Haley and state legislators is that they may have to decide whether to set up a health insurance exchange before federal regulations for the exchanges are in place.
"There's a lot of concern by states that they will choose to run their own exchanges, and then the federal regulations will come down, and many states will not agree with them," Keck said.
'A massive change'
A separate demand, starting to eat up hundreds of hours among Keck's staff, is preparing for as many as a half-million additional South Carolinians who may be eligible for Medicaid under the law.
Some of the new beneficiaries will be people who never have had private insurance but will be able to join the health care program for the poor thanks to raised income caps the law sets for adults.
Keck thinks tens of thousands of other S.C. residents, now covered by private insurers, also will flood onto the Medicaid program, either because their employers stop providing health insurance or because they choose to drop the plans that they now help pay for and switch to taxpayer-paid public coverage.
Fear that employers or employees would ditch private insurance for government coverage is the main reason DeMint and other Republicans oppose the law.
"To enroll 400,000 to 500,000 new individuals in a relatively short period of time is a very large and expensive task," Keck said. "That's a massive change in how we do business now."
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