Feb. 21--COLUMBIA, SC -- South Carolina's proposed Republican alternative to Obamacare -- paying hospitals to keep poor people out of emergency rooms -- "is not a solution to our crisis," the chief executive of the Midlands' largest hospital said Thursday.

But some of the state's other large hospitals, including the Greenville Hospital System and MUSC, called the plan by S.C. House Republicans an acceptable alternative to expanding Medicaid, the joint federal-state health insurance program for the poor and disabled.

The federal government wants South Carolina to expand its Medicaid program to cover anyone who makes less than 138 percent of the federal poverty level, or about $15,000. But the state's Republican leaders -- who control the S.C. House, Senate and Governor's Office -- have refused, saying that expansion would cost too much.

Instead, House Republicans this week put forward an alternative plan that would pay hospitals up to $35 million to steer uninsured patients to community health centers, free health clinics and rural health clinics. Lawmakers also pledged to give those health centers and clinics an extra $10 million in state money to care for those uninsured patients.

Those clinics, which the state gave $1.8 million this year, hailed the plan Thursday.

"The new plan is a positive alternative if the state does not decide to participate in the Medicaid expansion," said Lathran Woodard, chief executive of the S.C. Primary Health Care Association.

But the $35 million that S.C. Republicans propose to give hospitals will not come close to offsetting the amount they will lose if Medicaid is not expanded, said Charles Beaman, chief executive of Palmetto Health.

Beaman said the Affordable Care Act will cut federal payments to S.C. health care providers by an estimated $2.6 billion -- cuts that were supposed to be made up through Obamacare's expansion of Medicaid and its insurance payments.

"We believe Medicaid expansion in South Carolina is the right thing to do, and we encourage the state Legislature to move forward with it," Beaman said.

Beaman was joined by the S.C. Hospital Association, which put out a statement saying expanding Medicaid "is an integral part of meeting the challenges we face in improving the health status of our state."

But Howell Clyburn, vice president of community and governmental affairs for the Greenville Hospital System, said the proposal put forward by House Republicans is a good alternative.

"We support Medicaid expansion, but this is another way," Clyburn said. "It puts revenue into the hospitals and it clearly shows a willingness for all of us to work together."

The House Republican plan also would spend more than $30 million in rural areas of the state: $20 million to cover the cost of unreimbursed medical care given low-income patients at rural hospitals, $3 million to encourage doctors to work in underserved areas; and $8 million to expand the MUSC program in which doctors treat patients via video.

"In a time of limited resources, the committee is targeting its appropriations judiciously to areas of great need and this bodes well for improving the health status of our state," MUSC president Ray Greenberg said.

Some Democrats say they too like the plan, but warn Republicans it is not a cure for the state's health care funding problems.

Republicans plan to pay for their plan using $62 million in one-time surplus money -- money that is not guaranteed to be available next year, said state Rep. Harry Ott, D-Calhoun.

"They have no plan on how they would sustain this program going forward," Ott said. "If they were really serious... put this as a recurring line in the budget to pay for these things."

But House Ways and Means chairman Brian White, R-Anderson, said the plan will save the state money, money that can pay for the program in future budgets.

"If you keep people out of the emergency room and move them into the doctor's office, you are going to have some significant cost savings, and you can continue to pay for it with cost savings," he said.

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