Q and A with Thomas C. Alexander, South Carolina Senator

December 20, 2017

Program:  Reforming States Group

Thomas C. Alexander began his public service career in 1986, when he was elected to the South Carolina House of Representatives from District One, Oconee-Pickens County. In 1994, he became a state senator. A successful businessman, Alexander is the chairman of the Senate Labor, Commerce and Industry Committee and heads the Health and Human Services Subcommittee of the Senate Finance Committee. He has been participating in the Reforming States Group (RSG) for 14 years, has been a member of its Steering Committee for nine years, and past co-chair in 2015 to 2016. The Fund recently spoke with the Senator about his work as a state health policy leader in South Carolina and how the RSG has helped shape his approach.

There’s a lot of talk about state flexibility in health policy today. As a state leader, how are you trying to influence how your state develops its health policy agenda?
I approach this in several ways. I focus on areas where help is needed. I make sure that policy is evidence-based. And I try to be strategic, striving to get better outcomes with our resources. Let me give you some examples. We have data that demonstrates where the hot spots are in our state. For example, in rural areas, we’re seeing less access rather than more. Some hospitals have closed down and we need to make sure that there’s still some kind of front-line care. We have provided funding to try to meet the needs of rural communities with programs that reduce chronic illness. I supported funding for a solar-powered mobile health clinic operated by the Sullivan Center at Clemson University. It’s designed to be multi-functional and takes medical care to rural areas of the state. Last year, after Hurricane Mathew, we mobilized the clinic to help in disaster communities.

We are also making use of telehealth—communications systems that allow a physician to remotely diagnose and evaluate patients. This improves access to medical care—especially for those in rural settings—while also lowering costs. We’re working with the Department of Health and Human Services and the Department of Mental Health—we have great partnerships with them. We’ve had grants and private sector support. To me, these things are all about partnerships, communities, and professionals working together. In fact, the Medical University of South Carolina recently received a $600,000 grant and was named one of two national Telehealth Centers of Excellence in the United States by the US Department of Health and Human Services, an achievement we’re proud of.

Can you elaborate on the process by which you and other state leaders reached these accomplishments?
Take our work in aging. We are in the process of transitioning the Office of Aging to a cabinet-level agency. It’s currently housed in the Lieutenant Governor’s office. Changing it will elevate it. Right now, there are several fragmented offices that deal with our aging population. Working with stakeholders, we are looking at how we can incorporate all these programs into one office so that consumers will have one source to go to for all their resources and care. We have several working groups and are trying to unify the programs. It’s been crucial to bring along all the agencies dealing with aging as stakeholders as we do this work.

Are there any other aspects of your approach that you could comment on?
I learned early on to respect other people’s views. We all have different perspectives and we have to take that into account. I try to take a bipartisan approach from the beginning of the process, regardless of the topic we’re working on. I don’t wait until the middle or the end of a project to bring in bipartisan views. I have had success with various parties having a dialogue early on. That way you know the background and input of those you’re with—and can, to the best of your ability, work toward what you’re trying to accomplish. It’s an easy thing to overlook, but it’s worth the effort. Bipartisanship requires mutual respect. You have to find ways to listen to each other and have regard for other folks’ opinions even when you don’t share their views.

What role has the RSG played in your work?
The RSG’s evidence-based approach has its fingerprints on a lot of the things I’ve been able to do in South Carolina. It’s the gold standard of evidence-based programs, and that kind of information is vital to the evaluation of any policy. From the Appalachian Mountains to the midlands to the coast, we have a variety of needs in South Carolina. The RSG has done a tremendous amount of work on chronic illnesses, we’ve relied heavily on that information to move us forward in that area. It has also provided the foundation for me to keep in step with the future needs of the aging population—and given us the opportunity to plan. There are so many examples of what other states have done successfully—work on prison populations and health, on behavioral health integration, to name a few—that have helped us.

I learned from the RSG the importance of addressing behavioral health, of looking at the well-being of the whole person. There’s not a separation between behavioral health and physical health. RSG meetings emphasized the need to deal with these issues earlier rather than later in a person’s life and that’s why we’ve started with elementary school. I’ve been a leader in expanding elementary and middle school behavioral health services that will improve the ability of emotionally disturbed children to develop into well-functioning adults. Our government is providing funding to partner with school districts so that kids can get services in school settings. We take these services to where students are because transportation is often a key barrier to treatment. The program is available in over half the public schools in South Carolina. I’m not aware of any other state with a reach that large.

An RSG meeting is time well spent being involved with peers across the country. They bring folks together, to learn from one another. And the issues we discuss ensure that we remain on the forefront of health policy.