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South Carolina health insurance exchange

SC average rate increase just 1%; Assurant joining exchange

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  • October 31, 2014

South Carolina Rates and carriers

Assurant is joining the South Carolina exchange for 2015, and will bring the total number of carriers in the exchange to five.  Assurant joins the four companies that were already offering health insurance through the federally-run marketplace in South Carolina:Blue Choice Health Plan, Blue Cross Blue Shield of South Carolina, Consumers’ Choice Health Plan and Coventry Health Care of the Carolinas. (this page has more information about the participating carriers).

A preliminary report released by the U.S. Department of Health and Human Services (HHS) found premiums in South Carolina to be higher than the national average in 2014. In South Carolina, the average cost for the least-expensive bronze plan is $267 a month before tax credits or subsidies. The national average for the lowest cost bronze plans is $249 a month.

But things are looking good for 2015.  Rate changes were filed by South Carolina insurers in September, and the state Department of Insurance has already released some preliminary information on the new rates.  While there appears to be a large range in the upcoming price changes – decreases of up to 35 percent, and increases that range as high as 39 percent – the overall average rate change looks like it will be an increase of only about one percent.

2014 enrollment numbers

By April 19, 118,324 South Carolina residents had completed their private plan Obamacare enrollments in the exchange (HHS will provide an updated total in November).

In addition, 28,359 exchange applicants had enrolled in Medicaid, qualifying under the state’s existing guidelines (South Carolina has not expanded Medicaid under the ACA).

HHS released a report in June detailing average after-subsidy premiums in the federally facilitate marketplaces, and South Carolina is very much in line with the national averages:  87% of enrollees in the SC exchange received a subsidy, the same as the overall percentage across the 36 HHS-run exchanges.  And the average after-subsidy premium in SC is $84, just two dollars higher than the average across all 36 states

No Medicaid expansion

US Rep. James Clyburn (D – SC) views the ACA as the “Civil Rights Act of the 21st century” and is calling on South Carolina to embrace the law (including Medicaid expansion, which SC lawmakers have thus far resisted) and all that it can offer to the state and its residents.

In his article, Rep. Clyburn notes that SC ranks 43rd in the US in terms of overall health, and points out the myriad ways that the ACA can help to improve residents’ health.

In large part because of the state’s failure to expand Medicaid, the uninsured rate in South Carolina is still higher than the national average.  According to a Gallup poll released in August, 18.7 percent of state’s population was uninsured in 2013.  That rate stood at 16.8 percent as of mid-2014.

Compounding the problem created by the lack of Medicaid expansion in South Carolina, the state’s community health clinics are facing a significant cut in funding by 2016 if the federal government does not re-authorize a five-year trust that was created by the ACA and has been providing funds for community health clinics around the country.  It would need to be reauthorized by October 2015, but officials are not sure that is going to happen.  In SC, where 194,000 people are in the “coverage gap” because the state has not expanded Medicaid, the community health clinics fill a vital role in providing treatment on a sliding fee scale.  But their ability to continue to do is uncertain.

But there is one small sliver of good news in the South Carolina Medicaid program:  starting on December 1, adults who are covered by Medicaid in South Carolina will have coverage for preventive dental coverage, fillings, and extractions with up to $750 in services available for each member per year.

Leadership’s opposition to the ACA

Given Gov. Haley’s outspoken opposition to the Affordable Care Act, it is no surprise that the federal government is running the health insurance marketplace in South Carolina. Haley announced her decision in November 2012.

Despite the fact that nearly 20% of the population in South Carolina is uninsured, the state made headlines in 2014 thanks to anti-ACA legislation.  They started with a bill that would have effectively prohibited the implementation of the the ACA in the state.  

The curiously-named South Carolina Freedom of Health Care Protection Act (H3101) would have blocked state employees from participating in the exchange and would have reimbursed residents facing an IRS penalty for not complying with the ACA’s individual mandate.  The bill passed the SC House last spring, and Governor Nikki Haley supports the legislation.  However, it failed a second reading in the Senate on March 19.  

Republican lawmakers in SC aren’t giving up on their efforts to nullify the ACA though – Senate Republican Tom Davis introduced an amendment to the bill in early March in an effort to continue to fight against the law in a state that desperately needs the ACA.  But in early May, the SC Senate voted 23 – 19 to table the amendment.  Davis believes that Senate Republicans (with a majority) “didn’t deliver“, but uninsured and underinsured South Carolina residents probably see things a little differently.

Grandmothered plans

South Carolina was quick to accept President Obama’s policy cancellation compromise that allows carriers to extend existing plans that had been scheduled to terminate at the end of 2013.  And when HHS extended that proposal in early 2014, South Carolina was once again among the majority of states that opted to allow grandmothered plans to renew into 2015.

It’s now up to each carrier to determine whether they wan to allow their pre-2014 plans to continue to be eligible for renewal.  This gives many people – who had individual coverage prior to 2014 – another alternative to compare with the options available in the exchange, but some critics contend that it keeps healthy people out of the new ACA-compliant insurance pools.


Three federally funded groups launched training programs and outreach campaigns in 2013 to help consumers understand their options. DECO Recovery Management, Cooperative Ministry, and the Beaufort County Black Chamber of Commerce all received grants to hire “navigators.” Navigators provide unbiased information about the options available through the marketplace and help consumers through the enrollment process, but cannot be directly or indirectly paid by insurance companies.

South Carolina was among the states that received the least amount of federal funding in the initial planning grants – the state got $1 million.  This is a thousand times less than the $1 billion that California received (and several other states got hundreds of millions), but is predicated on the state’s refusal to promote the ACA – the money wouldn’t have been utilized by the South Carolina government.

Employee choice delayed in SHOP exchange

South Carolina is among the 18 states where the “employee choice” feature of the SHOP exchange has been delayed another year – from 2015 until 2016.  This benefit will eventually allow employees to select from among a broad range of plans selected by the employer, but until 2016, there will be only one plan available for employees to select.

South Carolina health insurance exchange links

State Exchange Profile: South Carolina
The Henry J. Kaiser Family Foundation overview of South Carolina’s progress toward creating a state health insurance exchange.

South Carolina Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(800) 768-3467  /