Health insurance in South Carolina
- Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
- Three carriers are offering health plans in the state’s exchange.
- Short-term health plans are available in South Carolina with initial plan terms up to 11 months.
- Uninsured rate at 10.5 percent in 2018, versus national average of 8.9 percent.
- The majority of South Carolina lawmakers are Republicans opposed to the ACA.
- South Carolina has not expanded Medicaid, leaving 101,000 people in a coverage gap.
- More than a million people – 20 percent of South Carolinians – are Medicare enrollees.
South Carolina health insurance at a glance
South Carolina’s federally facilitated exchange had just one insurer – Blue Cross Blue Shield of South Carolina offering plans in the exchange in 2018, but Ambetter (Absolute Total Care) joined the exchange for 2019 and Bright Health and Molina started offering plans for 2020. Premiums for existing plans changed very little from 2019 to 2020.
214,030 people enrolled in private individual market health plans through the South Carolina exchange during the open enrollment period for 2020 coverage. Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020. All of this applies to the individual market, so it does not affect people who get their health coverage from an employer or from the government, via Medicare, Medicaid, or CHIP.
Read our full overview of the South Carolina health insurance marketplace.
Medicaid/CHIP enrollment continues year-round for people who are eligible. South Carolina has not expanded Medicaid under the Affordable Care Act, which means the state’s pre-ACA eligibility guidelines still apply.
South Carolina fares poorly in overall health ratings
South Carolina ranked 41st out of the 50 states and District of Columbia by The Commonwealth Fund’s Scorecard on State Health System Performance in 2019.
The 2019 edition of America’s Health Rankings also placed South Carolina in the bottom quartile, at 42nd out of the 50 states in terms of overall health.
How has Obamacare helped SC?
According to US Census data, the uninsured rate in South Carolina was 15.8 percent in 2013, and 10.5 percent in 2018 (although it had been lower — at 10 percent — as of 2016; the national average uninsured rate has crept back up during the Trump administration).
South Carolina leadership’s opposition to the ACA means the state has thus far refused to expand Medicaid, so a cornerstone of the law’s ability to reduce the uninsured rate is not being utilized. A Kaiser Family Foundation analysis estimates that there are 101,000 people in the coverage gap as a result of South Carolina’s refusal to accept federal funding to expand Medicaid.
But the ACA has made comprehensive individual market coverage more affordable for South Carolina families with income between the poverty level and 400 percent of the poverty level. Nearly 179,000 South Carolina residents were receiving premium subsidies in 2019 that amounted to an average of $602/month. After the subsidies, those enrollees had average net health insurance premiums of just $62/month.
South Carolina and the Affordable Care Act
South Carolina’s US congressional delegation is comprised almost entirely of Republicans as of 2020. The GOP has both Senate seats, and five of the seven US representatives are Republican. Rep. Jim Clyburn, from the 6th District, and Rep. Joe Cunningham, from the 1st District, are the lone Democrats. Cunningham and Clyburn support the ACA, and Cunningham campaigned on additional health care reform proposals, including lowering the Medicare eligibility age to 55, allowing Medicare to negotiate with drug manufacturers, and limiting skimpy policies like short-term health insurance.
Lindsay Graham, South Carolina’s Senior Senator, was instrumental in Senate Republicans’ last-ditch effort to repeal the ACA in September 2017 via the Graham-Cassidy Amendment. But Graham noted after the effort failed that he had essentially no understanding of health policy, saying “Well, I’ve been doing [healthcare reform policy] for about a month. I thought everybody else knew what the hell they were talking about, but apparently not.”
Henry McMaster is the current Governor of South Carolina, and won his re-election campaign in 2018. McMaster was Attorney General in South Carolina before becoming lieutenant governor and then governor. During his time as AG, McMaster organized a legal challenge against the ACA.
South Carolina also has a strong Republican majority in both chambers of the state legislature.
South Carolina Medicaid/CHIP enrollment
South Carolina has no pending plans to expand coverage, despite tireless work on the part of consumer advocates. The ACA would have expanded Medicaid to cover all legal residents with incomes up to 138 percent of poverty. But in 2012 the Supreme Court ruled that states could opt out of Medicaid expansion, and South Carolina has been steadfast in its rejection of federal funding to expand Medicaid. Because the state refused to expand Medicaid, South Carolina has 101,000 people in the coverage gap, with no access to financial assistance with their health insurance.
Roughly 214,000 additional people would be eligible to enroll in Medicaid if the state were to expand coverage guidelines. But instead, enrollment is still contingent on South Carolina’s strict eligibility guidelines: Non-disabled adults without dependent children are ineligible regardless of income, and parents with dependent children are only eligible if their household income doesn’t exceed 62 percent of poverty (a little over $1000/month for a family of three).
South Carolina officials have said that instead of expanding Medicaid, they are focusing on their Healthy Outcomes program, which helps chronically ill people without health insurance get access to treatment through free clinics and hospital charity programs. Unfortunately, the program can only assist about 8,500 people – a tiny fraction of the people who are in the coverage gap in South Carolina.
Read more about Medicaid expansion in South Carolina.
South Carolina’s CO-OP
In 2014 and 2015, South Carolina residents could buy health insurance through Consumers Choice, the state’s Consumer Oriented and Operated Plan (CO-OP). The CO-OP was funded under the ACA with a grant from the federal government.
Nationwide, about $2 billion was awarded to CO-OPs in 22 states. In South Carolina, Consumers’ Choice Health Plan (CCHPSC) received about $87.6 million. However, by November 2015, officials had announced its closure. As of 2020, there were only four remaining CO-OPs offering plans in five states (all four of those CO-OPs appear to be fairly stable as of 2020, and there haven’t been any CO-OP closures since 2017).
Short-term health insurance in South Carolina
South Carolina has its own state regulations regarding short-term health plans – and short-term plan terms can’t last more than 11 months in the state, with a total duration of 33 months (including renewals).
Read more about short-term health insurance in South Carolina.
Does South Carolina have a high-risk pool?
Prior to 2014, individual health insurance was underwritten in nearly every state, including South Carolina. This meant that pre-existing conditions could prevent an applicant from getting coverage, or could result in significantly higher premiums or policy exclusions.
The South Carolina Health Insurance Pool was created in 1989 to give people an alternative if they were unable to obtain individual health insurance because of their medical history.
Implementation of the ACA and a guaranteed issue individual market has made high-risk pools largely obsolete, but the South Carolina Health Insurance Pool is still operational. This is partially due to the fact that the pool provides Medicare Supplement coverage to Medicare beneficiaries who are unable to qualify for medically-underwritten Medigap plans (this includes any Medicare beneficiary who is disabled and under the age of 65, since federal rules don’t provide any sort of Medigap guaranteed-issue provision for this population).
Medicare enrollment in South Carolina
By the end of 2019, there were 1,083,718 South Carolina residents enrolled in Medicare.
State-based health reform legislation
Scroll to the bottom of this page for a summary of recent South Carolina bills related to healthcare reform.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.