Largely resistant to the Affordable Care Act, South Carolina opted for a federally facilitated health insurance exchange and continues to refuse Medicaid expansion.
Has this resistance impacted public health and realistic, affordable access to healthcare in the Palmetto State? This brief guide examines residents’ overall health, access to health insurance, and the state’s approach to healthcare reform:
South Carolina health ratings
South Carolina ranked 40th out of the 50 states and District of Columbia by The Commonwealth Fund’s Scorecard on State Health System Performance in 2015. The state was scored on health indicators related to five measures: Access, Prevention & Treatment, Avoidable Hospital Use & Costs, Healthy Lives, and Equity.
With one of the nation’s 10 highest uninsured rates and a significant percentage of adults who skipped healthcare in the past year due to cost, South Carolina performed poorly in the Access measure. If the South Carolina improved to the level of the best-performing state, then 431,375 more adults would be insured and 404,183 fewer adults would go without needed care because of cost.
Additional details showing how the state was rated are available in the South Carolina scorecard.
The 2015 edition of America’s Health Rankings placed South Carolina squarely in the bottom quartile, at 42nd out of the 50 states in terms of overall health.
The state’s rating is helped somewhat by a relatively moderate disparity in health status and a somewhat low number of preventable hospitalizations. But the state’s public health challenges are formidable: A quarter of the population is physically inactive, and South Carolina has one of the nation’s higher uninsured rates. The state ranks in the bottom 20 for public health funding and the number of primary care physicians and doctors.
Trust for America’s Health provides more data on overall public health in South Carolina in their 20156edition of Key Health Data About South Carolina, which includes information on specific diseases and health factors. The Robert Wood Johnson Foundation has also compiled health data in South Carolina and broken it down to a county level; you can use this interactive map to see how the counties in South Carolina rank against one another.
How has Obamacare helped SC?
According to US Census data, the uninsured rate in South Carolina dropped from 15.8 percent in 2013 to 13.6 percent in 2014. Gallup survey data pegged the initial uninsured rate higher, at 18.7 percent, but found that by late-2015, the uninsured rate had dropped to 12.3 percent. The nation’s average dropped from 17.3 percent to 11.7 percent in the same time period.
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. The ACA has benefitted the 231,849 people who enrolled in coverage through the exchange (in both existing Medicaid/CHIP and private plans) during 2016 open enrollment, but there’s still a long way to go.
2017 SC health insurance plans and carriers
When 2017 open enrollment begins, South Carolinians will find just two carriers offering plans through the state’s federally facilitated health insurance exchange. The insurers and their proposed average rate increases are as follows:
- BlueChoice:36 percent
- Blue Cross and blue Shield of South Carolina:74 percent
Aetna (Coventry) and UnitedHealthcare previously offered plans through South Carolina’s exchange but will not be returning in 2016.
South Carolina qualified health plan enrollment
In November 2013, the Kaiser Family Foundation estimated that 491,000 people could potentially buy qualified health plans (QHPs) through South Carolina’s health insurance exchange, and that 336,000 of them would qualify for premium subsidies.
By the end of the third open enrollment period, January 31, 2016, a total of 231,849 people had enrolled in private plans through South Carolina’s exchange. This was a 10 percent increase over 2015 enrollment. Of the 204,846 effectuated enrollees on March 31, there were 91 percent receiving premium subsidies that averaged $312 per month.
2017 open enrollment begins November 1, 2016, and runs through January 1, 2017.
South Carolina and the Affordable Care Act
In 2010, both of South Carolina’s U.S. senators, Republicans Jim DeMint and Lindsey Graham, voted no on the ACA. In the U.S. House, four Republican representatives from South Carolina voted no, while two Democrats voted yes. Only one of them, Jim Clyburn, is still in office and is the lone Democrat in South Carolina’s current U.S. congressional delegation, which includes two Republican senators and six Republican representatives.
Gov. Nikki Haley is also fiercely opposed to the ACA, calling it “disastrous” and vowing to “continue to fight ObamaCare every step of the way.” Haley has a state legislature with a strong Republican majority, so her efforts to block ObamaCare in South Carolina have been largely successful. The state defaulted to a federally run exchange, and has refused to expand Medicaid.
South Carolina Medicaid/CHIP enrollment
South Carolina is currently one of 19 states that has not yet expanded Medicaid and has no pending plans to do so. 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 Governor Haley has steadfastly refused expansion.
Despite this, total Medicaid/CHIP enrollment in South Carolina has increased by 10 percent from 2013 to June 2016, largely as a result of outreach and education due to the ACA.
The general consensus is that states like South Carolina will eventually expand Medicaid because of the economics involved. The question is really when, rather than if. But in states where political leadership is strongly opposed to Obamacare, South Carolina Medicaid expansion could still be several years away.
Roughly 224,000 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).
Because the state refused to expand Medicaid, South Carolina has 123,000 people – about 17 percent of its uninsured population – in the coverage gap, with no access to financial assistance with their health insurance. These residents would be eligible for Medicaid if the state were to accept federal funds to expand coverage. But for now, there are no realistic insurance options available for people with incomes below the poverty level who do not qualify for Medicaid under the state’s existing guidelines.
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.
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 August 3, 2016, there were only seven CO-OPs remaining.
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 and does not yet have plans to terminate coverage. HIPAA-eligible and TAA-eligible (Trade Adjustment and Assistance Act) enrollees can still obtain coverage in 2015 and 2016. While SCHIP is still available for these applicants, they can also get policies in the individual market now, without having to worry about pre-existing conditions.
Medicare enrollment in South Carolina
South Carolina Medicare enrollment reached 941,169, about 19 percent of the state’s population, in 2015. As of 2013, South Carolina Medicare enrollment broke down as follows: 81 percent of beneficiaries were eligible based on age alone, while the other 22 percent qualified as the result of a disability.
Those who want additional benefits beyond what original Medicare includes may select a Medicare Advantage plan instead of traditional coverage. In South Carolina, nearly 23 percent of Medicare recipients make this choice compared with 31 percent of all Medicare recipients.
Medicare Part D plans are also an option for South Carolina Medicare beneficiaries who want to stand-alone prescription drug coverage. Roughly 49 percent of South Carolina Medicare enrollees also have a stand-alone Rx plan compared with 45 percent of all Medicare enrollees.
State-based health reform legislation
Here’s a summary of recent South Carolina bills related to healthcare reform: