South Carolina ranks 45th in access to health care even with more people insured than ever before

Beth Weddle found the policies and options on HealthCare.gov too overwhelming when she first tried to sign up for health coverage under the Affordable Care Act (ACA) marketplace in 2015.

She quickly sought help from a navigator and found a plan that worked for her needs.

The 62-year-old North Charleston property manager has had three surgeries in the past couple of years, relating to various problems with her neck and bladder. Her previous employer-provided health plan had a deductible of $5,000, a limit she says would have left her in the red had she gotten the care she needed.

“It had come to be $2,700 a quarter to have the insurance, and my deductible was so high that I was paying for insurance and I wasn’t able to use it,” Weddle said.

Weddle’s current ACA marketplace plan with BlueCross BlueShield of South Carolina however, includes add-ons for dental, vision, and extended hospital stays, and has a deductible of only $250, but a monthly premium of $974.

And if that seems high, it won’t get better any time soon. The South Carolina Department of Insurance approved an average rate increase for ACA marketplace policies of 31.33 percent for 2018. BlueCross BlueShield, the only insurer left in the marketplace for the state, justified the increase with a number of reasons. One was the Trump administration’s war against the ACA, evidenced by the White House’s announcement in October that it would end the $7 billion cost-sharing reductions that helped low-income consumers purchase insurance. Another reason was speculation that the individual mandate — the part of the Affordable Care Act that forces Americans to either buy insurance or face a penalty if their income allows it — might soon be repealed.

Weddle, for one, got word that her current monthly premium would jump to about $1,100.

Despite the burdensome price tag, she says she’s “absolutely” happy with her marketplace plan.

“No, I’m not happy with the premium at all, but whenever you compare it to what [I] had before, it’s better,” she says.

The uncertainty surrounding President Obama’s most contentious achievement does not seem to deter residents of the Palmetto State from signing up for what’s commonly referred to as ObamaCare. Open enrollment for 2018 ended on Fri., Dec. 15 and the number of people in South Carolina who signed up for policies offered in the exchange went up by 17 percent in the period between Nov. 1 and Dec. 9 as compared to the same period in 2016, according to data from the Palmetto Project, a nonprofit that helps people sign up for plans in the federal marketplace.

“It feels fast and furious to us,” said Palmetto Project director of programs Shelli Quenga in an interview with CP two days before open enrollment ended. “Our schedules are packed, and our folks are out in the community doing enrollments and providing as much assistance as they can.”

Non-profits, activists, and individual consumers are left with the task of promoting and maintaining a functioning market amidst curveballs from federal and state governments.

“Not in South Carolina,” said former Gov. Nikki Haley at the 2013 Conservative Political Action Conference. “We will not expand Medicaid on President Obama’s watch. We will not expand Medicaid ever.”

Actions that effectively stifle the law have made South Carolina the 45th state in terms of overall access to health care based on six metrics, according to a new study released last week by The Commonwealth Fund. The Fund’s senior scientist, David Radley, cites the lack of a Medicaid expansion as the number one culprit in the state’s low ranking.

“We see that states that expanded Medicaid had a much greater reduction in the number of uninsured people than states that didn’t,” Radley said in a phone interview with CP.

Ultimately, a combination of a strong state Medicaid program and ACA-enacted protections seem to help consumers the most. That’s exactly what Janene Smith learned when her daughter was born prematurely in January 2011.

Smith was covered through her husband’s small business group plan. When the business switched insurance companies to save money midway through Smith’s pregnancy, ACA provisions meant that the new insurer could not deny Smith coverage based on her pregnancy — considered a pre-existing condition under the old rules.
Insurance helped Smith cover her five-and-a-half week stay in the hospital following an emergency C-section, a value that she estimates to be between $150,000 to $200,000. After her daughter Violet was born, weighing in at one pound, her 10-month hospital stay was partly covered by Medicaid’s Katie Beckett waiver, a provision created for children with disabilities, which kicked in after 30 days of care.

Smith could have easily been denied private coverage had ACA protections not been in place, leaving a gap of 30 days of hospital costs at TKTKTKTK before Medicaid stepped in.

“We would’ve been responsible for that,” Smith said. “I would have never expected to have such a terrible experience with health care. You cannot be prepared, without insurance, to face these things.”

Now, more South Carolinians are better equipped to handle emergencies than ever before. Data from The Commonwealth Fund study reveals that South Carolina’s rate of uninsured adults ages 19-64 dropped from 23 percent in 2013 to 15 percent in 2016. At the same time, panic shakes up the market and creates a sort of self-fulfilling prophecy, with insurers expecting a collapse and raising premiums or pulling out of state marketplaces, and healthier, younger consumers opting out of signing up due to fear of rising costs.

“It’s a brand new market, it’s only three years old,” Radley said. “I don’t think people gave the market enough time to mature before they started critiquing it.”

The latest example of federally-influenced instability comes from Senate Republicans’ plan to include a repeal of the individual mandate in their new tax bill. If it passes, unsubsidized marketplace premiums in the state would rise by $923 a month by the year 2027.

Marketplace navigators say consumers are still surprised by how low their premiums are.

“They don’t realize the level of assistance they need,” said Quenga from the Palmetto Project. “The prices did go up a lot, but the tax credit also went up by the same amount, so the consumers are really shielded by that increase.”

In the meantime, 123,000 people in South Carolina remain in the coverage gap — “too rich” for Medicaid and too poor to afford health plans in the ACA marketplace.

“Try telling someone they’re not eligible for care,” Quenga said. “Because Governor Haley decided you didn’t need it.”