S.C. population of those with health coverage grew in 2018

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The number of people without health insurance coverage in South Carolina fell in 2018, the U.S. Census Bureau reports. The Palmetto State is one of three states, including Wyoming and New York, in which the number of uninsured residents dropped in 2018.

The uninsured rate in S.C. fell .5 percentage point from 2017 to 2018, despite the state’s refusal to expand its Medicaid program, according to the report. The number of South Carolinians without health insurance fell by 20,000, from 542,000 to 522,000, between 2017 and 2018.

Nationwide, the number of Americans without health insurance increased to 27.5 million in 2018, the first time the nation experienced an increase year-to-year since the Affordable Care Act was enacted.

“In general, the uninsured rate in states that expanded Medicaid eligibility prior to January 1, 2018, was lower than states that did not expand eligibility,” according to the Health Insurance Coverage in the United States report.

The Census Bureau compiles the quantitative figures in the report, but it’s up to interested parties to interpret the factors behind the numbers.

Examining the numbers

While the numbers are encouraging, University of South Carolina Darla Moore School of Business associate professor Robert Hartwig said they have to be put into perspective with national statistics.

“We still have to understand that the portion of South Carolinians without health insurance is much higher than it is in the United States overall — 10.5% versus 8.5% — even with the improvement in South Carolina and the deterioration elsewhere,” he said.

Hartwig is the director of the school’s Center for Risk and Uncertainty Management. As an economist, he’s studied the numbers and researched possible causes. Comparing S.C. to Wyoming and New York, the other two states that saw a drop in uninsured residents, Hartwig found no common factors. But he thinks S.C.’s economic growth could have caused the decline.  

“South Carolina is a state that has been a growth leader in terms of jobs. And it has produced significant in-migration to the state — people moving from other states to South Carolina for jobs — particularly in areas like manufacturing and construction,” he said. “And these jobs tend to have health insurance as a benefit.”

S.C. Department of Insurance Director Ray Farmer also suspects that the decrease of uninsured S.C. residents reflects the state’s recent economic growth.

“The economy in our state has been strong for a number of years, and I think this is probably a reflection of that,” he said. “We have seen slight growth in the individual and the group market, and I think it points toward more people working and more people insured.”

The decline also comes after a provision of the Tax Cuts and Jobs Act of 2017 that took effect in 2018 removed the individual mandate from Affordable Care Act coverage. Americans will not be penalized by the IRS for not having health insurance coverage.

The state’s health care industry pays close attention to the uninsured rate. The higher the number of uninsured in S.C., the more uncompensated care hospitals are likely to undertake and have to subsidize, industry insiders say.

“Our goal is always to expand and increase health coverage, so we look at that number every year and use it as a barometer to try and understand what reimbursements are going to look like each year,” said Schipp Ames, VP of communications, education and member services for the South Carolina Hospital Association.

Although the state’s uninsured decreased by just half a percentage point, Ames said any decrease affects health care. Ames said S.C. is one of the few states that has bucked national trends by increasing the number of people who have signed up for insurance exchanges offered through the Affordable Care Act, with more than 200,000 people have signed up for health insurance coverage through the ACA marketplace.

“The Affordable Care Act is interesting in that it provides coverage to those with low incomes, but once you start to make more money, you move out of qualifying for a subsidy,” he said. “So you could make the argument that as the economy improves, you have more folks who are moving off of Medicaid, who are moving off of subsidized plans, but may not have a job that provides them insurance, or they may not be able to still afford insurance without the subsidy, or without the help of Medicaid that they had before.”

Looking to the future

Hartwig is concerned that the number of uninsured will increase again now that the individual mandate for coverage has been lifted. He said some employees may drop their coverage if there is no longer a penalty for not having it, or employers may stop offering coverage.

To keep the system cost-effective, Hartwig said business should continue to offer employee health care plans and encourage all employees of all ages to participate. Plans that include wellness benefits and incentives or discounts such as gym memberships or meal plans can make healthier employees who don’t need to use their medical benefits as often, he said.

“Employers benefit from that, not only to lower health care costs, but decreased disability costs and decreased workers compensation costs, increased productivity and a variety of other measures that, overall, accrue to the benefit of the employer and the employee alike,” he said.

The hospital association plans to continue to study the change in numbers to determine if it’s an anomaly or a trend. It is also working to increase the number of people in South Carolina who have health insurance coverage. Since a reduction in federal funding to promote open enrollment in the ACA marketplace exchanges, Ames said medical advocacy groups nationwide are on their own to fill the void.

Earlier this month, Molina Healthcare of South Carolina announced it will be offering marketplace plans in 20 counties in 2020, as well as Medicare dual-special-needs plans in 43 counties.

Blue Cross Blue Shield South Carolina is the only company that offers marketplace plans statewide. Customers in Charleston County have the option of Absolute Total Care. Aetna withdrew from offering plans in the S.C. marketplace in 2016.

“We believe that South Carolina is an attractive market for Marketplace and Medicare DSNP expansion,” a Molina spokesperson said in an emailed statement. “These new offerings complement our existing Medicaid and Duals plans well, and they reflect Molina’s commitment to offering high-quality and affordable health care coverage to members at different points in their lives.”

Ames said the more providers offering plans in the state, the more advocates there are to encourage residents to get coverage.

“You also have more options and more choice, which is something we’re more and more learning is what consumers want,” he said. “So we do think that adding more providers and more choices for consumers can increase health coverage.”

To make up for the lack of national publicity for the 2020 open enrollment period in the ACA marketplace, which runs from Nov. 1 through Dec. 15, individual states and members of the local healthcare industry are running their own campaigns.

“Since there are not as many resources available to promote the Affordable Care Act, we’re working with communities, with hospitals, to have open enrollment events,” Ames said. “We’re trying to go to events that already exist — think the Okra Strut in Irmo, or the Peanut Festival in Florence — and we’re just trying to get out and be a voice advocating for health coverage.”

This article first appeared in the Oct. 21 print edition of the Columbia Regional Business Report.