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South Carolina and Health Reform

As you can imagine in your conservative state, health reform is not receiving the warmest welcome, but it still must take place in South Carolina. Many federal regulations have already caused the laws on health insurance to change, offering more care and coverage to citizens, with more laws on the way.

The state legislation recently signed a bill, the Freedom of Health Care Protection Act, to prevent anyone in the state from “enforcing or attempting to enforce such unconstitutional laws” and “establish criminal penalties and civil liability” for anyone to help health reform move forward in the state. If you couldn’t agree more with that bill, you’re living in the right place. However, the majority of Obamacare laws must be implemented and will change coverage for insurers and residents.

The GOP-led South Carolina government has opted against Medicaid expansion and for a federally-run exchange, leaving the remainder of health reform laws to take place regardless of the state’s stance. Health insurance in South Carolina has already experienced changes since 2010 when the law began to take its course. Insurers are now required to complete several tasks and avoid certain actions in order to stay in line with the federal law and provide more coverage. Consumers also have greater protections, allowing them to stay insured, especially when its most needed.


Current Health Reforms in South Carolina

South Carolina insurance companies have been asked to regulate their premium rates, not raising them by more than ten percent without having to face public questioning. Additionally, the medical loss ratio ensures companies do not spend more than 20 percent of premium income on company costs, putting the rest towards improving services and medical care. If a health plan does not comply with the 80/20 rule, they will either have to drop premium rates or send refund checks to all of their members. In 2012, the first year for rebates, about $19.6 million was refunded to privately insured South Carolinians, many of whom tried to find a way around accepting this extra money.

Insurers are also encouraged to provide free preventive care to any policyholder. This includes flu shots, cancer screenings, annual exams, and other services to keep you healthy and stave off any illness for which you are at risk. The law also cleared a larger number of preventive services for coverage, making women’s health care more available and affordable. A health plan cannot charge you copays, deductibles, or coinsurance for any approved preventive service.

Young adults up to age 26 have been given the option of staying on their parent’s health insurance in South Carolina and nationwide. As long as the dependent does not have access to coverage through their workplace, they may live out of the house, in another state, and be married without losing insurance. Within the first year of the ACA, 500,000 people in this age group stayed insured in South Carolina.

Limits on health benefits have also been removed under health reform. South Carolina insurers are no longer permitted to set lifetime maximums for any policyholder, which allows sick people to stay covered and not waste their money on an obsolete health plan. Annual benefit limits have also been restricted, set higher each year until eliminated entirely in 2014.

For people with health problems, a new risk pool was created to offer insurance while the law permitting them to buy any plan was carried out. South Carolina residents had access to the PCIP in order to gain coverage through the state until 2014 when the laws change. Individuals under age 18 cannot be rejected for private insurance under the ACA, regardless of their health status. Therefore, much of the risk pool was for adults who were declined or rated up for coverage.


Health Reform After 2014 in South Carolina

Once January 1, 2014 arrives, insurers and residents will have a slew of additional laws with which to comply. These include the individual mandate, requiring everyone in the state to have insurance or pay a tax on being uninsured. If you are too poor or your religion opposes insurance, you should be able to avoid the penalty, however. Obamacare also created a new form of health insurance in the state through the exchange, which will be open for enrollment in October 2013 and provide coverage to individuals and small businesses. South Carolina is allowing the federal government to take the reins on their state’s health insurance exchange, evading any responsibility for the program.

The exchanges will provide tax credits to those who apply with a certain income level. These subsidies will reduce premium rates and make coverage more affordable to those insured through the exchange plans, not private plans. Originally intending to establish Medicaid expansion as a non-optional endeavor, the law will only provide subsidies for people with income over 138 percent of poverty.

Individual health plans will be much more accepting in 2014, as they will not be able to decline an applicant for any reason. Exclusion periods and refusing to offer coverage for treatment of medical conditions will also be banned. Premium rates cannot be increased due to a person’s health status, occupation, or gender, as this is considered unjust, and can only be adjusted depending on age group and tobacco use.

All health plans statewide will have to include essential health benefits in their most comprehensive plans, which will be determined by the state. A minimum of ten different groupings of EHBs will be chosen by the state, and each of these categories will be covered through the exchange plans, as well. A few possible benefit groups to choose from are maternity and newborn care, hospital, prescriptions, preventive and disease management, and pediatric.

Medicaid expansion has been opposed outright by Gov. Nikki Haley, who claims the state will never expand Medicaid, especially not during this presidential administration. If they had, 350,000 more South Carolinians would be able to get insurance through the state-federal medical assistance program. Instead, the state’s Republican officials are working on an alternative, the “healthy outcomes” plan, which would assist between 7,000 and 10,000 individuals. Whether or not this insurance program materializes, the majority of the state’s low-income adults will be left in a bind.



Health Reform Updates

South Carolina Department of Insurance: Health Care Reform

South Carolina Healthy Connections Medicaid





1. Henry J. Kaiser Family Foundation. State Exchange Profiles: South Carolina.

2. Healthcare.gov. How the Health Care Law is Making a Difference for the People of South Carolina.