Since its beginning in 2000, the South Carolina Small Business Chamber of Commerce (SCSBCC) has been the state’s leading business advocate for making health insurance more affordable. During the decade of the 2000s, double digit increases in group health insurance premiums were recognized as unsustainable and had resulted in less than 40% of small businesses being able to offer employees health insurance.
The SCSBCC recognized the crisis in health care/insurance cost was its top priority. Affordable health care/insurance was essential to lower personnel costs to small businesses, make small businesses more competitive for retaining skilled workers and promote a healthier workforce.
The 850,000 South Carolinians uninsured were driving up the insurance premiums for the insured. This uncompensated care for the uninsured was determined to contribute about $1000 in extra premium annually to family coverage. It was clearly an imperative for all South Carolinians to have some form of health insurance that they could afford.
The SCSBCC launched a decade long effort to seek health insurance reform at the state and federal level. Working with the SC Appleseed Legal Justice Center, AARP-SC, SC Fair Share and other non-profit organizations these efforts culminated in successful state legislation and the passage of the Affordable Care Act by Congress in 2010. The result has been a stabilization of the health insurance market and smaller premium increases. At the end of this section is a review of how the Affordable Care Act has benefited South Carolina through during the first 5 years.
A Chronological Summary
2000—The SCSBCC and co-sponsored a series of small business forums with the South Carolina Governor Jim Hodges’ Office. From these meetings around the state the cost of health insurance was identified as a priority issue needing to be addressed.
2002—The SCSBCC president and founder Frank Knapp was appointed to the SC Health Insurance Policy Advisory Committee (HIPAC).
2003—The SCSBCC was the first business organization to propose a legislative solution to affordable health insurance for small businesses. The legislation, which eventually did not pass, would have created state small business health insurance pool. This pool, run and administered by the state would have been a vehicle for small businesses to aggregate for the purpose of obtaining group health insurance by self-funding.
2004—The SCSBCC successfully supported the creation of the Commission on Health Care Access to address the crisis in small group health insurance and work toward implementation of the recommendations of the HIPAC.
2005—The SCSBCC formed a coalition with the SC Appleseed Legal Justice Center, SC Fair Share, SC Association of Non-Profit Organizations and AARP-SC to hold public forums across the state. The “Crisis in Health Care: Remedies to Access & Cost” forums offered four potential solutions to the problem. Also, the SCSBCC and the SC Primary Health Care Association launched an innovative health care pilot program to match small businesses without insurance with a community health center to provide healthcare services at discounted rates.
2006—The SCSBCC joined the SC Appleseed Legal Justice Center, AARP-SC and SC Fair Share in proposing and supporting a budget amendment and legislation (Small Business Health Insurance Premium Assistance Act) to increase in the state’s cigarette tax to generate matching funds for a Medicaid buy-in program that would provide small businesses health insurance premium subsidies for workers under 200% of the federal poverty level. The SCSBCC also supported expanding the State Health Insurance Program (SCHIP) to make children in households with incomes up to 200% of poverty eligible to receive health insurance through Medicaid.
2007—The SCSBCC again supported the Small Business Health Insurance Premium Assistance Act that failed the previous year. With the support of the SCSBCC the expansion of the SCHIP program passed the legislature but without a cigarette tax increase. The SCSBCC then successfully worked to override Governor Mark Sanford’s veto of the legislation.
2008—The SC Legislature passed legislation to simply allow fewer small businesses to form health group cooperatives. Frank Knapp, president of the SCSBCC, criticized the bill as “only feel-good legislation that offers false hope to small businesses” and predicted its failure to solve the health insurance crisis, a prediction that came true when only one failed attempt to form a cooperative subsequently took place. The legislature also passed the SCSBCC supported plan to increase the state cigarette tax by 50 cents a pack to give premium assistance to small businesses that offer health insurance to low income employees. Governor Mark Sanford vetoed the bill and the House failed to override the veto.
2009—The SC House again passed the SCSBCC supported legislation to increase the cigarette tax by 50 cents a pack and give premium assistance to employers for providing health insurance to employees below 200% of the federal poverty level. The SC Senate ran out of time to vote on a modified version of the bill. The SCSBCC supported national healthcare reform and encouraged Congress to include small business health insurance tax credits and not require small businesses to provide health insurance.
2010—Congress passed the Affordable Care Act (ACA) with strong support from the SCSBCC, which was recognized by SC Congressman James Clyburn for its efforts. The SC Legislature voted to raise the state’s cigarette tax from7 cents per pack to 57 cents. Because the ACA provided a tax credit for small businesses offering health insurance, the new revenue from the cigarette tax would be placed in a Medicaid Trust Fund, a provision supported by the SCSBCC.
2011—The SCSBCC supported legislation to create a state-run health insurance exchange under the ACA. This exchange would be the marketplace where individuals and employees of small businesses could obtain health insurance in 2014. The bill did not come out of committee clearing the path for a federally-run exchange for the state. The SCSBCC supported legislation to ban “most favored nation” clauses in contracts between health insurance carriers and healthcare providers. These clauses restrict competition between carriers resulting in increased insurance premiums. The SCSBCC conducted a “Small Business HealthCare Listening Tour” to inform small businesses across the state of the benefits in the ACA.
2012—The SCSBCC, along with the SC Appleseed Legal Justice Center and AARP-SC, supported the state expanding Medicaid to citizens with incomes of up to 138% of the federal poverty level as allowed under the ACA. Small businesses would benefit from having low income workers receiving health insurance through the government thus reducing employer healthcare costs and producing healthier more productive workers. The effort to pass a ban on “most favored nation” clauses in healthcare contracts failed.
2013—The SCSBCC promoted the opening of the Health Insurance Marketplace and worked to educate small business owners and the media of the facts about the Marketplace and opportunities for small businesses. The SCSBCC continued to support the expansion of Medicaid under the ACA.
2014—The SCSBCC used in-person presentations, webinars, social media and the media to educate small business owners on the opportunities under the Affordable Care Act. The SCSBCC collaborated with a coalition of organizations to develop plans to encourage the legislature to “close the coverage gap” that has developed for uninsured South Carolinians who fall below 100% of the federal poverty level and thus are not eligible for premium support through the Marketplace yet do not qualify for Medicaid.
2014/2015—The Palmetto Project was awarded a statewide Affordable Care Act Navigator grant and contracted with the SCSBCC for outreach to the state’s small businesses. In partnership with the Small Business Administration, local chambers of commerce, the SC Small Business Development Centers, the SC Hispanic Chamber of Commerce, municipalities and other organizations, the SCSBCC conducting seminars and webinars for small businesses to educate them on SHOP (Small Business Health Insurance Options) under the ACA. The SCSBCC also worked with the media, trade associations and general public to provide information about and utilization of SHOP.
5 Years Later: How the Affordable Care Act is Working for South Carolina
From the Office of the Secretary of the U.S. Department of Health and Human Services
The Affordable Care Act is working to make health care more affordable, accessible, and high quality for the people of South Carolina.
Making health care more affordable and accessible through the Health Insurance Marketplaces: Through the Marketplace, South Carolinians had the option of signing up for quality health coverage at a price they could afford. Whether they visited the simpler, faster and more intuitive website at HealthCare.gov or contacted the call center, they found more choices and competitive prices.
In South Carolina, 210,331 consumers selected or were automatically re-enrolled in quality, affordable health insurance coverage through the Marketplace as of Feb. 22. Nationwide, nearly 11.7 million consumers selected a plan or were automatically enrolled in Marketplace coverage.
Marketplace Signups and Tax Credits in South Carolina:
- 88 percent of South Carolina consumers who were signed up qualified for an average tax credit of $278 per month through the Marketplace.
- 69 percent of South Carolina Marketplace enrollees obtained coverage for $100 or less after any applicable tax credits in 2015, and 92 percent had the option of doing so.
- In South Carolina, consumers could choose from 5 issuers in the Marketplace in 2015 – up from 4 in 2014.
- South Carolina consumers could choose from an average of 59 health plans in their county for 2015 coverage – up from 25 in 2014.
- 71,407 consumers in South Carolina under the age of 35 are signed up for Marketplace coverage (34 percent of plan selections in the state). And 58,806 consumers 18 to 34 years of age (28 percent of all plan selections) are signed up for Marketplace coverage.
South Carolina has received $1,000,000 in grants for research, planning, information technology development, and implementation of its Marketplace.
Open enrollment for 2015 coverage ended on Feb. 15, 2014. Open enrollment for 2016 coverage runs from November 1, 2015 to January 31, 2016. Consumers should visit HealthCare.gov to see if they qualify for a Special Enrollment Period because of a life change like marriage, having a baby or losing other coverage. Enrollment in Medicaid and the Children’s Health Insurance Program is open year round.
Reducing the number of uninsured Americans: Nationwide, since the Affordable Care Act’s coverage expansion began, about 16.4 million uninsured people have gained health insurance coverage – the largest reduction in the uninsured in four decades. And Gallup recently announced that the uninsured rate in South Carolina in 2014 was 15.4 percent, down from 18.7 percent in 2013.
New coverage options for young adults: Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 2.3 young people who would otherwise have been uninsured have gained coverage nationwide.
Expanding Medicaid: Thanks to the Affordable Care Act, states have new opportunities to expand Medicaid coverage to individuals with family incomes at or below 133 percent of the federal poverty level (generally $32,253 for a family of four in 2015). This expansion includes non-elderly adults without dependent children, who have not previously been eligible for Medicaid in most states.
Twenty-eight states plus DC have expanded Medicaid under the Affordable Care Act. South Carolina has not expanded Medicaid and as of January 2015, only 93,531 South Carolinians have gained Medicaid or CHIP coverage since the beginning of the Health Insurance Marketplace first open enrollment period. If South Carolina expanded Medicaid, an additional 198,000 uninsured people would gain coverage. The expansion would be paid 100 percent by federal funds for the first three years and federal funds would never fall below 90 percent of costs thereafter. Across the nation, approximately 11.2 more Americans are now enrolled in Medicaid and CHIP.
Providing better value for your premium dollar through the 80/20 Rule: Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, rather than administrative costs like salaries or marketing, or they have to provide you a refund. This means that 205,229 South Carolinians with private insurance coverage benefited from $13,187,815 in refunds from insurance companies, for an average refund of $92 per family because of the Affordable Care Act.
Scrutinizing unreasonable premium increases: In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. South Carolina has received $1,000,000 under the new law to help fight unreasonable premium increases. Since implementing the law, the fraction of requests for insurance premium increases of 10 percent or more has dropped dramatically, from 75 percent to 14 percent nationally. To date, the rate review program has helped save Americans an estimated $1 billion.
Removing lifetime limits on health benefits: The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 1,458,000 people in South Carolina, including 566,000 women and 397,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely starting in 2014.
Ending discrimination for pre-existing conditions: As many as 1,991,315 non-elderly South Carolinians have some type of pre-existing health condition, including 256,208 children. Today, health insurers can no longer deny coverage to anyone because of a pre-existing condition, like asthma or diabetes, under the health care law. And they can no longer charge women more because of their gender.
Expanding mental health and substance use disorder benefits: The Affordable Care Act increases also access to comprehensive coverage by requiring most health plans to cover ten essential health benefit categories, to include hospitalization, prescription drugs, maternity and newborn care, and mental health and substance use disorder services. The health care law expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans nationwide, including 866,665 South Carolinians.
Covering preventive services with no deductible or co-pay: The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.
Because of the Affordable Care Act, 76 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 1,084,000 in South Carolina. And women can now get coverage without cost-sharing of even more preventive services they need. Of the 76 million Americans with expanded access to free preventive services, 29.7 million are women, including 443,000 in South Carolina receiving expanded preventive services without cost-sharing.
Investing in the primary care workforce: As a result of historic investments through the health care law and the Recovery Act, the numbers of clinicians in the National Health Service Corps are near all-time highs with 9,200 Corps clinicians providing care to approximately 9.7 million people who live in rural, urban, and frontier communities. The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there. As of September 30, 2014, there were 131 Corps clinicians providing primary care services in South Carolina, compared to 54in 2008.
Increasing support for community health centers: The Affordable Care Act increases the funding available to community health centers nationwide. Health Center grantees in South Carolina have received $141,193,957 under the health care law to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces.
Of the $141,193,957 awarded to South Carolina, $3,776,969 was awarded to South Carolina health centers to help enroll uninsured Americans in the Health Insurance Marketplace. Overall, since 2013, South Carolina health centers used these funds to help more than 85,767 South Carolina residents with enrollment into affordable health insurance coverage, with 15,865 of those being assisted between October and December 2014. These investments ensure that health centers continue to be a trusted resource for assistance with enrollment in the Marketplace, Medicaid and CHIP in South Carolina.
In South Carolina, 20 health centers operate 147 sites, providing preventive and primary health care services to 325,015 South Carolinians, including 33,912 Latinos and 174,818 African Americans.
Preventing illness and promoting health: Through Fiscal Year 2013, South Carolina has received $33,363,298 in grants from the Prevention and Public Health Fund created by the health care law. This fund was created to support effective policies in South Carolina and nationwide, such as initiatives focused on tobacco cessation, obesity prevention, health coverage enrollment assistance, and increasing the primary care and public health workforce, so that all Americans can lead longer, more productive lives.
A Stronger Medicare Program
Making prescription drugs affordable for seniors: In South Carolina, people with Medicare have saved nearly $240,780,649 on prescription drugs because of the Affordable Care Act. In 2014 alone, 98,862 individuals in South Carolina saved over $95,732,101, or an average of $968 per beneficiary. In 2015, people with Medicare in the “donut hole” received a 55 percent discount on covered brand name drugs and a 35 percent discount on generic drugs. And thanks to the health care law, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed. Nationally, over 9.4 million people with Medicare have saved over $15 billion on prescription drugs since the law’s enactment, for an average savings of $1,598 per beneficiary.
Covering preventive services with no deductible or co-pay: With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2014 alone, an estimated 39 million people benefited from Medicare’s coverage of preventive services with no cost-sharing. In South Carolina, 696,175 individuals with Medicare used one or more free preventive service in 2014.
Cracking down on fraud and abuse: The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. More than $27.8 billion has been returned to the Medicare Trust Funds since 1997 because of these fraud enforcement efforts. For every dollar spent on health care-related fraud and abuse activities in the last three years the administration has recovered $7.70.