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 1990s, 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 uninsured South Carolinians uninsured were driving up the insurance premiums for the insured. The 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.
Beginning with its formation in 2000, 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.
A Chronological Summary
2000—The SCSBCC 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 South Carolina 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 for funding. The SCSBCC then successfully worked to override Governor Mark Sanford’s veto of the legislation.
2008—The SC Legislature passed legislation to 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 had developed for uninsured South Carolinians who fell below 100% of the federal poverty level and thus were not eligible for premium support through the Marketplace yet did 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.
2016/2019—SCSBCC continued to support the ACA. As the efforts by Congress to defund important features of the ACA took effect, the cost to small business owners began to rise. The entrepreneurs were typically older and not eligible for premium assistance when obtaining a health insurance policy through the Marketplace. The SCSBCC partnered with an insurance broker to work with these small business owners to find them alternative, affordable individual policies with comprehensive benefits.