Impact of the Affordable Care Act in South Carolina
Hundreds of thousands of South Carolinians have gained coverage, and millions more have had their coverage substantially improved
Today, the U.S. Department of Health and Human Services released an extensive compilation of state-level data illustrating the substantial improvements in health care for all Americans over the last six years. The data show that the uninsured rate in South Carolina has fallen by 38 percent since the Affordable Care Act (ACA) was enacted in 2010, translating into 317,000 South Carolinians gaining coverage. And, in addition to residents who would otherwise be uninsured, millions more South Carolinians with employer, Medicaid, individual market, or Medicare coverage have also benefited from new protections as a result of the law.
“As our nation debates changes to the health care system, it’s important to take stock of where we are today compared to where we were before the Affordable Care Act,” said Secretary Sylvia M. Burwell. “Whether South Carolinians get coverage through an employer, Medicaid, the individual market, or Medicare, they have better health coverage and care today as a result of the ACA. Millions of Americans with all types of coverage have a stake in the future of health reform. We need to build on our progress and continue to improve health care access, quality, and affordability, not move our system backward.”
Highlights of today’s data release include:
Employer Coverage: 2,487,000 people in South Carolina are covered through employer-sponsored health plans. Since the ACA was enacted in 2010, this group has seen:
- An end to annual and lifetime limits: Before the ACA, 1,458,000 South Carolinians with employer or individual market coverage had a lifetime limit on their insurance policy. That meant their coverage could end exactly when they needed it most. The ACA prohibits annual and lifetime limits on policies, so all South Carolinians with employer plans now have coverage that’s there when they need it.
- Young adults covered until age 26: An estimated 35,000 young adults in South Carolina have benefited from the ACA provision that allows kids to stay on their parents’ health insurance up to age 26.
- Free preventive care: Under the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no extra cost to consumers. This provision benefits 1,955,568 people in South Carolina, most of whom have employer coverage.
- Slower premium growth: The average premium for South Carolina families with employer coverage grew 4.8 percent per year from 2010-2015, compared with 7.2 percent over the previous decade. Assuming South Carolina premiums grew in line with the national average in 2016, family premiums in South Carolina are $2,800 lower today than if growth had matched the pre-ACA decade.
- Better value through the 80/20 rule: Because of the ACA, health insurance companies must spend at least 80 cents of each premium dollar on health care or care improvements, rather than administrative costs like salaries or marketing, or else give consumers a refund. South Carolinians with employer coverage have received $3,611,086 in insurance refunds since 2012.
Medicaid: 994,804 people in South Carolina are covered by Medicaid or the Children’s Health Insurance Program, including 630,610 children and 127,328 seniors and people with disabilities covered by both Medicaid and Medicare. The ACA expanded Medicaid eligibility and strengthened the program for those already eligible.
- 160,000 South Carolinians could gain coverage: An estimated 160,000 South Carolinians could have health insurance today if South Carolina expanded Medicaid under the ACA. Coverage improves access to care, financial security, and health; expansion would result in an estimated 18,000 more South Carolinians getting all needed care, 22,800 fewer South Carolinians struggling to pay medical bills, and 190 avoided deaths each year.
- Up to 87,000 South Carolinians with a mental illness or substance use disorder could get help: 87,000 South Carolinians, or an estimated 32 percent of those who could gain Medicaid coverage through expansion, have a mental illness or substance use disorder.
- South Carolina could be saving millions in uncompensated care costs: Instead of spending $170 million on uncompensated care, which increases costs for everyone, South Carolina could be getting $1 billion in federal support to provide low-income adults with much needed care.
- Children, people with disabilities, and seniors can more easily access Medicaid coverage: The ACA streamlined Medicaid eligibility processes, eliminating hurdles so that vulnerable South Carolinians could more easily access and maintain coverage.
Individual market: 204,846 people in South Carolina have coverage through the Marketplace. Individual market coverage is dramatically better compared to before the ACA:
- No discrimination based on pre-existing conditions: Up to 1,991,315 people in South Carolina have a pre-existing health condition. Before the ACA, these South Carolinians could have been denied coverage or charged an exorbitant price if they needed individual market coverage. Now, health insurance companies cannot refuse coverage or charge people more because of pre-existing conditions.
- Tax credits available to help pay for coverage: Before the ACA, only those with employer coverage generally got tax benefits to help pay for health insurance. Now, 186,345 moderate- and middle-income South Carolinians receive tax credits averaging $312 per month to help them get covered through HealthCare.gov.
- Women pay the same as men: Before the ACA, women were often charged more than men just because of their gender. That is now illegal thanks to the ACA, protecting roughly half the people of South Carolina.
- Greater transparency and choice: Before the ACA, it was virtually impossible for consumers to effectively compare insurance plan prices and shop for the best value. Under the ACA, South Carolina has received $1 million in federal funding to provide a more transparent marketplace where consumers can easily compare plans, choosing among 25 plans on average.
Medicare: 974,114 people in South Carolina are covered by Medicare. The ACA strengthened the Medicare Trust Fund, extending its life by over a decade. In addition, Medicare enrollees have benefited from:
- Lower costs for prescription drugs: Because the ACA is closing the prescription drug donut hole, 98,589 South Carolina seniors are saving $107 million on drugs in 2015, an average of $1,088 per beneficiary.
- Free preventive services: The ACA added coverage of an annual wellness visit and eliminated cost-sharing for recommended preventive services such as cancer screenings. In 2015, 549,051 South Carolina seniors, or 76 percent of all South Carolina seniors enrolled in Medicare Part B, took advantage of at least one free preventive service.
- Fewer hospital mistakes: The ACA introduced new incentives for hospitals to avoid preventable patient harms and avoidable readmissions. Hospital readmissions for South Carolina Medicare beneficiaries dropped 6 percent between 2010 and 2015, which translates into 1,237 times South Carolina Medicare beneficiaries avoided an unnecessary return to the hospital in 2015.
- More coordinated care: The ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve. 12 Accountable Care Organizations (ACOs) in South Carolina now offer Medicare beneficiaries the opportunity to receive higher quality, more coordinated care.