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    Does insurer drop out in South Carolina risk health of individual exchange?

    Just how sick is South Carolina’s individual healthcare exchange?

    Citing unprofitability, UnitedHealthcare announced it would pull out of South Carolina at the end of 2017.  It was followed by Coventry, a subsidiary of Aetna, which served 14 of the state’s 46 counties.


    Related: DOJ files suit to block two mega-mergers of health plan giants


    Blue Cross and its subsidiary, Blue Choice, is now the only statewide insurer selling coverage through the healthcare.gov insurance exchange. Currently about 216,000 people out of a state population of nearly 4.8 million obtain coverage through the federal Healthcare.gov exchange.  South Carolina declined to set up a state-based health insurance exchange.  

    The state guarantee fund, also called a reinsurance fund, had to pay $48 million in outstanding claims for the 67,000-member Consumers Choice Health co-op when it went into receivership at the end of 2015.


    Further reading: As insurers leave Obamacare exchanges, doctors pay the price


    “In South Carolina, we never had a rich or competitive health insurance marketplace in general,” says Sue Berkowitz, JD, director, SC Appleseed Legal Justice Center. According to Berkowitz, South Carolina policymakers opposed to the ACA were unwilling to fix or capitalize the co-ops that would have provided additional consumer options. Berkowitz explains that Blue Cross, which is a private, for-profit corporation, dominates much of the state’s health insurance market; hence the state’s insurance market lacks the oversight and regulation that could tamp down insurance rates.

    Next: Part of a national trend

    Wendy Wolfson
    Wendy Wolfson is a contributing author for Medical Economics.


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