Covering South Carolina's uninsured

Unless you fall in the Coverage Gap, a no man's’ land of no health insurance, you wouldn’t know it exists. But for uninsured adults like Melissa Jones, a single mother of two, the Coverage Gap is very real and very stressful. Melissa never questioned whether or not she would take her children to the doctor—Medicaid covers them. Her health was another story.

Her employer did not offer health insurance. When she could no longer afford to manage chronic medical conditions through an urgent care center, Melissa went to the Oconee Medical Center emergency department. “It was a horrible feeling not having health insurance. I wondered if I were to get seriously ill or die, who would take care of my children?”

Melissa’s story is all too common in South Carolina where an estimated 200,000 other South Carolinians fall into the Coverage Gap: too “rich” for Medicaid and too poor to purchase coverage in the Affordable Care Act (ACA) Marketplace with the help of federal subsidies. Many low income South Carolinians have been lost in the healthcare shuffle.

In 2013, the Kaiser Family Foundation estimated that there were 336,000 uninsured South Carolinians who would qualify to buy coverage with a subsidy under the Affordable Care Act, (ACA) also known as Obamacare. Despite the intentions of the federal government, getting coverage with a subsidy would not be easy for the Palmetto State’s uninsured. The State of South Carolina opted not to expand Medicaid and did not offer a state-sponsored marketplace. Public sentiment toward Obamacare was less than favorable. The shaky launch of did little to sway opinions. Still, ACA represented the best chance for many uninsured South Carolinians to get health insurance.

South Carolina’s provider community, including AccessHealth SC, South Carolina Hospital Association, hospitals and the South Carolina Department of Health and Human Services (DHHS), rallied to educate the public. Paid media, enrollment fairs, websites, and certified application counselors worked to clear the confusion and help people make the best decisions for themselves and their families. Enrollment in the ACA Marketplace began slowly, with just 2,700 enrolled in the first two months. Momentum slowly built and by March, there was a rush for coverage. Ultimately, of the state’s 750,000 estimated uninsured, an estimated 51,000 previously uninsured people enrolled through the Marketplace and paid their first month premium. Another 85,000 uninsured were determined to be Medicaid eligible and were enrolled by health centers, hospitals, AccessHealth SC networks, DHHS and others. These individuals in the Coverage Gap, many of whom are hard working and proud, still need help. Fortunately, AccessHealth SC and its ten community networks of care actively serve this population by providing access to care.

Melissa’s story has a happy ending. A friend encouraged her to contact Mountain Lakes AccessHealth. They connected her with a primary care doctor to help her manage her chronic health conditions and provided access to medications through Welvista. She was able to secure a new job with health insurance coverage and no longer needs Mountain Lakes AccessHealth to bridge the gap. “It’s someone else’s turn,” Melissa said with a smile.

05-18-2015 12:34 (EDT)