By Liz Segrist

lsegrist@scbiznews.com

Published Sept. 9, 2013

It is too soon to tell whether the state’s estimates for increased health insurance rates in the federal exchanges are accurate, Gov. Nikki Haley said today in Charleston.

The S.C. Department of Insurance has estimated that health insurance rates in the soon-to-be-established federally facilitated exchanges will increase by 50% to 70% in the individual market and by 10% to 20% in the small group market. The U.S. Department of Health and Human Services has since challenged the estimates.

“I don’t know if there’s any way we’ll ever know until it happens. What those are is estimates,” Haley said at the 2013 Medicaid Enterprise Systems Conference in Charleston. “So, I don’t think it’s far-fetched when they say it could be up to 70% increases. It lets everyone know it’s something to worry about.”

The state insurance department completed its review last month of health insurance forms and rates for carriers that are seeking federal certification to sell in the exchange created under the Affordable Care Act.

The U.S. Department of Health and Human Services wants to see the evidence to back up the state’s claims of increases. It also wants to make sure the state is comparing similar policies. Comparing policies with minimal coverage and high deductibles with robust policies with preventive measures could skew results, according to the federal department.

“I don’t think any state or any governor knows exactly what we’re walking into,” Haley said. “What I do know in South Carolina is that it’s going to be people and families first. It’s going to be about outcomes for health care so that we can do everything we can to keep people healthy, but it will be at the pace of South Carolina, not at the pace of Washington, D.C.”

In July, the state’s second-largest issuer of individual health insurance announced plans to pull out of the market by the end of the year. Medical Mutual of Ohio said it will help 28,000 Carolina Care policyholders find another carrier.

When asked if other carriers would leave the market or scale back, Haley said she expects carriers to get creative in figuring out how to manage the Affordable Care Act changes.

The federal government plans to open enrollment of a new health insurance exchange Oct. 1. South Carolina opted out of a state-run exchange.

In addition to dealing with the state’s Medicaid system and the implementation of the Affordable Care Act, S.C. Health and Human Services Department Director Tony Keck said the state’s health care industry and government need to be looking ahead in health care.

“Let’s figure out what the 2010, 2020 and 2050 problem is first, and then let’s design solutions that can solve those problems,” Keck said Monday in Charleston. “We don’t want to be fighting the wars of the past. We want to be fighting the wars of the future.”

The state needs to use data to determine its biggest health issues and how to address poor health outcomes and excess health care costs, Keck said. In 2011, the Medicaid budget accounted for $5.9 million, or 28%, of the state budget.

“What we need is for people to think beyond current technology solutions … think about the customers, the changes happening in Medicaid,” Keck said.

Haley said she wants the state to focus on improving health at a lower cost by triaging patients in the emergency room and by holding patients accountable if they are supposed to take a drug or stop smoking, for example.

“If we focus on that primary health care upfront we will have less cost going later, so that’s really what we’re looking at is how do we get to that early,” Haley said.

Under the Affordable Care Act, employers with 50 or more employees are required to provide insurance to them. Employers were given an extension until Jan. 1, 2015, to provide the health care insurance to employees without a penalty. Meanwhile, insurance carriers are preparing for Oct. 1, the opening of the Health Insurance Marketplace.