Barely two months remain before Oct. 1, when the federal government opens enrollment on a new health insurance exchange.

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There are a lot of unknowns about the Affordable Care Act.

How much will health insurance rates increase next year? Will the federal health insurance exchange be ready Oct. 1 to process new applicants? How many low-income residents will take advantage of federal subsidies to help pay for a plan?

A starting place for more information is the federal government’s health care website,

South Carolina-specific Medicaid questions should be directed to the S.C. Department of Health and Human Services, (888) 549-0820, or

The S.C. Department of Insurance can by reached by phone, (803) 737-6160, or online,

An estimated 906,400 uninsured South Carolinians will need to sign up for health insurance to comply with the Affordable Care Act. But there is still a huge void of information about how the act will affect residents here.

There is a lot of political posturing about “Obamacare,” but when it comes to the real meat of federal health care reform, the federal and state governments have done virtually nothing to help explain how the system will work.

“I’m a little concerned about Oct. 1, maybe a little bit more than a little bit,” said local benefits consultant Colin Smoak. “I have real fears and concerns that these exchanges are not what they want them to be. I have a real concern about whether they’re going to be up and running.”

A marketing blitz by the federal government will infuse $3.6 million, or about 78 cents per person, into South Carolina community groups and health centers to promote the law.

Like many other states, including Georgia, Tennessee and Alabama, that have opted to participate in the federal exchange instead of establishing their own exchanges, South Carolina has not spent any state money to promote the law to the public.

But a series of emails recently released to The Post and Courier by the S.C. Department of Health and Human Services reveals that earlier this year there was a detailed marketing plan to help the state clarify what the Affordable Care Act means for South Carolinians and to explain how they can sign up for insurance on the federal exchange.

The plan, written in April, included local television spots, direct mailings, a social media campaign, outdoor advertising and outreach efforts at local festivals. The report also suggested news conferences in all major media markets and a health care summit hosted by Gov. Nikki Haley or Health and Human Services Director Tony Keck.

None of these ideas were implemented.

‘Single-most dramatic change’

This four-page report was generated by Chernoff Newman, a private communications firm, at the request of the Health and Human Services Department. The firm signed a $1 million, five-year contract with the agency in December for ongoing communications and public relations consulting. Other state agencies, including the S.C. Department of Agriculture and the S.C. Education Lottery, have similar contracts with the Columbia-based company.

In the report, Chernoff Newman calls health care reform, “the single most dramatic change in the health care delivery system that has occurred in a generation. It affects almost all of, if not literally, 100 percent of the population of the State of South Carolina.”

Keck, a vocal critic of Obamacare, said this week that he was previously unaware that the report existed and that none of these ideas about marketing the federal law were ever realistically considered by his staff because it’s not South Carolina’s job to promote it.

“I’m not going to take responsibility for all the federal government’s failures,” Keck said. “I mean, they would love for me to spend $20 million here setting up new call centers and doing advertising and everything else, but that’s the job that they took.”

Complicated new law

Meanwhile, the public is starved for information.

A poll by the Kaiser Family Foundation published this spring found that 42 percent of Americans are unsure if the Affordable Care Act is even still a law.

“Nobody understands it at all,” said Jill Fuson, manager of policy events and conferences at the Riley Institute at Furman University, which is hosting a four-part lecture series on the Affordable Care Act this summer. It’s the largest program of its kind geared to the public in South Carolina to date.

“People were taking notes, and they were just very attentive and soaking it all up,” Fuson said. “They’ve heard so much and don’t understand anything.”

The series was conceived, she said, because there is widespread confusion about the legislation, which was passed by Congress in 2010 and upheld by the U.S. Supreme Court in 2012.

“People don’t get into the depth,” said Mike Reindorp, a Greer resident, who attended the second lecture on Wednesday. “They form their opinions on talking points.”

Reindorp is one of about 250 Upstate residents who have paid $45 for tickets to the Furman University program.

Margaret Manning of Greenville said she attended the Wednesday lecture to get “an academic perspective.”

“We don’t get a lot of depth,” Manning said. “Near as I can tell, there aren’t many people who really understand.”

Even some health care experts are confused.

“It’s gigantic and complicated,” said Dr. Bill Moran, a Medical University of South Carolina internist.

Moran polled an audience of doctors about their knowledge of the law earlier this year at a conference for the Society of General Internal Medicine in New Orleans. He said 98 percent responded that they had been asked by a patient about the law, but most said they knew “almost nothing” or only “a little” about it.

“And those are docs — they aren’t even patients,” Moran said.


State agencies may not be spending resources to market the law, but they are scrambling to comply with it.

“I’ve got people who are working day in and day out to implement a law that they poorly conceived and are poorly executing,” said Keck, of S.C. Health and Human Services. “I’ve got lots of people working on it.”

That includes expanding the department’s call center to handle an anticipated increase in call volume about Medicaid and insurance-related questions.

Insurance Department Director Ray Farmer said his agency is now reviewing proposed health insurance plans that will be available for purchase on the federal exchange.

“That’s our responsibility and we’ll continue to do that,” Farmer said. “It’s an entirely new federal program so people are unaware at this point really what to expect, what the program will do. As we get closer to October, I imagine they will get their questions answered.”

The Associated Press contributed to this report. Reach Lauren Sausser at 937-5598.