About 100 servers, line cooks and dishwashers working at the Charleston Crab House don't have health insurance and face an uncertain year ahead.


Consumers' Choice Health Plan won't enroll its first members until next fall.Brokers, health providers and employers who want more information about the new health cooperative should visit its website: www.cchpsc.org

As more of the Affordable Care Act (commonly known as "Obamacare") kicks in, they will either receive coverage or face financial penalties.

Key dates

MARCH 2010:President Obama signs the Affordable Care Act into law.JULY 2012: Consumers' Choice, South Carolina's new health care co-op, receives its federal loan and opens its headquarters in North Charleston.OCTOBER 2013: New health care insurance co-ops, including Consumers' Choice, are expected to begin to enroll their first members.JAN. 1, 2014: Coverage starts for new co-op members; certain employers and citizens face financial penalties if they fail to enroll in new health insurance plans.MORE INFOConsumers' Choice Health Plan won't enroll its first members until next fall.Brokers, health providers and employers who want more information about the new health cooperative should visit its website, www.cchpsc.org.

Their boss, John Keener, said he recently met with three insurance experts about what to do next, "and we've gotten three different opinions on how the 'Obamacare' package is going to affect restaurants."

Who are S.C. uninsured?

South Carolina has an estimated 901,000 residents who do not qualify for Medicaid or Medicare and do not have health insurance. In total, about 23 percent of the state's population is uninsured - higher than the 18 percent national average. Here's a breakdown of who they are:Adults 737,200Children 163,800 Work full-time 514,400Work part-time 143,800Unemployed/don't work 242,800White 503,100Black 282,400Hispanic 95,200Kaiser Family Foundation; www.statehealthfacts.org/profileind.jsp?cat=3&sub=40&rgn=42

"We're at a standstill now until we find out what the rules are," he said.

Several miles up Interstate 26 from Keener's downtown Charleston and James Island restaurants, a new nonprofit is building its headquarters and laying groundwork to help people like those employed at the Crab House.

There are many questions that must be answered and milestones that must be passed before the Consumers' Choice Health Plan begins enrolling its first members, the people who eventually will run this new South Carolina nonprofit insurer, but perhaps the biggest and simplest question is this: Will it work?

Headquartered here

The South Carolina headquarters for Consumers' Choice takes up 6,500 square feet of an anonymous, single-story office building on Lacross Road, across from the former North Charleston City Hall.

When President Barack Obama signed the Affordable Care Act into law two years ago, he established the blueprint for such insurance co-ops, which are getting their start-up money via a loan from the U.S. Department of Health and Human Services.

The new cubicles, computers and Consumers' Choice signs are among the most tangible signs of the $87.8 million federal loan.

Most of the money has not arrived, and much of it will be held in reserve to meet the requirements under state law.

Jerry Burgess, a former senior executive in the health care industry, helped found two previous nonprofits in South Carolina and Tennessee that tried to tackle how to improve the value of health care for employers and their communities.

Burgess said he remembers the rainy day in Philadelphia a few years ago when he read a newspaper account about Congress considering the co-ops, a rare part of the legislation that had bipartisan roots.

Burgess was among those who were part of the $1.5 million effort to apply for the loan to get South Carolina's co-op off the ground.

"It's going to be like a new Blue Cross, but where we're different, the people on our board of directors are average policy holders," he said. "They'll be elected by the policy holders, and that's what makes us a cooperative."

The decision to put its headquarters in the Charleston area was not a difficult one.

"It's the largest market. It just makes sense to be there," Burgess said. "Plus there was more talent to recruit there and more members eventually to sell to."

'Mission driven'

Talking to the first few dozen employees at Consumers' Choice, it's clear they view their work as more than a job.

"We are mission driven, we are not profit driven. That means very explicitly we're not going to make excess profit and send it to Wall Street," Burgess said. "We're going to make enough money to stay in business, and we're going to use any gains to lower premiums for common people."

Adrian Grimes, the director of communications, had vowed that she would not return to work in health care, but she changed her mind. Likewise, Alice Kral, the office manager, went to The Citadel and got her master's degree in business administration partly because she was wanted to leave the nonprofit sector for a new challenge.

"If you had talked to me about Obamacare before I interviewed for this job, I would have said nuh-uh (no)," Kral said. "I'm not political at all."

She then went on the job interview as a favor to a friend, "and I just fell in love with the mission. You can't find a better mission in this state than trying to provide affordable health insurance for everybody."

Ken Johnson, a former regulator with the S.C. Department of Insurance, was among the volunteers who put the co-op application together last year. He became involved because he felt the model would work, and he is now the senior vice president and insurance compliance officer.

"Fortunately, under Jerry Burgess' leadership, we all have the same DNA in understanding and believing in what we're trying to do," Johnson said. "What everybody needs to understand is there's no perfect fix for a problem that's run amok for 75 years. We have to start somewhere."

Facing the competition

What remains to be seen is how the co-op fares in the competitive health care insurance industry.

While Consumers' Choice is focusing on those without insurance, it also is developing a business plan to appeal to businesses and others who already have health insurance.

And other established companies such as Blue Cross Blue Shield will be able to sell through the new federal exchange and try to reach the same uninsured consumers. The exchange will be a website where consumers can compare companies, plans and prices.

Consumers' Choice officials were not critical of Gov. Nikki Haley's recent decision not to set up a separate state health insurance exchange. "We're fairly certain now there will be an exchange in January 2014," Burgess said. "Whether it was a state exchange or a federal exchange, we are neutral on that issue."

"We're like a speck on the back of an elephant, and the elephant is Blue Cross," Burgess said. "We're like David going up against Goliath, and that's OK. David had a chance, and so do we."

Patti Embry-Tautenhan, director of corporate relations for Blue Cross in South Carolina, said Blue Cross welcomes the competition.

"The marketplace has told us that our longevity and stability matters to customers," she said. "Now, more than ever, our focus is on collaborating with providers to improve the quality of the delivery of health care, which in turn reduces rising cost trends."

The immediate challenge facing Consumers' Choice is to create its own provider network, beginning by contracting with hospitals and then reaching out to doctors and other health care providers.

The co-op also must receive its license from the state, figure out its commercial side and create a care coordination plan that will work with fitness centers, smoking cessation programs and social workers.

Around 2015, the governing body of Consumers' Choice will transfer to a 12-member board of South Carolina residents, including eight who are policy holders, and one representative each from the hospital sector, specialized medicine, general care practitioners and insurance brokers.

A lot of unknowns

Many people, including South Carolina's approximately 900,000 uninsured, don't have a clue about the changes to come, Grimes said.

About 60 percent of those who responded to a CVS Caremark survey said they would need help with understanding health insurance terms and descriptions and with navigating the new health care landscape.

In a sense, the Crab House's Keener is ahead of the game. He already has mulled scenarios about how his company will deal with the changes to come.

He has read reports of one restaurant chain switching more of its employees to part-time status to try to avoid the health care law's penalties. He said he has thought about separating his two restaurants legally to get under the 50-employee maximum that triggers the penalty.

And he worries how the numbers will work out for him and his workers.

"It's a tough dilemma for everybody to work through," he said. "A couple of employees asked us what does it mean to us. We have no idea."

Reach Robert Behre at 937-5771.