Doctor and hospital choice will shrink under some new health insurance plans next year, and many Republicans are seizing the opportunity to blame these narrower provider networks on the Affordable Care Act.

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But Gov. Nikki Haley's top health care policy adviser told a room full of insurance company executives Friday that fewer choices are a step in the right direction and that conservatives who criticize this strategy are "ill-advised."

"If somebody else is paying the bill, I don't think there should be any expectation that people can go wherever they want, whenever they want, for whatever they want," said Tony Keck, director of the S.C. Department of Health and Human Services. "It's very important to start to focus our networks on people who provide the most value."

His comments, made during a panel discussion at The Sanctuary Hotel , contrast with those made by other Republicans who have attacked President Barack Obama for his broken promises.

"When the President first introduced Obamacare, he said, 'If you like your insurance plan, you can keep it,' and 'If you like your doctor, you can keep your doctor' - but this has proven to be not exactly true," wrote U.S. Rep. Tom Rice, R-S.C., in a recent letter to some of his Georgetown constituents.

A statement prepared by the U.S. Senate Republican Policy Committee last month called this "access shock" the president's "next public relations disaster."

Provider networks under many new health plans offered both on and off the federal health insurance marketplace will be narrower than past plans.

For example, in the Lowcountry, neither Medical University Hospital nor Roper St. Francis Healthcare are included in-network for new individual policies offered by BlueCross BlueShield of South Carolina, the largest private insurer in the state. This does not affect BlueCross BlueShield customers insured through large group employers.

While unpopular with many customers and conservative lawmakers, constraining patient choice by narrowing provider networks is seen as a way for insurance companies to control costs amid a sea of changing regulations brought on by the new federal health care law.

"Under Obamacare, the health insurance companies are not able to do a lot of rating of customers. There's no pre-existing illness," said Jim Ritchie, a former South Carolina legislator and the executive director of the S.C. Alliance of Health Plans. "So the only way you can keep it affordable for as many people as you can is to focus on quality with the doctors."

Keck, who manages the $6.5 billion Medicaid program in South Carolina, called this strategy "incredibly important."

"Many, many providers are way on the outlier edge in terms of cost and quality and yet, in the past, we've included them in our networks and we just can't do that anymore. We don't do that in any other business except for health care," he said. "Some of the national Republicans who are using this as a cudgel - I think it's an ill-advised strategy."

The S.C. Alliance of Health Plans held its annual conference on Kiawah Island this week.

Reach Lauren Sausser at 937-5598.