Hospitals in South Carolina are providing the same amount of charity care, if not more, than they were before the Affordable Care Act insurance marketplace launched last year, a South Carolina Hospital Association executive said this week.

"There are some hospitals where it's worse, some hospitals where it's the same. It's not going down - I know that," said Rozalynn Goodwin, the hospital association's vice president for community engagement.

"I wouldn't surprise me to see minimal or no impact (from the Affordable Care Act)," said Dr. Pat Cawley, CEO of Medical University Hospital. "We haven't seen any big change in the numbers at MUSC."

South Carolina hospitals provided more than $1 billion worth of uncompensated care last year to low-income patients who were uninsured and ineligible for Medicaid. The state and federal governments reimbursed them $471 million for it during the 2014 fiscal year.

"I think we forget - someone not having insurance doesn't mean that hospitals aren't being paid to care for that person," said S.C. Medicaid Director Tony Keck. He noted that hospitals across the state still made a $1.1 billion profit last year. "I don't know what data the (hospital association) has to back up their statement."

One of the main objectives of the federal health care law is to reduce the percentage of residents across the country without insurance. But South Carolina is one of about half of all states that will not participate in the Affordable Care Act's Medicaid expansion, so hospitals here are still treating many low-income, uninsured patients, Goodwin said.

The Supreme Court made Medicaid expansion an optional provision of the law in 2012. Most conservative states, including South Carolina, opted out.

"We didn't have the type of enrollment that a lot of other states had," said Goodwin. The South Carolina Hospital Association supports Medicaid expansion. Keck, a member of Gov. Nikki Haley's Cabinet, does not.

Still, Medicaid enrollment is growing here, he said. More than 85,000 people have newly enrolled in the low-income health insurance program since Jan. 1, bringing total enrollment in the state to about 1.1 million residents.

Another 85,000 South Carolinians purchased a private insurance policy through the Affordable Care Act marketplace between October and mid-April, but many of them may have been previously insured, making it difficult to determine exactly how the percentage of residents who are uninsured has changed.

"I guess its hard for most people to imagine hospitals have more uninsured patients when the data shows South Carolina has seen a decrease in the number of uninsured people since last year," Keck said.

A new analysis published by the Urban Institute on Tuesday estimates that the number of uninsured adults across the country fell by about 8 million between September and June, but most drastically in states that expanded Medicaid eligibility.

Various projections estimate the percentage of uninsured residents in South Carolina dropped from 19 percent before open enrollment on HealthCare.gov to about 13 percent or 14 percent when it closed this spring.

Hard numbers are harder to come by. Goodwin speculated that the percentage of uninsured residents in South Carolina dropped by only 10 percent during the same time frame. A spokeswoman for the South Carolina Department of Insurance said the agency has no way to track this data.

Recent Census data shows about 750,000 South Carolinians were uninsured before HealthCare.gov launched Oct. 1, Goodwin said.

Haley's spokesman said this about the current numbers of uninsured residents: "Accepting Obamacare and expanding an already broken Medicaid system didn't make sense for South Carolina two years ago and absolutely nothing has happened since then to change that. Just as Governor Haley will never stop working to prevent this disaster of a program from hurting our state - she will also never stop pursuing and implementing the state-based solutions that will actually improve the health of South Carolinians."

Reach Lauren Sausser at 937-5598.