Obamacare is having its biggest year yet in South Carolina, even as health insurers struggle to make money off all these new customers.

Health insurance for children

A new report by the nonprofit Robert Wood Johnson Foundation shows that the percentage of children without health insurance in South Carolina has dropped substantially since 2010.

Six years ago, an estimated 10.1 percent of children in this state weren’t insured. In 2014, the most recent year for which data is available, only 5.6 percent of kids had no insurance.

The state Medicaid agency can take all the credit for the improvement.

In 2011, the department implemented a policy called “Express Lane Eligibility.”

The program pulls information from the Department of Social Services to automatically enroll children in a Medicaid plan.

Now, if a child’s family receives food stamps or money through Temporary Assistance for Needy Families, the child receives Medicaid benefits. An additional application isn’t required.

During open enrollment, which ended Jan. 31, more than 231,000 people in this state signed up for a health insurance policy through the federal marketplace. Nearly 50,000 of them live in the Charleston area.

In a prepared statement, U.S. Health and Human Services Secretary Sylvia Burwell called the 2016 enrollment window a success.

“The Health Insurance Marketplace is changing people’s lives for the better,” she said.

Shelli Quenga agreed. She works for Palmetto Project, a nonprofit organization based in North Charleston that won a federal grant to help residents enroll in policies on HealthCare.gov.

Open enrollment in 2016 was more popular than any previous year, Quenga said.

“Our numbers for (South Carolina) are 10.5 percent higher than 2015,” she said. “I think people were definitely motivated by the increased fine.”

With few exceptions, adults who don’t have health insurance this year will be fined at least $695 when they pay taxes next year.

Meanwhile, some health insurance companies say the Affordable Care Act doesn’t make financial sense for them, even though they’re gaining so many new customers.

UnitedHealth, the country’s largest health insurance company, warned late last year that it might stop selling plans on the federal marketplace. Consumers’ Choice Health Plan, an insurance cooperative established in South Carolina with a multimillion-dollar federal loan, closed its doors last year, even after selling more Affordable Care Act plans in South Carolina than any other insurer.

On Thursday, Blue Cross Blue Shield of North Carolina said it may consider stop selling Obamacare plans, too.

Patti Embry-Tautenhan, a spokeswoman for BlueCross BlueShield of South Carolina, said her company is watching the situation closely.

“It is well documented that many ACA (Affordable Care Act) plans have lost money due to an influx of sicker customers using more medical services,” Embry-Tautenhan said. “We have been very conservative in our planning and relied on our long prior experience in the South Carolina market to set fair rates, which so far have aligned with our claims experience. However, we continue to pay close attention to the market as we do not yet fully know the effects of the exit of Consumers’ Choice on our 2016 experience.”

South Carolina Department of Insurance Director Ray Farmer recently said the enrollment data he reviewed indicated that many people waited until the last minute to purchase a policy on the federal exchange before the Jan. 31 deadline.

“We’ve tracked (enrollment) over the last three years and you can see about two weeks before any deadline, it just goes off the charts,” Farmer said.

Still, hundreds of thousands of South Carolinians don’t have health insurance. Many of them fall into the Affordable Care Act’s coverage gap. They can’t afford private coverage and don’t qualify for the low-income Medicaid program.

South Carolina leaders have not expanded Medicaid eligibility with federal funds available through health care law.

While enrollment is technically closed for 2016 coverage, the federal government makes exceptions for patients who have experienced complex issues or “life qualifying events,” such as divorcing a spouse, having a baby or moving to a new state.

For more information about purchasing health insurance during a special enrollment period, visit www.HealthCare.gov or call 1-800-318-2596.