More South Carolina residents than ever used the federal exchanges last year to sign up for 2019 health insurance, even as the Affordable Care Act weathered attacks and the number of people buying plans for themselves across the country declined.

New numbers from the S.C. Department of Insurance show 203,402 enrolled in and paid for a health insurance plan using the exchanges conceived by President Barack Obama, setting a new record for the state. 

The uptick was slight, totaling about 4,300 more than last year, or about a 2 percent gain. Enrollment was open between Nov. 1 and Dec. 15.

Ray Farmer, director the S.C. Department of Insurance, said the number of signups was about what should be expected. 

Ray Farmer testifies at Senate Hearing (copy)

South Carolina Insurance director Ray Farmer. File/Provided

"It hasn't gone up immeasurably," he said. "It's pretty consistent with previous years. I don't think you can draw any big conclusion from that other than the people in the in marketplace who are looking for coverage are able to find it."

Customers who bought insurance on the exchanges for 2019 represent about 4 percent of the state's population. 

In South Carolina, 45 percent of the population have health insurance through their employer, according to the Kaiser Family Foundation. About 11 percent of residents lack health insurance. Most of the rest are covered through public insurance programs: Medicare, Tricare and Medicaid.

Though this year's increase was modest, it is the first the number enrolled breaks 200,000 and sets a record going back to 2014, the year act took effect. Ninety-two percent of people signed up for coverage this year are receiving help from the government to pay for their premiums. They are 42 years old, on average.

Information from the federal government showed an opposite trend for the country. Nationwide, 300,000 fewer people signed up for health insurance on the Affordable Care Act exchanges than last year, the Centers for Medicare & Medicaid Services reported. The change represents roughly a 4 percent decline.

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The report attributed that decline to lower unemployment. More people in the workplace means more people who have employer-offered health insurance.

But this year was also the first there was no rule in place requiring people to sign up for health insurance or pay a penalty. President Donald Trump led an effort to have parts of the Affordable Care Act, including that rule, repealed.

The entire Affordable Care Act was recently thrown into doubt when a federal judge in Texas ruled the entire law was unconstitutional. The ruling is under appeal.

Farmer said his focus is on attracting more companies to the market that targets individuals. BlueCross BlueShield of South Carolina is the only insurer selling plans throughout the state. In 2015, consumers in parts of the state had five companies to choose from.

This year, there was a new entry into the health insurance marketplace. Absolute Total Care wrote plans only for Charleston County residents. The Department of Insurance isn't allowed to release specific information about how many people bought policies from the company.

Reach Mary Katherine Wildeman at 843-937-5594. Follow her on Twitter @mkwildeman.