Modern Jim Crow in Medicine: BCBS of SC Systematically Underpaying Black Physicians

 By Lachin Hatemi M.D.

South Carolina’s population is approximately 25.9% Black, one of the highest percentages in the nation. The state’s history of racial inequality is deeply intertwined with its healthcare system. As recently as the 1960s, it was not uncommon to find medical clinics and hospitals operating with separate entrances and waiting rooms for White and Black patients. Although federal civil rights laws ended legal segregation decades ago, significant health disparities continue to persist across South Carolina.

South Carolina ranks among the states with the highest prevalence of diabetes in the United States. The burden of diabetes and its complications is not distributed evenly. The disease is concentrated in poorer counties, particularly those along the Interstate 95 corridor, often referred to as the “Corridor of Shame.” This region has long struggled with high poverty rates, underfunded schools, limited healthcare access, and chronic shortages of public resources. It is also home to some of the highest percentages of Black residents in the state.

The consequences are visible in health outcomes. For years, some of South Carolina’s highest rates of diabetes-related lower-extremity amputations have occurred in rural and predominantly Black communities. Despite advances in medical science and improvements in diabetes treatment, residents of these communities continue to experience dramatically worse outcomes than those living in more affluent areas.

A striking example can be found by comparing two South Carolina ZIP codes.

Richland County’s 29203 ZIP code has historically experienced some of the state’s most concerning health outcomes, including elevated rates of diabetes complications and amputations. Unlike many underserved communities, 29203 is not located in a remote rural county. It sits only minutes from the South Carolina State House, where lawmakers make decisions affecting healthcare policy. The ZIP code is also home to major healthcare institutions, including facilities operated by Prisma Health.

In contrast, Lexington County’s 29072 ZIP code presents a very different picture. The community is relatively affluent, predominantly White, and served by Lexington Medical Center, one of South Carolina’s most highly regarded healthcare systems. Lexington Medical Center has built an extensive network of clinics throughout the county, providing residents with convenient access to primary care and specialty services. Health outcomes in the area consistently outperform those seen in many underserved communities across the state.

Why do two communities located only a few miles apart experience such different healthcare realities?

Why are healthcare systems in affluent communities expanding while providers serving vulnerable populations struggle to survive?

These questions become even more important when examining the challenges faced by community-based providers. Eau Claire Cooperative Health Centers, founded by Black physicians to serve historically underserved neighborhoods in Richland County, was created because many residents lacked adequate access to healthcare. For decades, organizations such as Eau Claire filled critical gaps in care. Yet in recent years, financial pressures have forced clinic closures and service reductions.

At first glance, many observers assume these differences result from management decisions, physician performance, or patient demographics. However, another factor deserves closer scrutiny: the economics of healthcare reimbursement.

I operate an urgent care clinic in Lexington County. Despite serving record patient volumes—often seeing 80 to 90 patients per day—I frequently found myself struggling with the same financial pressures affecting clinics across South Carolina. After seven years in practice, I began asking a simple question: How can some healthcare organizations consistently expand while others struggle to remain open?

The answer led me to one of the least transparent aspects of healthcare finance: physician fee schedules.

A physician fee schedule is essentially a pricing document that assigns a reimbursement amount to each medical service identified by a CPT code. Much like a restaurant menu lists prices for food items, a fee schedule determines how much a health insurer will pay for a particular medical service.

In South Carolina, BlueCross BlueShield of South Carolina dominates the commercial insurance market. For most physician practices, participation in the BlueCross network is essential for survival. Without a contract, many clinics would lose access to a significant portion of insured patients.

Fee schedules, however, are generally treated as confidential documents. Providers are often prohibited from sharing them publicly, making it difficult for physicians to compare reimbursement rates across organizations.

As I investigated reimbursement practices, I discovered substantial variations in payments for identical services provided by different healthcare organizations. In some cases, providers received dramatically different reimbursement amounts for the same CPT code despite delivering comparable services to patients covered by the same insurer.

If these differences are widespread, they could have significant consequences. Higher reimbursement rates generate revenue that can be reinvested into hiring physicians, opening new clinics, purchasing equipment, and expanding services. Lower reimbursement rates leave providers with fewer resources to invest in patient care and community growth.

The result is a cycle in which well-funded healthcare systems continue to expand while safety-net providers serving vulnerable populations face mounting financial challenges.

This raises important public policy questions.

What factors determine reimbursement rates between insurers and providers?

Are reimbursement disparities contributing to healthcare access gaps across South Carolina?

Do current contracting practices unintentionally reinforce longstanding racial and economic inequalities?

These questions deserve careful examination by policymakers, regulators, healthcare leaders, and the public.

BlueCross BlueShield of South Carolina occupies a unique position within the state’s healthcare system. Because of its market influence and its role in administering health benefits for large public and private employers, its reimbursement policies affect healthcare access for hundreds of thousands of South Carolinians.

State officials, legislators, and regulatory agencies should ensure that reimbursement systems promote equitable access to care and do not inadvertently disadvantage providers serving historically underserved communities. Greater transparency in physician reimbursement could help policymakers better understand whether payment disparities are contributing to unequal healthcare outcomes.

Let’s compare apples to apples. For example, if you visit a podiatrist in Lexington County owned by Lexington Medical Center, BlueCross BlueShield of South Carolina (BCBS) pays approximately $225 for CPT code 99204, a new patient office visit. In another ZIP code, if you visit a podiatrist practice owned by Black physicians and serving predominantly Black patients, such as Eau Claire Cooperative Health Centers or Physicians Foot Care, the reimbursement is closer to $100 for the exact same service. Likewise, if the podiatrist orders a foot X-ray, Lexington Medical Center receives approximately $78.81 for CPT code 73630, while Eau Claire and Physicians Foot Care receive about $35 for performing the identical service

The State of South Carolina has significant leverage in this discussion. BlueCross BlueShield of South Carolina administers health insurance benefits for hundreds of thousands of state employees and their families, making the state one of the company’s most important clients. State officials should use that influence to ensure that reimbursement policies are fair, transparent, and do not contribute to unequal access to healthcare.

South Carolina has spent decades dismantling the legal barriers of the Jim Crow era. Any payment system that disproportionately disadvantages providers serving Black communities deserves careful public scrutiny. Healthcare reimbursement should be based on objective standards and quality of care—not on a provider’s location, ownership structure, or the demographics of the patients they serve.

Who Actually Controls BCBS of SC?

 By Lachin Hatemi M.D.

For most of the last 80 years, BlueCross BlueShield of South Carolina has operated as a mutual insurance company under South Carolina law—specifically, Section 38-18-50. That structure is not just a legal technicality; it is supposed to embody a simple, powerful idea: the policyholders are the owners. In turn, those policyholders are meant to elect a board of directors that provides real oversight of the company’s executives and acts in the best interest of the people whose premiums sustain the enterprise.

But somewhere along the way, that promise appears to have been hollowed out.

Instead of a system where policyholders meaningfully choose their representatives, what exists today looks more like a closed loop. A small circle of insiders—along with legal architect Angela DeDee Rowe—has shaped a governance structure in which directors are effectively selected by the very leadership they are supposed to oversee. The result is a board that answers inward, not outward.

Consider the composition of that board. Three of its members—Michael J. Mizeur, Edward Sellers, and David Pankau—are current or former CEOs of the company. Their continued presence raises an obvious question: how independent can oversight be when it is conducted by those who once held, or still hold, executive power? Without reform, these individuals can remain in place indefinitely, stepping down only by personal choice.

The rest of the board does little to broaden perspective in the ways that matter most. Not a single physician, nurse, or pharmacist sits at the table. In a healthcare company responsible for the coverage and claims of millions, the absence of medical expertise is striking. Instead, the board is populated largely by lawyers, bankers, and business professionals—individuals whose skills may be valuable, but who do not bring frontline healthcare insight to decisions that directly affect patient care and costs.

Longevity is another concern. Several directors have served for decades: Merl Code since 2000, John Foos since 2011, Edward Sellers since 2001, and Minor Shaw since 2007. Over the company’s entire 80-year history, there has reportedly never been a contested board election. That is not stability; it is stagnation.

The nomination process lies at the heart of the issue. A nominations committee—drawn from within the existing structure—puts forward a slate of directors that, in practice, faces no opposition. Policyholders receive proxy ballots, but these function more as formalities than as instruments of choice. There is no meaningful mechanism for independent candidates to appear on the ballot, no quorum requirement to ensure broad participation, and no safeguard against the concentration of voting power.

The result borders on the absurd: even if the vast majority of policyholders decline to vote, a minimal number of ballots can still confirm the entire slate. In some cases, even incomplete or blank submissions may be interpreted in ways that favor the preselected candidates. This is not democratic governance; it is the appearance of it.

All of this raises a deeper concern: whether the current system complies with the spirit—if not the letter—of South Carolina law. A mutual insurer is supposed to be accountable to its members, not insulated from them. When governance structures become self-perpetuating, that accountability erodes.

The stakes are not abstract. BlueCross BlueShield of South Carolina is not just another private company. It plays a central role in the healthcare system, administering claims for state employees, federal workers, military families through TRICARE, and millions of Medicare beneficiaries via its subsidiary, Palmetto GBA. Decisions made in its boardroom ripple across South Carolina and far beyond.

Yet the individuals making those decisions are often far removed from the everyday realities of policyholders. Many are in their 70s and 80s, long removed from the pressures facing working families struggling with rising premiums, denied claims, or limited provider networks. When rate increases or policy changes come before the board, they are reportedly approved with little resistance—rubber-stamped rather than rigorously debated.

Reform is not just desirable; it is necessary. Opening the nomination process to independent candidates, establishing term limits, requiring healthcare expertise on the board, and ensuring meaningful participation by policyholders would be a start. These are not radical ideas—they are basic principles of good governance.

Regulators, including the South Carolina Department of Insurance, should take a hard look at whether the current structure fulfills the intent of the law. If they do not act, policyholders themselves may need to seek remedies through the courts.

At its core, this is a question of ownership and accountability. A mutual insurance company belongs to its members. If those members cannot effectively choose their leaders or influence decisions, then the mutual model has been reduced to a legal fiction.

We ask the current directors of the company to resign immediately and open space for new, younger and independent directors. South Carolinians—and the millions who rely on this institution nationwide—deserve better.

Ed Sellers: The Man Who Never Really Left BlueCross BlueShield of South Carolina

 By Lachin Hatemi M.D.

M. Edward “Ed” Sellers is one of the most influential figures in the modern history of South Carolina’s healthcare system. A Kentucky native and graduate of Vanderbilt University and Harvard Business School, Sellers arrived in South Carolina after working for Westinghouse Electric, Boston Consulting Group and the Blue Cross and Blue Shield Association in Chicago. He joined BlueCross BlueShield of South Carolina in 1987 as president and chief operating officer. He was elected to the company’s board in 1989, became CEO in 1992 and was named chairman in 2001.

Sellers led the company during an extraordinary period of expansion. When he joined BlueCross in 1987, the company reported approximately $220 million in revenue and 3,000 employees. By the time he retired as CEO in 2010, revenue had increased to approximately $3.8 billion and employment had grown to about 11,000 people. The company had also expanded well beyond traditional health insurance into government contracting, Medicare and TRICARE administration, life insurance, property and casualty insurance, technology and other businesses.

David S. Pankau succeeded Sellers as president and CEO on August 1, 2010. But Sellers did not disappear from the organization. When he stepped down as CEO, the company announced that he would continue as chairman of the board.

Sixteen Years Later, Sellers Still Has a Seat at the Table

That continued involvement is remarkable.

Ed Seller occupies a seat as one of the directors of the 10 member board, a voting position which needs to be elected every year and pays a significant salary. Ironically, most policy holders would not even recognize Ed Seller’s name.

Publicly available records show that Sellers remains chairman/director of the BlueCross BlueShield of South Carolina Foundation. The Foundation’s most recent publicly reported financial information shows approximately $357.7 million in net assets at the end of 2024, with approximately $21.4 million in charitable grants and distributions during 2024. Sellers is listed as chairman/director, alongside executives including Erika Kirby and Michael Mizeur.

The Foundation is not a small charitable organization. It has become a significant institution in South Carolina healthcare philanthropy. Its stated mission is to support nonprofit organizations, government agencies and educational institutions working to improve health outcomes throughout the state. Since 2003, it says it has awarded more than 724 grants and supported more than 281 nonprofit organizations.

This gives Sellers influence extending beyond the insurance company’s traditional business operations. Through philanthropy, board relationships and the broader BlueCross corporate structure, a former CEO who retired from his executive position more than a decade ago remains connected to institutions that influence healthcare policy, nonprofit organizations and healthcare initiatives across South Carolina.

A Corporate Empire Much Larger Than an Insurance Company

It is important to understand what BlueCross BlueShield of South Carolina actually is.

The organization describes itself as a mutual insurance company. Its own provider manual states that BlueCross is a mutual insurer headquartered in Columbia, South Carolina. The company evolved into a mutual insurance organization after South Carolina repealed the legislation that had originally created BlueCross and BlueShield in 1969. The two organizations subsequently merged in 1971.

Regulatory documents have described the company as being owned by its policyholders.

That ownership structure raises an important public-policy question: How much influence should a former chief executive retain over an organization that ultimately exists to serve its policyholders?

Sellers’ continuing role makes that question particularly relevant.

He is not simply a retired executive appearing at occasional corporate events. Public records continue to identify him as chairman/director of the BlueCross BlueShield of South Carolina Foundation, while corporate and industry organizations have continued to identify him in leadership or emeritus positions associated with the BlueCross organization. For example, CGS Administrators’ board information identifies Sellers as chairman emeritus of the BlueCross BlueShield of South Carolina board.

The Larger Question: What Kind of Healthcare System Did Sellers Help Build?

Sellers’ supporters can point to an impressive record of corporate growth. Under his leadership, BlueCross expanded from a relatively small regional insurer into a multibillion-dollar enterprise with thousands of employees and extensive government-contracting operations.

But corporate growth and healthcare outcomes are not necessarily the same thing.

South Carolina continues to face significant challenges involving access to primary care, physician shortages, rural healthcare access, hospital consolidation and the financial viability of independent medical practices.

That creates a legitimate question for policymakers and the public:

Did the business model developed during the Sellers era ultimately strengthen South Carolina’s healthcare system—or did it contribute to a system increasingly dominated by large insurers and large hospital systems?

One particularly important area for investigation is the relationship between insurance reimbursement and the survival of independent physician practices.

Independent physicians frequently argue that reimbursement negotiations are not conducted on a level playing field. A large insurer negotiating with a small physician-owned practice possesses substantially greater economic leverage. If reimbursement rates are significantly lower for independent practices than for large health systems or affiliated organizations, independent practices may eventually find it difficult to remain financially viable.

That issue deserves examination through actual claims data rather than rhetoric.

For example, policymakers should examine reimbursement rates paid by BlueCross to physician-owned practices compared with rates paid to hospital-owned practices for identical CPT codes and identical services. They should examine network participation, reimbursement disparities, facility fees, professional fees and the economic consequences of different contracting arrangements.

If significant differences exist, the next question should be why.

The Allegations Deserve Evidence—Not Dismissal

There are serious allegations that BlueCross reimbursement and network policies have disadvantaged independent physician practices and encouraged consolidation of healthcare into larger hospital systems.

However, Sellers’ extraordinary longevity at the highest levels of the organization makes his leadership record an appropriate subject of public examination.

If the policies that shaped today’s healthcare marketplace were developed during his tenure, then understanding the Sellers era is essential to understanding how South Carolina arrived at its current healthcare environment.

The investigation should therefore focus on measurable facts:

• What did BlueCross pay independent physicians compared with hospital-owned practices?

• Were physicians excluded from networks for reasons unrelated to quality or cost?

• How did reimbursement rates change over the Sellers and Pankau eras?

• Did reimbursement policies contribute to the closure or sale of independent medical practices?

• Did BlueCross contracts create economic incentives favoring particular healthcare systems?

• How much did BlueCross spend on physician reimbursement versus administrative expenses?

• What compensation and deferred-compensation arrangements were established for senior executives?

• Who approved those arrangements?

• What role did the board play?

• And ultimately, did these policies serve the interests of BlueCross policyholders?

These questions can be answered with contracts, claims data, financial statements, board records and regulatory filings.

The Executive Compensation Question

Another issue that warrants careful examination is executive compensation and deferred compensation.

There have been concerns about a large “Rabbi Trust” or deferred-compensation arrangement involving senior BlueCross executives. This $450 million in deferred compensation should be investigated by legislators and SCDOI.

That distinction matters.

If a $450 million executive deferred-compensation structure exists, the public deserves to know its precise terms, beneficiaries, funding mechanism and approval process. But those facts should be established through audited financial statements, regulatory filings or the underlying trust documents rather than presented as established fact without supporting documentation.

The Power of Institutional Longevity

Perhaps the most unusual aspect of Sellers’ career is not simply how long he served as CEO. It is how long his influence has continued after leaving the CEO’s office.

He led BlueCross for 18 years as CEO and remained chairman after retiring from the chief executive position. More than a decade later, public records still identify him as chairman/director of the organization’s Foundation.

That kind of institutional continuity is unusual in corporate America.

It also creates a legitimate governance question.

When the same individual remains connected to an organization for decades, the issue is no longer simply whether that person has formal executive authority. It is also whether informal relationships, institutional knowledge, board relationships and personal influence continue to shape decision-making.

Sellers’ supporters might describe that continuity as experience and institutional stability.

Critics might describe it as excessive concentration of influence.

Both interpretations deserve to be tested against the facts.

South Carolina Needs Transparency, Not Personalities

The debate over Ed Sellers should ultimately not be about whether one elderly retired executive is personally responsible for every problem in South Carolina healthcare.

That would oversimplify a complicated system.

The more important question is whether the governance and business practices developed over decades have produced the healthcare marketplace South Carolina needs today.

BlueCross is enormously influential in the state. Its decisions affect physicians, hospitals, employers, patients and taxpayers. Its Foundation controls hundreds of millions of dollars in assets and distributes tens of millions of dollars to organizations throughout South Carolina.

That level of institutional influence demands transparency.

South Carolinians should be able to understand who makes the decisions, how those decisions are made, how executives are compensated, how provider reimbursement is determined and whether the system treats independent physicians and large healthcare organizations fairly.

Ed Sellers’ five-decade association with BlueCross makes him an important figure in that history.

But the goal should not be to replace one personality with another.

The goal should be to build a healthcare system in which policyholders, patients and physicians—not institutional insiders—have the strongest voice.

If South Carolina wants to improve healthcare access, preserve independent medical practices and reduce unnecessary consolidation, it needs to examine the financial and governance structures that brought the state to its current position.

And that examination should include the Sellers era, the policies established during his tenure, and the influence that remains today.

BlueCross BlueShield and the Fight for South Carolina’s Urgent-Care Market

 By Lachin Hatemi M.D.

For years, South Carolina’s urgent-care market has been shaped by a powerful combination: a dominant health insurer and a large urgent-care network that the insurer itself owned.

That network was Doctors Care, which grew to 52 locations across the state. In November 2024, BlueCross BlueShield of South Carolina sold Doctors Care’s parent company, UCI Medical Affiliates, to North Carolina-based Novant Health for approximately $79.4 million. The transaction included 52 Doctors Care urgent-care clinics and 20 Progressive Physical Therapy locations.

The sale changed the ownership—but it does not erase the questions about how the market operated before the sale.

When an Insurer Also Owns an Urgent-Care Chain

BlueCross BlueShield of South Carolina has historically been the dominant commercial insurer in the state. An earlier National Institute for Health Care Reform analysis estimated that BlueCross held about 60% of South Carolina’s commercial insurance market at the time.

That creates an unusual competitive dynamic when the same organization also owns a major provider network.

For an independent urgent-care operator, being excluded from the dominant insurer’s network can be devastating. Patients with BlueCross coverage may face higher out-of-network costs or simply choose another clinic.

And South Carolina has already seen several public disputes over this issue.

MEDcare: A Public Fight Over Network Access

In 2014, MEDcare Urgent Care, led by Dr. Radwan Hallaba, publicly fought BlueCross after the insurer moved to remove MEDcare from its network.

MEDcare said BlueCross had “de-selected” the company despite its previous participation in the network. After a highly publicized dispute involving patients, businesses and political leaders, BlueCross reversed the decision and MEDcare returned to the network.

This was not simply a contract dispute.

For an urgent-care company, network status can determine whether patients can afford to walk through the front door.

Nason and American Family Care

Nason Medical Center in the Lowcountry faced a similar confrontation. In 2014, BlueCross announced that Nason was scheduled to leave its network, but the two sides reached an agreement allowing Nason’s five urgent-care centers to remain in-network.

Four years later, another dispute received significant attention.

American Family Care, a national urgent-care operator, complained that several newer South Carolina locations were being excluded from BlueCross’s network. State Representatives Mike Burns and Bill Chumley asked to meet with BlueCross over allegations that the insurer was restricting competition.

According to the Journal of Urgent Care Medicine, five AFC locations initially faced rejection from the BlueCross preferred-provider network. The controversy became particularly interesting because some of the rejected locations were reportedly within three miles of Doctors Care locations.

BlueCross rejected allegations that it was acting anticompetitively, describing the accusations as unfounded. In 2019, BlueCross and several AFC locations ultimately reached an agreement to join the network.

But they demonstrate that network access can become a major competitive weapon in the urgent-care business.

The Bigger Problem: Reimbursement

Network participation is only half of the equation.

The other half is how much an insurer pays different providers for the same service.

I have obtained and analyzed what I believe to be a comprehensive set of BlueCross BlueShield of South Carolina negotiated fee schedules covering urgent-care providers across the state. My analysis identified approximately 56 urgent-care companies and roughly 250–300 locations, although some contracts cover multiple locations.

One of the most commonly billed urgent-care codes is CPT 99213, representing an established-patient office or outpatient visit.

The reimbursement differences in the data are striking.

For 99213, the negotiated rates in the data range from approximately $36 at one independent urgent-care provider to more than $145 at a hospital-affiliated urgent-care provider.

That is roughly a fourfold difference for the same CPT code.

The lowest figure in my analysis was associated with Broken to Better Urgent Care in Rock Hill, while one of the highest was associated with Lexington Medical Center’s urgent-care clinics.

These numbers require additional independent verification and contract-level analysis before they can be presented as proof of discriminatory conduct. But if the figures are accurate, they raise an obvious question:

Why should two clinics providing the same service receive dramatically different reimbursement simply because of ownership or affiliation?

The Pattern Is Bigger Than One Clinic

The providers appearing toward the bottom of my analysis include:

• Broken to Better Urgent Care in Rock Hill (Closed One Location)

• Carolina Health Urgent Care in Greenville (Permanently Closed)

• Kid Care Pediatric Urgent Care

• Urgent Care LLC in Florence (Permanently Closed)

• Gaffney Urgent Care

• Gold Star Urgent Care in Florence

• Bella Clinical Care in Columbia

• Johns Island Urgent Care

Several of these businesses have reportedly closed locations, reduced hours or experienced financial difficulties.

But reimbursement is one of the most important variables in the economics of an urgent-care clinic. Most of the clinics on the lowest paid list, is either closed or financially struggling.

If an independent clinic receives $36 for a service while another provider receives $145, the difference is not theoretical. It can determine whether the clinic can hire another physician, remain open evenings and weekends, purchase equipment or survive another year.

A Market That Rewards Consolidation

This creates a powerful economic cycle.

Independent clinic enters the market → struggles to obtain favorable insurance contracts → receives lower reimbursement → loses money → closes or sells → hospital system acquires more providers → hospital system becomes larger and more powerful.

The cycle benefits consolidation.

And once a hospital system owns primary-care practices, urgent-care centers, specialists, imaging facilities and hospitals, it can capture revenue at multiple stages of a patient’s healthcare journey.

That is why the urgent-care market cannot be viewed simply as a competition between medical clinics.

It is a competition over patients, insurance contracts and the downstream healthcare revenue those patients generate.

The Doctors Care Sale Changes the Story—but Not the Question

BlueCross’s sale of Doctors Care to Novant Health was an important development.

Today, Doctors Care operates under the Novant Health umbrella. Novant acquired UCI Medical Affiliates in November 2024 and subsequently rebranded the 52 Doctors Care locations as Novant Health Urgent Care.

But the fundamental question remains:

Was South Carolina’s urgent-care market ever truly competitive when the state’s dominant commercial insurer also owned the largest urgent-care network?

That question deserves serious examination by regulators, legislators, employers and patients.

Because if an insurer can determine who gets into the network and how much each provider gets paid, while simultaneously owning a major provider network, the potential conflict of interest is obvious—even if no law has been violated.

Patients Ultimately Pay the Price

The consequences go beyond individual doctors.

When independent urgent-care clinics disappear, patients have fewer choices.

When reimbursement becomes inadequate, physicians stop opening clinics in smaller communities.

When independent practices close, physicians often have only one realistic alternative: go to work for a large hospital system.

And when independent competition disappears, healthcare becomes increasingly concentrated in the hands of a few large organizations.

The question South Carolina should be asking is not simply whether BlueCross complied with its contracts.

It is whether the state’s healthcare marketplace provides a level playing field for independent physicians.

Because a healthcare system cannot claim to promote competition while simultaneously making it economically impossible for independent doctors to compete.

Patients need more choices, not fewer.

And South Carolina needs an urgent-care market where a physician-owned clinic has a genuine opportunity to compete with a hospital-owned clinic—based on quality, access, efficiency and patient satisfaction, rather than simply on who controls the insurance contract.