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Affordable Health Care is at Stake in This Election

By V. Susan Hutchinson

Healthcare coverage for many, many South Carolinians is at stake in this election as the Affordable Care Act (ACA) is under attack by Republicans and the Trump Administration, and the only way to fight back is to vote out politicians who are preventing residents from having access to affordable healthcare.


So, if you rely on the ACA for your healthcare coverage, or you are on Medicaid, you must vote for SC House candidates Bruce Fischer (Dist. 56) and Tony Cahill, (Dist. 107), as well as Melissa Watson, candidate for the 7th Congressional District, U.S. Senate candidate Jaime Harrison and Joe Biden for President of the United States.

It will be a vote for expanding, not repealing healthcare in America.

Here’s what’s going on that makes this so important and the need so immediate.

The ACA is now on life support as it has been challenged as unconstitutional by several Republican-led states in a lawsuit supported by the Trump Administration. On November 10, the U.S. Supreme Court (SCOTUS) will review the case and by that time, Trump’s hand-picked jurist, Amy Coney Barrett, will be on the bench. If the ACA is struck down, healthcare coverage for those who rely upon it will be gone, including coverage for pre-existing conditions. And Medicaid expansion will be over.

Those are the facts.

When the ACA was enacted, it expanded Medicaid eligibility to non-elderly adults with incomes up to 138 percent of the federal poverty level, making millions more Americans eligible across the nation. But residents of South Carolina were left out in the cold.

That’s because SCOTUS ruled that Medicaid expansion was optional for all states and South Carolina is one of 14 states, all led by Republicans, that refused to implement the expansion.

As of June 2020, the uninsured rate in South Carolina was 12.6 percent. With Medicaid expansion, that rate would drop to 8.0 percent as thousands more South Carolinians would be covered.

The Claim: It’s Too Expensive to Expand

The ACA requires the federal government to pay 90 percent of service costs for low-income adults who are covered under Medicaid expansion. This means states that have implemented expansion only have a cost burden of 10 percent. Although the number of people enrolled in Medicaid would increase with expansion, this increase in federal funding means the percent increase for combined Medicaid and the Children’s Health Insurance Program (CHIP) in South Carolina would be just 14.9 percent.

The state legislature must stop looking solely at the increase in spending with Medicaid expansion. In a May 2020 article from The Commonwealth Fund, three reasons were given to look past the “sticker price”.

  • Expansion allows states to cut spending in other parts of their Medicaid program.
  • It would reduce spending outside of Medicaid, especially on state-funded health services for the uninsured – since fewer people would be uninsured.
  • It may increase state revenues due to taxes related to Medicaid expansion or taxes on increased economic activity that it triggers.

Cherry picking data without looking at the big picture continues to leave thousands of people in South Carolina uninsured because they don’t qualify for Medicaid and are not eligible for the tax credits under the ACA. There are also more far reaching implications, especially to rural communities across the state.

Impact on Rural Communities

Poverty levels in South Carolina, as in other states, vary by county with urban areas having lower levels than the rest of the state. However, even counties like Horry and Charleston still have poverty levels just over 14 percent.

Making things worse, South Carolina has implemented a work requirement for adults on Medicaid. This means that most adults who qualify for the program must prove they work at least 80 hours per month, volunteer, or are looking for a job. This additional requirement was implemented by the Trump administration with the intent of promoting employment instead of helping low-income parents with their healthcare needs.

Impact on Rural Health

More than 1.2 million South Carolinians are on Medicaid, with 33 percent living in rural areas. Passing the work requirement can be viewed as a cut to Medicaid, as 26,000 Medicaid recipients in South Carolina are expected to lose coverage by the fifth year of its implementation. As a result, hospitals will be unable to collect payment from these new self-pay patients who will have lost their Medicaid eligibility and are unable to obtain other healthcare coverage. For rural hospitals that rely heavily on Medicaid payments, it could mean layoffs or closure.

Dr. Bruce Fischer, candidate for SC House 56, is concerned about healthcare in rural areas of Horry County as well as across the state.

A clinical psychologist, Fischer is a strong advocate for improved access to healthcare especially for residents in rural areas, and understands the financial impact throughout the healthcare system when patients do not have access to coverage.

“Despite Lindsey Graham’s claims to the contrary, rural hospitals would be saved, not closed, by taking the Medicaid expansion,” he said.

In South Carolina, four rural hospitals have closed since the ACA was passed in 2010. In 2019 alone 120 rural hospitals closed across the United States.

According to the report from the Chartis Center for Rural Health, rural hospitals in states with Medicaid expansion decreased the risk of closing by 62 percent, and states with the most closures are all those that have refused to expand Medicaid. Fortunately, South Carolina does not currently have the rate of closure of states like Texas and Georgia, but that could change at any time.

The COVID-19 pandemic has increased the need for Medicaid expansion due to rising unemployment. Thousands of people across the state lost healthcare coverage when they lost their jobs and may not be eligible under the current Medicaid requirements or for the ACA.

By refusing to expand Medicaid in South Carolina, Governor Henry McMaster and the Republican controlled statehouse are forcing rural, low-income residents to remain without critical healthcare coverage, even during a pandemic. They are forcing them to take on enormous medical debt should they end up with a long-term illness and to risk their lives trying to get to the care they need when their local hospital closes and the nearest one is an hour or more away.

South Carolina needs Medicaid expansion, but that will not happen unless the balance of power in Columbia is changed from Republican to Democrat. It’s as simple as that.

Vote blue for the healthcare future of South Carolina.

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