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Health Care: Medicaid

It is not enough for candidates to just say "I will expand Medicaid on Day One." Voters need to understand why this important to everyone and how it will be paid for to gain their support. This is true of all of the major issues South Carolinians will be hearing about over the next year as the campaigns for the office of Governor release position statements to the press and the public.

Expanding access to health care in South Carolina is of particular importance to me. As a health care advocate, I have seen countless people who had to forego needed medical treatments because they had no insurance and could not afford the high cost of health care.

Yet, for nearly a decade, South Carolina has been eligible to receive significant funding from the Federal government to allow the state to expand Medicaid to cover approximately 350,000 low-income citizens. These funds come from taxes already being paid by South Carolinians as a part of their federal income taxes. For every dollar South Carolina would spend to expand Medicaid, an additional seven dollars would be received from the federal match.


Despite the economic and health benefits of expanding Medicaid, SC Governor McMaster has refused to do so for the last 6 years.

South Carolina currently ranks 40th in the country for uninsured people, with nearly 6% of children and 12% of adults with no health insurance. Looking at race, the rates are clearly disparate, with uninsured rates of 8.6% for whites, 11% for blacks, and 30% for Hispanics. Even more telling is that for lower income families the uninsured rate is 15%, but for those with higher incomes the rate is is less than 5%.


This inequality in health care must change if we are truly a state that cares about all people. To quote Desmond Tutu, "There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in."

  • The burden of the cost of uncompensated care is passed on to those with insurance in the form of higher insurance premiums.
  • The long-term consequences of not having health insurance leads to shorter lives and more preventable illnesses for those without insurance due to a lack of preventative screening and early intervention that comes with having an established relationship with a primary health care doctor.
  • Higher rates of bankruptcy due to medical bills for those with no insurance also has a disproportionately negative effect on our overall economy.
  • Recent studies that compare overall personal medical debt between residents of states that have expanded Medicaid against states like South Carolina that have not shown a significant decrease in overall debt for those with increased health coverage.


The federal government recognizes the need for Medicaid expansion in states like ours. Soon after President Biden took office in January of 2021, his administration incentivized Medicaid expansion for South Carolina and other states. Medicaid expansion is now completely covered at 100% (including administrative costs) by the federal match for two years, after which South Carolina would be responsible for 10% of the cost of expansion.  Additional incentives would also boost the federal match for existing South Carolinians on Medicaid that could be used to cover the 10% match for up to an additional four years.

In other words, Medicaid can be expanded to include a quarter of a million low-income South Carolinians who currently have no health insurance or cannot afford to purchase a health insurance policy without any need to include it in the SC budgeting process for 4 to 6 years. By the time it does need to be included in the state budgeting process, other measures I will implement as Governor will have made it more beneficial to fund than not. So, let's look at the details of how I believe we should expand Medicaid.

As Governor, I will not only expand Medicaid on Day One, I'll also require our state public health agency to set aside the additional funds they receive to cover the 10% state match that will be required after the first two years. This fund balance will be used to cover the cost of expansion for several additional years.

I'll also work to establish partnerships with health care providers to create multiple health centers that will accept Medicaid insurance in underserved rural areas across our state. No one should need to travel long distances to access affordable primary or emergency care.

Since the state is reimbursed for each visit and procedure by Medicaid enrollees, the more people use the insurance the more funds the state receives. This is an important point... Increasing the number of people covered by Medicaid actually increases the federal funds coming to South Carolina, and every dollar of those funds goes into the economy of our state.

Creating more rural health centers will also create thousands of jobs in the health care industry while letting the private health care sector create locations that will be accessible and convenient for those who are covered by Medicaid expansion.

The state public health agency responsible for Medicaid will also be directed to apply for a federal waiver to allow Medicaid coverage to be added to the SC Health Care exchange as a private payer option. By creating competition with the private sector insurers currently dominating the marketplace, we will both lower the cost and improve the quality of health insurance for everyone.

I will also put an end to Gov. McMaster's work requirements for Medicaid recipients and restore funding to Planned Parenthood for women's health services. These restrictive policies created needless barriers to health care access that ultimately harm the health and livelihood of lower income South Carolinians.

The Covid pandemic has shown us the importance of having a public health approach that is very different than what we have today in South Carolina. The fact that so many people in our state have no health insurance created a disproportionate effect on those with lower incomes and those who are not white. As we struggle as a state to recover from the pandemic and increase the number of people who get vaccinated, the lack of trusted relationships with primary care doctors who can recommend vaccinations to their patients is having a negative impact on those efforts.

I am confident that this comprehensive shift in the health care policies of South Carolina will not only save lives, but ultimately lower the cost of health insurance for everyone... All without the need to raise state taxes to do so. It's time to stop people from dying earlier than they have to, and let them live healthier, more productive lives.  It's up to all of us to go upstream, and save the people of South Carolina who are drowning in a river of illness and medical debt.

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