South Carolina is on the verge of a major healthcare crisis. Last week, Cooperative Health clinics announced the closure of five of their clinics. They’re predominantly located in rural communities that already have limited access to care. Lake Monticello and Ridgeway are in Fairfield County, where there are currently no pediatricians. There are fewer than nine primary care providers and no hospital in a county with more than 20,000 people.
There have been four hospital closures or conversions in South Carolina - one of which was in Fairfield County - since 2005. South Carolina hospitals already carried $3.2B in uncompensated care last year, so the OBBA cuts worsen this existing financial strain. And SC rural hospitals have thin margins (0-4%) and high Medicaid/Medicare patient loads, with 5 identified most at risk. OBBA exacerbates their fragility and threatens local care. Challenges in individual hospitals aren’t outliers - it’s a situation we’re likely to see play out as Medicaid cuts are implemented and the Affordable Care Act subsidies lapse.
By 2034, 180,000 and 290,000 South Carolinians could lose health insurance coverage. Currently 571,200 South Carolinians signed up for plans in 2024 via the Affordable Care Act Marketplace. Nearly 95% of these enrollees received subsidies to help lower premium costs. But if Congress fails to extend Enhanced Premium Tax Credits, an estimated 221,967 could lose coverage. If tax credits expire, premiums for marketplace plans rise by $588 on average per year. But that’s not evenly spread across the state - on the high end, premiums in Beaufort County will go up to $800 per year.
This is already paired with the impact of access to healthcare will become more precarious. 51,000 residents will also lose their Medicaid coverage and many others may lose it as work requirements are implemented. And while statewide 15% of South Carolinians will no longer have health insurance post-cuts, residents in places like Jasper County already have an uninsured rate of 19% today.
The financial strain on South Carolina households is already severe and will also grow worse - further exacerbating the existing problems in the employer-based system, Medicaid, and the ACA marketplace. Today, nearly 9% of South Carolinians carry medical debt with residents in Laurens, Fairfield, Edgefield, and Marlboro carrying more than 15%. South Carolina has the second highest level medical debt per capita among its residents.
With no Medicaid expansion, the primary group of South Carolinians impacted by cuts to Medicaid are seniors, children and disabled. Their families will have to in turn absorb that cost for that care themselves. The nursing homes, hospitals, and health centers that depend on - and Medicare cuts may not be off the table.
The same is true for employer sponsored plans. In 2023, the average employer-sponsored family plan in the state cost $22,035 annually, with deductibles averaging $4,337 in a state where, in 2020, the average individual salary was $57,216. In some counties - like Dillon, Marion, and Williamsburg, the average individual salary is under $40,000.
Many of the same challenges carry over to the individual market. For a household in Camden with an income of $55,653, their silver plan premiums would increase by $2,059 annually, if the subsidies expire. For a household in Chester County with an income of $51,216 (164% of the poverty level), their silver plan premiums would increase by $1,875 annually, if the subsidies expire. For a household in Marion County with an income of $34,501, their silver plan premiums would increase by $628 annually, if the subsidies expire.
For many families, this is simply too much and they’ll drop their entirely.
Taken altogether - these changes will leave an indelible and negative imprint on our communities. The stakes are clear: South Carolina’s families, economy, and health system depend on keeping coverage within reach. As I said last week - we need to mobilize communities, elevate local voices, and educate on policies that could preserve public health. That means working with partners to share the data, training trusted messengers, and holding decision-makers accountable for the health outcomes of their constituents. I hope you’ll join us in our work.