Joyce Brown can't get a Medicaid card in South Carolina and, like many applicants recently denied coverage here, she may have qualified for the government's low-income health insurance program if conservative leaders had changed their minds about Obamacare or if the federal law was written differently.

Brown is less than two years shy of 65, and until she can apply for Medicare, the North Charleston woman doesn't know how she will cope with an unexpected medical emergency.

The federal Affordable Care Health won't help her and she's too poor to buy private health insurance. She only makes $11,000 a year as a part-time caregiver. Her small savings account was nearly depleted last year after she paid a $4,000 medical bill.

"I went to that website to apply for Obamacare. It said that I did not qualify for the Obamacare assistance, but I could purchase insurance through a private company," she said. "When I looked into that, BlueCross BlueShield was wanting to charge me $400 a month. It was unbelievable - the price was something I can't do. Another company was even higher."

More than 85,000 South Carolinians signed up and paid for private health insurance through the Affordable Care Act marketplace between October and March, according to the S.C. Department of Insurance. The vast majority of those customers qualified for assistance to help pay their monthly premiums, making coverage more accessible and affordable than ever before for many people. But Brown counts herself among an estimated 200,000 residents in this state who have been shut out of options.

She can't get a Medicaid card - she applied in December but was denied - and she doesn't qualify for a federal subsidy to offset the cost of private insurance, either. The Affordable Care Act only provides those subsidies to residents who earn between 100 and 400 percent of the federal poverty level. Brown's annual income falls below that threshold.

The Obama administration contends that if South Carolina leaders reversed course and expanded Medicaid under the Affordable Care Act, Brown wouldn't need that subsidy.

"I'm not a charity case. I'm just out of luck," she said. "Yes, I'd like to have insurance and I'd like the State of South Carolina to accept the (Medicaid) expansion."

Even though South Carolina is considered a "non-expansion" state, Medicaid enrollment here is actually growing. An analysis published this month by Avalere Health shows Medicaid in South Carolina grew more than 5 percent between October and March as residents who were previously eligible but unenrolled for a variety of reasons started signing up. It's called the "woodwork effect."

Additional data provided by the state Medicaid agency shows about 8,000 more applications were filed between October and March compared with the same six months a year before, but the program's "ineligible determination rate" increased only 3 percent year-over-year.

John Supra, the deputy director for operations and information management at the state Medicaid agency, warned that an "apples-to-apples" comparison between the two years is difficult.

For example, he said, between October and December 2012, the agency launched Express Lane Eligibility, which enrolled 92,000 children into the Medicaid program, resulting in a one-time surge that won't bear out in subsequent years.

But these numbers mean little to Brown. She remains uninsured, hopeful that her relatively good health will keep her out of the hospital for the next few years.

"I've never asked for charity. I've never asked for anyone to do anything for me," she said. "I don't want to be one of the people who has to rely on going to the emergency room as my primary source of health care." I don't do that."

Reach Lauren Sausser at 937-5598.