Health Overhaul

House Speaker Paul Ryan of Wis. uses charts and graphs to make his case for the GOP's long-awaited plan to repeal and replace the Affordable Care Act during a news conference on Capitol Hill in Washington on March 9, 2017. File/J. Scott Applewhite/AP

South Carolina will be at the bottom of the heap if Republicans follow through on their proposed deep cuts to Medicaid, a Kaiser Family Foundation analysis found this week.

A bill that passed the House of Representatives would cut funding to Medicaid, the health insurance program for the poor, by $834 billion during the next decade.

South Carolina and 10 other states were identified as a group that would be in the most trouble if such cuts are signed into law, according to the recent Kaiser analysis.

That Republicans want to cut Medicaid and move its administration to the states should come as little surprise, said Robert Hartwig, a University of South Carolina professor who previously ran the Insurance Information Institute. Republicans, Donald Trump included, campaigned on repealing and replacing the Affordable Care Act.

"It’s one part of that," Hartwig said, "but it’s the one that touches the lives of more Americans in a more substantial way."

A number of factors will put South Carolina at a greater risk than most other states, the Kaiser Family Foundation analysis found:

  • South Carolina has the fourth-highest federal match rate, meaning the federal government contributes a lot of money to the state's Medicaid program compared to other states. For every dollar the state government spends on Medicaid, the federal government gives about $2.50 to South Carolina, said Allison Valentine, a policy analyst with Kaiser. "The state would need to make up those dollars," she said. 

  • There is not much money in the state budget to spare. The Kaiser analysis cited "low taxable resources per capita" as a reason South Carolina might be at risk. People in the state also have low personal income, on average. 

  • Many people fall into the "coverage gap" in South Carolina, meaning they do not qualify for Medicaid, don't receive insurance from their employer and cannot afford to buy it themselves on the private market. With Medicaid cutbacks, that gap is likely to grow. Today, 13 percent of adults younger than 65 do not have insurance in South Carolina, Kaiser reported. 

  • Access to health care in South Carolina remains a problem. Kaiser reports 16 percent of adults surveyed in the state said they didn't see a doctor because of high costs. Poor access diminishes the overall health of the state population.

The Senate's final health care plan is uncertain and shrouded in secrecy. A Senate bill is expected to see a vote within weeks, but Senate Republicans have refused to release any draft of the legislation and have promised scant hours of debate before a vote is taken. 

The Republican proposal would cap how much Medicaid spends on each individual, and states would need to decide how the cash is allocated. That could mean pitting groups like seniors, the disabled and children against each other, said Sue Berkowitz, director of the Appleseed Legal Justice Center. She also said if new problems arise — or if the opioid epidemic worsens — the state may find it difficult to respond.

"It will put an incredible strain on our budget," she said. 

Hartwig said the state has four options: Legislators can increase taxes or introduce a new tax; borrow money; find a way to make the current dollars go further; or cut programs. Each is a tough sell, he said. 

But Hartwig said the cuts will serve as a nationwide experiment, and states will learn how to find the best solutions.

"The view from Washington is this is what America voted for," he said. "State legislators are going to be put to the test in terms of how they manage health care systems for the poor."

Reach Mary Katherine Wildeman at 843-937-5594. Follow her on Twitter @mkwildeman.