North Carolina Rep. Donny Lambeth and state Sen. Kevin Corbin, both Republicans, speak at the South Carolina Statehouse in Columbia on Tuesday, Sept. 24, 2024, as advocates for Medicaid expansion. (Skylar Laird/SC Daily Gazette)
COLUMBIA — If Cliff Arnold had health insurance to cover the cost of the procedure he needs to manage kidney issues, he would get back to work right away, he told reporters.
But after losing his job two years ago because of a failing kidney and complications from diabetes, Arnold lost his health insurance. His disability paychecks, while barely enough to pay for regular expenses, are too much to qualify him for Medicaid.
“At the end of the month, I’m sweating to see if I can make it” until his next disability check, Arnold said during Tuesday’s news conference at the Statehouse.
Pointing to stories like Arnold’s, Cover SC, a coalition of nonprofits that officially launched Tuesday, is aiming to convince legislators to expand Medicaid eligibility to more adults like Arnold.
The group of nearly 100 organizations is leaning on North Carolina’s recent expansion as proof that Republican leaders could change their minds. The coalition includes health care providers and associations, civil rights groups, advocates for the poor, the Catholic Diocese for the state, and the Catawba Indian Nation.
South Carolina is one of 10 states that have not expanded Medicaid eligibility to cover all adults with incomes up to 138% of the federal poverty level, as the 2010 federal health care law commonly known as Obamacare intended.
North Carolina’s Republican-controlled Legislature approved an expansion last year. Since enrollment of newly eligible North Carolinians began Dec. 1, more than 500,000 people have signed up for the health coverage, according to the office of Gov. Roy Cooper.
Convincing South Carolina legislators to do the same will be an uphill battle, advocates acknowledged.
“It’s not just one time around” that the group’s supporters will need to contact their legislators, said North Carolina state Rep. Donny Lambeth, a Winston-Salem Republican. “Go back again. Go back again. Go back again, because this is a journey you’re on. It’s not going to happen overnight.”
Even the mention of Medicaid expansion tends to rankle state GOP leaders.
A clause senators put in their budget proposal this year would have examined a number of potential health care system reforms, including what it would mean to expand Medicaid.
The House agreed to keep the study group in the Legislature’s final package. But McMaster vetoed the budget clause, writing in his veto letter that the idea of looking for affordable health care was a “worthy endeavor” while reiterating his opposition to Medicaid expansion.
But with more states expanding their coverage, including Republican-dominated states that once balked at the idea, coalition members are hopeful, said Teresa Arnold, chair of the coalition and Cliff Arnold’s sister.
“We’re in much better shape today than we were 10 years ago, because we have the data,” Arnold said. “That’s what we’re going to be doing, is educating each legislator one by one and their constituents on the benefits of Medicaid expansion.”
Coalition members plan to start by sitting down with local leaders, persuading city and county councils to pass resolutions supporting Medicaid expansion. If the local backing is there, advocates can more confidently tell legislators that their constituents want expansion, Arnold said.
“That’s crucial, because (legislators) need backing from their local folks to learn that way,” Arnold said.
Medicaid expansion could cover 360,000 more people in SC, new report says
A similar coalition in North Carolina spent 10 years talking to legislators before its Legislature passed an expansion, said Peg O’Connell, who was the chair of that group. South Carolina has the benefit of learning from North Carolina’s mistakes and successes, she said.
Starting local was a major help for the North Carolina group, as was having county-by-county data to show legislators how many of their own constituents stood to benefit from expanding Medicaid. The group focused on the impact for people, O’Connell said.
“I’m hoping what we learned in North Carolina, that this is not a toxic political issue, can help other non-expansion states,” O’Connell said.
Who’s eligible now?
Under South Carolina’s existing eligibility rules, non-disabled, non-elderly adults without children don’t qualify for full coverage by Medicaid.
Parents can qualify if they make 67% of the federal poverty level or less, which is $16,650 per year for a family of three. Children 18 and under still qualify if their parents earn at or below 208% of the poverty level, or a maximum of $53,706 for that same family of three.
People like Arnold, who have a disability established with the Social Security Administration, can make up to $15,060 per year for one person.
Around 1.1 million people in the state are enrolled in South Carolina’s full Medicaid program, according to the state’s Medicaid agency. Expanding Medicaid could cover somewhere around 360,000 more people, a study commissioned by Cover SC found.
That includes about 100,000 people who already receive some benefits under the state’s “family planning” program for adults making less than 200% of the poverty level. The limited benefit program covers birth control options and preventive health screenings, but not the medical treatment for problems discovered by exams.
The expected increase also includes South Carolinians who are already eligible for Medicaid but not enrolled — who would likely sign up amid education about an expansion — and people who qualify for federally subsidized health insurance, said lead researcher Leighton Ku.
Opponents of expansion have said they worry about giving free health care to people who could otherwise work. Another big hurdle the coalition will need to overcome is the price tag that comes with expanding eligibility.
Overcoming the cost hurdle
The federal government covers 90% of the cost for people in an expansion — compared to about 70% of the share in the existing program. That would increase South Carolina’s costs to roughly $2.5 billion if legislators decided to expand Medicaid next year, according to a study Cover SC commissioned.
The state’s 10% share is estimated at $270 million in the first year. Three years after launch, the cost is expected to grow to $356 million, the study found.
Due to the continually rising cost of health care, the state’s share of expenses would almost certainly grow annually. In this year’s budget, the state put an additional $36 million into Medicaid just to cover existing services, $51 million more to increase doctors’ rates in an effort to ensure they accept Medicaid patients, and $16 million for additional mental health benefits. That brought the state’s spending on the government health insurance program to almost $2.2 billion this fiscal year, or 15% of the total budget for state taxes.
Cost was a major problem for North Carolina legislators, too, said Lambeth and state Sen. Kevin Corbin, a Republican who represents the state’s mountainous western corner. But they found a workaround by taxing the state’s hospitals, which would benefit from an increased number of people seeking health care, to pay for the state’s portion.
If the tax ever stops being able to cover the state’s part of the deal, leaving taxpayers to make up the difference, North Carolina’s expansion would end.
“That was a political talking point we could bring back to our respective Republican caucuses,” Corbin said.
Whether or not that would be a possibility in South Carolina remains up in the air. Cover SC members are in the beginning stages of conversations with legislators, Arnold said.