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EDITORIAL: Medicaid can help bridge S.C. divide
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EDITORIAL: Medicaid can help bridge S.C. divide

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It comes as no surprise that new rankings of South Carolina counties have Orangeburg County among the least healthy.

The annual County Health Rankings report, released by the University of Wisconsin Population Health Institute with the South Carolina Institute of Medicine and Public Health as the lead dissemination agent here, shows health disparities persist, with urban and wealthy counties in general faring much better than rural and poorer South Carolina.

For more than a decade, the County Health Rankings report has examined the multiple factors that impact how long and how well people live. Where they live is a factor. Orangeburg County ranks 35th in health outcomes and 34th in health factors. Bamberg is 37th and 35th while Calhoun is 24th in both categories.

According to the 2021 rankings, the five healthiest counties are Beaufort, followed by York, Charleston, Dorchester and Greenville. The least healthy are Williamsburg, ranked at the bottom of the list, followed by Allendale, Lee, Dillon and Marion.

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Although the data used to calculate the 2021 rankings are from 2019 and earlier and thus do not yet reflect the impact of COVID-19, IMPH states that “the pandemic has brought to the forefront the differences in opportunity we see by race, ethnicity and place — differences we must urgently tackle if we want to have a fair, inclusive and equitable recovery for all.”

As explored in IMPH’s COVID-19 Health Disparities Report released in December 2020, the pandemic has interacted with existing disparities in social and environmental determinants of health, which has magnified its impact — particularly on people of color in South Carolina. Many find themselves in difficult circumstances: living in food deserts without access to broadband internet, computers or cell phone service.

The new report on health in the state comes as South Carolina Senate Democrats are urging state leaders to revisit the issue of expanding access to the Medicaid program, which funds health care for the poorest South Carolinians.

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The state has remained among 12 that did not expand the federally backed program after passage of President Barack Obama’s Affordable Care Act. S.C. leaders have said that once federal incentive money for the expansion phases out, the program will be too expensive.

The new federal stimulus legislation includes a new effort to expand Medicaid. The U.S. government would pay 5% more of the state's current Medicaid expenses for two years instead of the 70% it currently pays. It would pay 90% of the expenses of new Medicaid beneficiaries for an indefinite period, according to the nonprofit Kaiser Family Foundation. (NOTE: The percentages of government payments have been corrected from an earlier version of this editorial).

Gov. Henry McMaster, as did his predecessor Nikki Haley, has continued to reject the expansion, which estimates indicate would include about 200,000 more people.

The Senate Democrats, including Orangeburg County Sens. Brad Hutto and Vernon Stephens, held a news conference on Tuesday calling on McMaster to accept the U.S. offer on Medicaid. The Democrats said expanding Medicaid would come back in billions of dollars in growth in the health care industry and more people willing to work, and in savings from people having insurance so they go for care before a problem becomes catastrophic and too expensive.

As pointed out by Hutto and reported by The Associated Press, Medicaid expansion would help patients who work but don’t get health insurance from their jobs. He said it would also help health care providers such as the Regional Medical Center, which as a publicly owned hospital treats patients whether they can pay or not.

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“Everybody deserves to be treated, everybody deserves to be served, and that’s exactly what RMC does,” Hutto said. But the cost of serving the uninsured falls back on the taxpayers of Orangeburg and Calhoun counties, or on people who have health insurance and have to pay higher rates.

“When those doctors aren’t reimbursed or paid, then somebody’s got to pick up that cost and, ultimately for us in Orangeburg, it’s the taxpayers. So we are very much in favor of calling on the governor to take a second look, a third look at this opportunity,” Hutto said.

The IMPH rankings are another illustration of what retired Orangeburg County Sen. John Matthews calls the two South Carolinas – the haves and have-nots -- based on the wealth of counties. Expanding Medicaid would help bridge a health care gap for the poorest counties – and bring needed funding to providers currently serving those being underserved or not served at all with health care.

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