South Carolina must expand Medicaid to help frontline workers, uninsured residents

The COVID-19 pandemic has taken a tremendous toll on our state’s economy. Employers across industries have had to make difficult decisions about operations in response to lockdowns, decreased tourism, and ever changing state and federal health guidelines.

Now that the state has fully reopened and South Carolina businesses are adjusting to a new normal, they are facing another obstacle: Many workers don’t want to return — at least, not to the way things were before the pandemic.

From grocery store cashiers to construction workers to nursing assistants, these folks kept South Carolina moving forward during the pandemic, but many of them lack health insurance, adding another layer of risk to their jobs that has — rightfully — brought up doubts about whether that risk is worth the pay.

The solution? Expand Medicaid to cover the nearly 200,000 people who are currently uninsured in the state, half of whom are low-wage workers on the front lines of our state’s service economy. To help these workers back to work, we must start by prioritizing their health.

South Carolina is one of just 12 states that has resisted Medicaid expansion under the Affordable Care Act (ACA). Under our state’s existing guidelines, only adults with children making up to $712 a month are eligible for Medicaid.

This is far below the ACA’s allowance of incomes up to $1,482 a month. Of those who would become eligible through expansion, 75% are adults living below the poverty level.

To those of us looking at the numbers, the connection between lacking healthcare coverage and today’s labor shortage is crystal clear.

South Carolina’s service economy thrives on the coast, where uninsured workers have kept things running.

Take Horry County, home to popular tourist destination Myrtle Beach, where more than one-fifth of working adults don’t have health insurance. In Charleston, one of the top travel destinations in the nation, 14% of workers are uninsured.

This issue exists beyond the coast, too.

From Oconee and Union to Saluda and Sumter, South Carolina faces high rates of uninsured adults working across industries such as construction, manufacturing, and warehousing. In fact, our state has more uninsured workers per county than the average county in the nation.

Unless we can ensure health care coverage for these workers and keep them safe amid the ongoing pandemic, legislators risk driving South Carolina into another economic crisis before we fully recover from the last one.

Today’s labor shortage is not driven by people who would rather collect unemployment than work. This excuse neglects the fact that workers in low-paying jobs in South Carolina were facing vast health disparities before the pandemic, and many are living in homes with people who are at higher risk for severe illness from the virus.

Without health benefits to protect them and their loved ones against COVID-19, these high-risk, low-paying jobs are no longer worth it to them.

It’s also not a matter of whether we can afford it. The federal government covers 90% of the cost to expand Medicaid, leaving just 10% of the cost to South Carolina. Currently, South Carolina is covering 29% of the cost.

The case of Medicaid expansion nearly writes itself, lowering current state expenditures by $190 million.

We need to look beyond cost and consider who is excluded from the current Medicaid program: our essential workers.

Isn’t it in our economy’s best interest to help them manage their illnesses and stay healthy?

Detractors say that expanding Medicaid will hurt our state’s economy, but after everything we witnessed during the pandemic, I don’t believe it can get any worse.

Sue Berkowitz is the director of South Carolina Appleseed Legal Justice Center.