South Carolina has second-highest level of medical debt in US, but little hope of expanding Medicaid coverage – InsuranceNewsNet

by Sue Berkowitz son was born in 1993 with a heart defect. Three years later, Berkowitz and her husband lost their health insurance when her nonprofit employer lost funding. Private insurance denied health coverage for her 3-year-old son due to his pre-existing condition.

Berkowitz was already working in health advocacy, but after her experience with her donation, she became even more invested in her health advocacy and legal work in Caroline from the south. She worked to get votes from Caroline from the south to help pass the Affordable Care Act in 2010, which prohibits insurers from denying coverage because of a pre-existing condition. Berkowitz cried as he watched the bill pass.

“I still remember sitting next to my son, who said, ‘Well, I know you worked hard for this,'” Berkowitz recalled. “I said, ‘I’m crying because you won’t be denied for insurance once you’re on your own. “”

Two years later, Caroline from the south lawmakers made it clear that Medicaid expansion would not be picked up there. Berkowitz, director of the South Carolina Appleseed Legal Justice Centerhas advocated for expansion ever since.

Caroline from the south is one of 12 states that has not expanded Medicaid to cover people living below 138% of the poverty level. It also has the second highest level of people with medical debt in the country, at 22% – nearly double the national rate, according to data from the Urban Institute.

Experts say there is a link between Medicaid expansion and medical debt. In states that have embraced Medicaid expansion, medical debt has gone down, said Theodoros Giannouchos, a professor at the Arnold School of Public Health to University of South Carolina. Some states saw their medical debt cut in half after enacting Medicaid expansion, he said.

Medical debt often falls on the shoulders of uninsured low-income adults who don’t have children, Giannouchos said. These are the same people who would most likely be covered by the Medicaid expansion, he said. About 13% of the inhabitants of Caroline from the south are not insured, according to the Kaiser Family Foundation.

Without Medicaid, care options are limited. Many people end up in the emergency room for non-urgent care needs that could be covered by a primary care provider, Giannouchos said. His research found that the rate of people going to emergency rooms for non-emergency medical issues is significantly lower in states that have expanded Medicaid.

Free and charity clinics in Caroline from the south try to provide an alternative to emergency services for the uninsured, which helps them avoid medical debt, said the chairman of the board of directors of the South Carolina Free Clinic Association Suzie Foley. The free clinics try to help those in between, adults who don’t qualify for government coverage but can’t afford insurance.

“The very people most people assumed would get some relief from the Affordable Care Act, at least in Caroline from the southwere totally left to dry without a cover,” she said. Even with Medicaid expanded, Foley expects there will still be a gap to cover, but it’s a positive step.

Foley sees the need for more coverage. Many patients with chronic conditions often end up with medical debt that could have been avoided with coverage, she said.

“These bills that accrue to the uninsured are related to chronic conditions and are actually preventable if they had access to care, if they had medications they could afford, if they could access followed,” Foley said.

In Caroline from the southmedical debt is worse in Marlboro Countywhere 37% of residents have medical debt, followed closely by Laurens County to 36.8%, according to the Urban Institute The data.

Those with medical debt may have their wages or tax returns garnished, Berkowitz said. A bill to prevent health care providers from pursuing medical debt collection or reporting the debt to credit agencies has failed in the South Carolina House in 2021.

“We are seeing the garnishment of wages and tax returns from people who can least afford it in Caroline from the south“, Berkowitz said. “Some people end up with the little income they took.

Berkowitz said she feels for hospitals, which need money to operate.

Caroline from the south hospitals provide more than $1.8 billion per year in free or reduced-rate care, South Carolina Hospital Association said Vice President of Strategic Marketing and Communications Schipp Ames. Hospitals receive approximately 90 cents on every dollar spent on Medicaid patients, Ames said.

“When these payments are not received, it can have a significant impact on a hospital’s ability to fund services for its community,” Ames said.

Berkowitz hopes the Medicaid expansion will benefit hospitals as well as patients, as patients who previously couldn’t pay would get coverage, she said. An estimated 350,000 more people would be eligible for expanding Medicaid, according to the Urban Institute. It is estimated the number of uninsured people in Caroline from the south could decrease by about 37%, the Urban Institute found.

The hospital association advocates for health coverage for low-income South Carolinas, Ames said.

The expansion was not passed by the Republican-controlled government because of politics, Berkowitz said. Republicans traditionally did not support Medicaid expansion. Some cite potentially high costs to cover the 10% expansion costs that the federal government does not cover, Giannouchos said. Some have worried about the reliability of federal funding, he said.

There have been some shifts in sentiment about Medicaid expansion and health coverage, he said. After 10 years, federal funding hasn’t changed, Giannouchos said. The COVID-19 pandemic has underscored the importance of health care, he said.

The American Rescue Plan Act provided an additional incentive: more money for states that recently expanded Medicaid. Giannouchos said states that expand Medicaid also often see decreases in other public health coverage costs that go unpaid.

The changes have given Berkowitz and other defenders she works with more hope.

“We have renewed hope. We know there is a growing need,” she said. “Hopefully we can show economically what this means for states and have a real discussion about it. We want to make the business case.”

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John A. Bogar