The Basics of Health Insurance and the Uninsured in SC

The following section gives you an overview of the different types of health insurance coverage in South Carolina, federal health insurance programs, the growing gap in insurance for working age adults and how the adoption of Medicaid extension is a cost effective way to address this problem.

How is insurance coverage provided(6)

MYTH: Most South Carolinians Have Insurance through Employment

Most people think if health insurance in the United States as mainly provided in a group plan offered by an employer.  In fact, less than half of people insured in SC are covered by an employer plan. 

Federally Funded Healthcare Programs: Medicare and MedicaidLong-term Trends in Health Insurance Coverage. Showing 69% in 1970 to 57% in 2020

Medicare is a federally funded program and administered program created in 1965 to provide coverage for all people over 65. Medicaid, also created in 1965, is a jointly federal/state funded and state administered program for low income individuals and families.  Some services are mandated, but each state establishes its own income eligibility criteria.  The state’s contribution depends on state average income. Lower income states receive higher federal contributions.  In South Carolina, the federal government contributes approximately 70% of the cost.

The Medicaid program was designed as a "safety net" for the following groups: very low income seniors (particularly those in need of long-term care), disabled people, single parent caretakers and people unable to find work during periods of high unemployment.



The Decline in Employer Insurance Coverage and the Rise of Uninsured

From the passage of legislation enacting Medicaid to the 2000s, the number of people without insurance increased to a high of 18% for adults less than 65 years old in 2010.  This was driven in part by the financial market collapse and recession in 2008, but more fundamentally by the long-term reduction in employers – particularly small businesses – offering health insurance.  From the 1970s to 2010, the percentage of people covered by employer insurance decreased from 70% to the upper 50%.

In addition to the decline in employer insurance, the transition of the US economy toward lower wage service jobs and part-time work. The numbers of those workers unable to afford the rising cost of healthcare led to the increase of uninsured adults.

Key Congressional Actions that Aimed to
Address the Growing Numbers of Uninsured Under 65

1997: Congress passes the Childrens' Health Insurance Program (CHIP)

What it does: Covers children who are not eligible for Medicaid but with family income too low to afford health insurance; in most states up to 200% of poverty. Only 4.6% of children under 19 lack health insurance in SC.

2010: Congress passes the Affordable Care Act (ACA) 

What it does: The federal government extends Medicaid to all adults under 138% of poverty, with the federal government paying 90% of the cost. ACA also created a market exchange for health plan coverage of adults, subsidized in sliding scale up to 400% of poverty.

2012: Supreme Court orders Medicaid extension to be at state option
To date, 40 states have passed extension, including most recently North Carolina in 2023. South Carolina is only one of 10 that have refused extension. 

Medicaid Today in South Carolina

How is insurance coverage provided(14)

The Health Coverage Gap for Working Age Adults in SC

Medicaid Insurance Coverage Today in SC and Under Medicaid Expansion
What Does Eligibility Look Like?

  • Today
    • 67% FPL for family of 3 - $16,656
  • Under Expansion
    • 138% FPL for family of 3 - $34,307
    • 138% FPL for single adult - $20,120
The number of working age adults that are uninsured today is .......