Sources
Find all of the sources we used for our materials here. Have further questions on our sources? Reach us at infocoversc.org. Interested in joining Cover SC to attend our meetings and learn more? Visit our Get Involved page to join today.
County Fact Sheet
The Milken Institute
DHEC County Health Profile
Urban Institute, Urban Data Catalog, Debt in American 2022
US Census Bureau, Small Area Health Insurance Estimates 2020
Cover SC Two Page Infographic
- AP Report, July 2026
- KFF, Percent of Private Sector Establishments That Offer Health Insurance to Employees by Firm Size, 2024
- US Bureau of Labor Statistics, Coverage in Employer Medical Care Plans Among Workers in Different Age Groups, March 2023
- In a 2024 contract with Cover SC, Leighton Ku, PhD – a health economist with the George Washington University Milken Institute School of Public Health – estimated enrollment, cost and economic impact of Medicaid expansion. The report is on the Cover SC website. He projected 334,000 adults would enroll in Medicaid expansion. However, HR 1 (known as OBBB) passed in 2025 mandates enrollee work (80 hrs/mo.), school attendance requirements or exemptions due to medical frailty or childcare. Although the most expansion enrollees work or meet exemptions, The Urban Institute projected a wide range of 27% – 55% reduction in enrollment due to the variability of hourly work and the state administrative and enrollee challenge of documenting adherence to the requirements. (Urban Institute, Projected Reductions in Medicaid Expansion Enrollment Under OBBB’s Work Requirements and Six Month Redetermination, March 2026) In addition, using updated American Community Survey census data and CMS exchange enrollment data by income Cover SC found a larger number of people than the Milken estimate could be eligible based on income. With such uncertaintyand pending an official SC state estimate of expansion enrollment, rather than estimating a particular enrollment number or range, Cover SC opted to document a minimum number we believe could be enrolled.
The large range in the Urban Institute numbers reflects the differences across the states in their administrative capability to determine eligibility on-line, the new law’s flexibility for states in adopting even more frequent eligibility reviews, and in the number of months with 80 hours of work that are required to meet the standard. The Urban Institute models 3 scenarios depending on a state’s administrative capability and how strict the state is in setting the work and exemption standards.
Cover SC modeled a 36% reduction in enrollment which yielded 215,000 projected expansion enrollees in 2027, although this number is highly variable. This is the mid-point between the scenario where the state has a good administrative capability to determine eligibility without significant enrollee provided documentation, and adopts standards that recognize work variability in the low income population, and a scenario where the state has to rely more on enrollee reporting and adopts stricter standards to determine work compliance. A third scenario was not considered where the state has limited ability to determine eligibility without significant enrollee reporting and where the state either redetermines eligibility more than two times/year or adopts a very strict monthly work standard. - KFF, The Intersection of Medicaid and Work: An Update, February 2025
- To estimate the cost per expansion enrollee and total cost to Federal and State governments at the 90/10 match, the Milken Institute report used the 2023 current cost/adult enrollee provided by the SC Department of Health and Human Services (DHHS) and inflated it to 2026-2028. Since that report was completed, two issues with the cost estimates have surfaced. The first is those estimates may contain substantial supplemental, or “state directed payments” to hospitals, where the state share is paid for by a hospital revenue tax rather than state funds – therefore it is not a “cost” to the state. These payments are also mandated by HR 1 to decrease dramatically beginning in 2028. The second issue is that across the 40 states that have expanded Medicaid eligibility it appears that the cost of those enrollees is higher than the basic adult parent population. Cover SC adjusted the Milken cost numbers to reflect both the reduction in state directed payments and the possible increase in cost for this population. As with enrollment estimates, the numbers are so uncertain, that prior to an official State estimate we opted to document that the State would receive at least a $1 billion in federal investment.
- Commonwealth Fund, The Impact of Medicaid Expansion on States’ Budgets, May 2020
- The economic benefits of expansion outlined in the 2024 Milken Institute report were calculated using a nationally known economic investment model. For new estimates, Cover SC used the $1 billion minimum federal investment vs. the $2.7 billion FY 27 federal investment in the Milken report, and proportionatly reduced the estimated economic benefits. We then used a conservative low number to illustrate the potential economic output, jobs and tax revenue impacts of Medicaid expansion.
- South Carolina Hospital Association, South Carolina Hospitals and the One Big Beautiful Bill, June/July 2026
- National Bureau of Economic Research, Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data, July 2019, revised January 2021
- Diabetes Care, Impact of Medicaid Expansion on Diabetes Care, May 2020
- Cardiovascular Quality and Outcomes, Association of Medicaid Expansion with Rates of Utilization of Cardiovascular Therapies Among Medicaid Beneficiaries Between 2011 and 2018, January 2021
- Women’s Health Issues Journal, Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality, January 2020
- South Carolina Hospital Association, South Carolina Hospitals and the One Big Beautiful Bill, June/July 2026
- Rand Research Report, Prices Paid to Hospitals by Private Health Plans, December 2024