WALHALLA, S.C. — Nestled within the foothills of the Blue Ridge Mountains, a small main care clinic run by Clemson College attracts sufferers from throughout the area. Many are Hispanic and uninsured, and a few are prepared to journey from different counties, bypassing nearer well being care suppliers, simply to be seen by Michelle Deem, the clinic’s bilingual nurse practitioner.
“Patients who speak Spanish really prefer a Spanish-speaking provider,” Deem stated. “I’ve gotten to know this community pretty well.”
Clemson doesn’t function an educational medical middle, nor does it run a medical faculty. Arguably, the general public college is greatest identified for its soccer program. But, with hundreds of thousands of {dollars} earmarked from the state legislature, it has expanded into delivering well being care, with clinics in Walhalla and past. College leaders are trying to deal with gaps in rural and underserved elements of a state the place well being outcomes routinely rank among the many worst within the nation.
“Some of these communities have such high need,” stated Ron Gimbel, director of Clemson Rural Well being, which operates 4 clinics and a fleet of cell well being items as a part of the college’s Faculty of Behavioral, Social and Well being Sciences. “They have so many barriers that impact their ability to be healthy.”
Clemson Rural Well being is one among a number of applications making an attempt to fulfill this want within the state.
“Rural health is trendy,” stated Graham Adams, CEO of the South Carolina Workplace of Rural Well being.
State lawmakers nationwide are spending hundreds of thousands of {dollars} to deal with a rural well being care disaster lengthy within the making. For greater than a decade, although, Republican-controlled legislatures in most Southern states have refused billions in federal funds that would offer public medical health insurance protection to extra low-income adults. These are the identical states the place racial well being disparities and well being outcomes are sometimes worse than in different areas.
Almost each state has prolonged Medicaid protection for girls within the months after they provide start. However 10 states haven’t absolutely expanded Medicaid protection with federal cash made accessible underneath the 2010 Inexpensive Care Act. Seven of those states — Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee, and Texas — are within the South. With few exceptions, adults with out kids in these states don’t qualify for Medicaid protection, no matter their revenue stage.
Georgia Gov. Brian Kemp and South Carolina Gov. Henry McMaster, each Republicans, not too long ago introduced plans to increase Medicaid in restricted methods to incorporate some dad and mom. The South Carolina plan would impose work necessities on a few of these newly eligible Medicaid beneficiaries, whereas the Georgia plan would enable some dad and mom of younger kids to skirt the state’s current Medicaid work guidelines. Each plans require federal approval.
Jonathan Oberlander, a professor and well being coverage scholar on the College of North Carolina, stated he doesn’t count on to see any of the remaining states speeding to totally increase Medicaid. Earlier than Donald Trump took workplace on Jan. 20, Republicans in Washington had already expressed their intention to dramatically reduce spending for Medicaid, which covers 72 million folks at a value of practically $900 billion.
“There’s a large gray cloud hanging over Medicaid expansion right now, and that’s because there’s so much uncertainty about what the Trump administration and congressional Republicans are going to do,” Oberlander stated.
Even so, in South Carolina this 12 months the advocacy group CoverSC plans to foyer the Normal Meeting to go a invoice to undertake Medicaid enlargement, stated Beth Johnson, regional authorities relations director for the American Most cancers Society Most cancers Motion Community and a CoverSC board member. The state’s legislative session started Jan. 14.
If such a measure had been authorised, the federal authorities would cowl 90% of the state’s Medicaid enlargement prices and South Carolina can be anticipated to pay 10%, or an estimated $270 million in the course of the first 12 months, based on a 2024 report by the Milken Institute College of Public Well being at George Washington College.
Throughout all 10 non-expansion states — which, outdoors the South, additionally embody Kansas, Wisconsin, and Wyoming — about 1.5 million folks fall right into a protection hole, based on 2024 estimates from KFF, the well being info nonprofit that features KFF Well being Information. Which means they don’t qualify for Medicaid protection or monetary help to purchase insurance coverage by the federal market.
Lots of the individuals who would qualify for Medicaid if these states had been to increase eligibility are gig staff, Johnson stated. They play music, drive for Uber, or ship pizza, and so they usually don’t qualify for medical health insurance by their jobs.
“They are providing services that we all appreciate,” she stated. “And they simply can’t afford health insurance.”
In some South Carolina communities, Clemson Rural Well being makes an attempt to fill this hole by offering main care, most cancers screenings, vitamin training, and diabetes administration for uninsured sufferers freed from cost or at lowered charges. Solely about half of the sufferers seen by Clemson Rural Well being have medical health insurance, Gimbel stated, in contrast with 92% of the U.S. inhabitants.
In the course of the present state fiscal 12 months, Clemson Rural Well being has been underwritten by a $2.5 million contract, its largest supply of funding, from the state Division of Well being and Human Companies, which administers Medicaid in South Carolina and operates with a finances authorised by state lawmakers.
That’s a comparatively small amount of cash in contrast with the $47.5 million the state legislature has given to the Medical College of South Carolina lately to maneuver into rural communities. MUSC has served Charleston for many of its 200-year historical past, however since 2019 it has expanded throughout the state by buying, constructing, or partnering with seven rural hospitals — some getting ready to closure — and one freestanding emergency division. MUSC is ready to open an extra rural hospital this 12 months.
Different states have made related investments. The College of Georgia, for instance, has established a brand new medical faculty, partly to ship extra physicians into underserved and rural areas. The Georgia Normal Meeting kicked in half the price of a brand new $100 million constructing for medical training and analysis in Athens.
In the meantime, the Tennessee Normal Meeting handed a finances final 12 months that included $81 million for quite a lot of rural well being initiatives.
Exterior the South, state legislatures in Colorado, Nevada, West Virginia, and elsewhere have made current investments in rural well being, along with increasing Medicaid eligibility.
A few of this spending has been prompted by a wave of rural hospital closures — greater than 100 since 2010, based on the Cecil G. Sheps Heart for Well being Companies Analysis on the College of North Carolina.
It’s not but clear what long-term influence a few of these initiatives could have — for example, whether or not the Clemson program will “reduce premature mortality, decrease preventable hospitalizations, and improve overall quality of life,” because it goals to do, based on its web site. Some public well being specialists level out that bolstering the variety of rural clinics, hospitals, and medical doctors within the South gained’t matter a lot if sufferers can’t afford to make an appointment.
“Lack of ability to pay is one of the greatest barriers,” stated Adams, the Workplace of Rural Well being chief.
Oberlander stated conservative lawmakers typically contemplate tasks reminiscent of constructing new rural clinics extra politically palatable than increasing Medicaid protection.
“The further away you get from the ACA, the less polarized the politics of health care,” he stated.
South Carolina Senate President Thomas Alexander, a Republican who lives in Walhalla, stated the Normal Meeting is prepared to spend money on some rural well being initiatives to enhance well being care entry.
“Just because you expand Medicaid doesn’t mean you’ve expanded access to the services,” Alexander stated. “I want to focus on expanding access to the services.”
Gimbel wouldn’t touch upon Medicaid enlargement in South Carolina, and he stated it’s too quickly to know the way federal Medicaid modifications underneath the Trump administration may have an effect on funding for Clemson Rural Well being, which presently receives cash from the state’s Medicaid company. However making the Clemson program financially solvent may take a number of extra years, he stated.
“If rural health was profitable,” he stated, “we wouldn’t have a rural health problem.”
