WALHALLA, S.C. — Nestled within the foothills of the Blue Ridge Mountains, a small major care clinic run by Clemson College attracts sufferers from throughout the area. Many are Hispanic and uninsured, and a few are keen 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 mentioned. “I’ve gotten to know this community pretty well.”
Clemson doesn’t function an instructional medical middle, nor does it run a medical college. Arguably, the general public college is finest recognized 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. Faculty leaders try to handle gaps in rural and underserved components 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,” mentioned 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 School 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,” mentioned Graham Adams, CEO of the South Carolina Workplace of Rural Well being.
State lawmakers nationwide are spending hundreds of thousands of {dollars} to handle 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 offer beginning. However 10 states haven’t absolutely expanded Medicaid protection with federal cash made obtainable beneath the 2010 Reasonably priced 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 youngsters 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, lately introduced plans to increase Medicaid in restricted methods to incorporate some mother and father. The South Carolina plan would impose work necessities on a few of these newly eligible Medicaid beneficiaries, whereas the Georgia plan would enable some mother and father of younger youngsters to skirt the state’s present Medicaid work guidelines. Each plans require federal approval.
Jonathan Oberlander, a professor and well being coverage scholar on the College of North Carolina, mentioned he doesn’t count on to see any of the remaining states speeding to completely increase Medicaid. Earlier than Donald Trump took workplace on Jan. 20, Republicans in Washington had already expressed their intention to dramatically lower spending for Medicaid, which covers 72 million folks at a price of almost $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 mentioned.
Even so, in South Carolina this yr the advocacy group CoverSC plans to foyer the Basic Meeting to go a invoice to undertake Medicaid enlargement, mentioned 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 have been permitted, the federal authorities would cowl 90% of the state’s Medicaid enlargement prices and South Carolina could be anticipated to pay 10%, or an estimated $270 million in the course of the first yr, in response to a 2024 report by the Milken Institute Faculty of Public Well being at George Washington College.
Throughout all 10 non-expansion states — which, exterior the South, additionally embody Kansas, Wisconsin, and Wyoming — about 1.5 million folks fall right into a protection hole, in response to 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 way of the federal market.
Lots of the individuals who would qualify for Medicaid if these states have been to increase eligibility are gig employees, Johnson mentioned. They play music, drive for Uber, or ship pizza, and so they usually don’t qualify for medical health insurance by way of their jobs.
“They are providing services that we all appreciate,” she mentioned. “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 major care, most cancers screenings, vitamin training, and diabetes administration for uninsured sufferers freed from cost or at decreased charges. Solely about half of the sufferers seen by Clemson Rural Well being have medical health insurance, Gimbel mentioned, in contrast with 92% of the U.S. inhabitants.
Through the present state fiscal yr, 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 Providers, which administers Medicaid in South Carolina and operates with a finances permitted by state lawmakers.
That’s a comparatively small sum of money in contrast with the $47.5 million the state legislature has given to the Medical College of South Carolina in recent times 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 on the point of closure — and one freestanding emergency division. MUSC is about to open a further rural hospital this yr.
Different states have made related investments. The College of Georgia, for instance, has established a brand new medical college, partly to ship extra physicians into underserved and rural areas. The Georgia Basic 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 Basic Meeting handed a finances final yr that included $81 million for quite a lot of rural well being initiatives.
Outdoors 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, in response to the Cecil G. Sheps Heart for Well being Providers Analysis on the College of North Carolina.
It’s not but clear what long-term impression a few of these initiatives could have — as an illustration, whether or not the Clemson program will “reduce premature mortality, decrease preventable hospitalizations, and improve overall quality of life,” because it goals to do, in response to its web site. Some public well being consultants level out that bolstering the variety of rural clinics, hospitals, and medical doctors within the South received’t matter a lot if sufferers can’t afford to make an appointment.
“Lack of ability to pay is one of the greatest barriers,” mentioned Adams, the Workplace of Rural Well being chief.
Oberlander mentioned conservative lawmakers typically think about tasks equivalent to 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 mentioned.
South Carolina Senate President Thomas Alexander, a Republican who lives in Walhalla, mentioned the Basic Meeting is keen 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 mentioned. “I want to focus on expanding access to the services.”
Gimbel wouldn’t touch upon Medicaid enlargement in South Carolina, and he mentioned it’s too quickly to understand how federal Medicaid adjustments beneath the Trump administration would possibly 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 would possibly take a number of extra years, he mentioned.
“If rural health was profitable,” he mentioned, “we wouldn’t have a rural health problem.”
