The Crisis in Rural Healthcare
A Policy Briefing for South Carolina Leaders
The Situation at a Glance
South Carolina's rural communities face a deepening healthcare crisis, driven by financial strain and gaps in coverage. The data below highlights the most urgent challenges requiring immediate policy attention. Click each metric for more context.
Rural Hospitals Closed
8
Since 2005, leaving thousands of residents in "care deserts" without local emergency services.
In The Coverage Gap
102,000
Uninsured adults who earn too much for Healthy Connections but too little for ACA subsidies.
Rural Uninsured Rate
12.6%
Significantly higher than the 10.1% uninsured rate in South Carolina's urban counties.
Core Challenges
Two intertwined issues drive the rural health crisis: a growing gap in insurance coverage and affordability, and the accelerating decline of local providers and facilities. Explore the data behind these challenges below.
The Widening Coverage Gap
South Carolina is one of ten states that has not expanded Medicaid, creating a "coverage gap." An estimated 102,000 uninsured South Carolinians, many in rural areas, fall into this gap. Their incomes are above the state's stringent Healthy Connections eligibility limits but below the federal poverty level, making them ineligible for subsidized ACA Marketplace plans.
This problem is set to worsen. Enhanced ACA subsidies, which made coverage affordable for over 350,000 residents, will expire after 2025 without congressional action. This would lead to an average premium increase of 89% for subsidized enrollees, pushing coverage out of reach for thousands more and further straining rural economies.
Actionable Solutions
Addressing this crisis requires decisive, evidence-based policy action. The following proposals represent the most effective strategies to stabilize rural healthcare, improve health outcomes, and ensure economic vitality for communities across the Palmetto State.
The Single Most Impactful Step: Close the health insurance coverage gap by expanding eligibility for Healthy Connections. This would provide coverage to the 102,000 residents who currently have no affordable options.
- Economic Benefit: Draws down billions in federal funds, creates jobs, and stimulates local economies.
- Hospital Stability: Provides a critical financial lifeline to struggling rural hospitals by reducing uncompensated care costs, a primary driver of closures.
- Improved Health: Ensures access to preventive care, chronic disease management, and life-saving treatments, leading to a healthier, more productive workforce.
The Single Most Impactful Step: Provide additional appropriations to TennCare and ACA subsidy eligibility to reduce the number of uninsured Tennesseans.
- Economic Benefit: Creates jobs and stimulating local economies.
- Hospital Stability: Provides a critical financial lifeline to struggling rural hospitals by reducing uncompensated care costs, the primary driver of closures.
- Improved Health: Ensures access to preventive care, chronic disease management, and life-saving treatments, leading to a healthier, more productive workforce.