Some 700,000 South Carolina non-elderly adults aged 19 to 64 lived at or below 138 % of the Federal Poverty Level (FPL) in 2011.[1] The Affordable Care Act expands eligibility for Medicaid to those with incomes below 138 % FPL. Children at these income levels are already covered under our Medicaid and seniors 65 and above are nearly all covered by Medicare. Of those 700,000 nearly half (46 percent) reported themselves as uninsured in 2011.[2]

A large proportion (two-thirds) of South Carolina’s uninsured non-elderly adult population (ages 19-64) at or below 138 % of the Federal Poverty Level was either employed or unemployed but seeking work. Among them two-thirds were employed (40 percent) or unemployed but in the labor force (27 percent). One-third was not in the labor force.

South Carolina is generally a low-wage state, ranking 44^th among the 50 states and the District of Columbia for annual median wage. (ftp://ftp.bls.gov/pub/special.requests/oes/oesm12st.zip.) Two-thirds of South Carolina workers are in occupations where half the employees make a wage which would qualify a full-time (40 hours per week) worker with a family of four for the Medicaid Expansion under the Affordable Care Act.

The two largest industries with uninsured employees who would be Medicaid eligible are Restaurants and Other Food Services and Construction. For the most part, the industries in which the uninsured working poor toil are the industries that take care of us, our parents and our children.

If instead of looking at industries (who you work for) we look at disaggregated occupations (what you do), we see this even more clearly. The most populous uninsured occupations are cashiers, maids and housekeepers, cooks and waiters and waitresses.

Wholly aside from the compelling justice and economic arguments for a Medicaid Expansion, the people who interact with our lives most intimately— handling our food, our cash and cleaning our homes and hotel rooms—are most likely not to have health coverage and reasonable access to health care. Think about that the next time you go to a grocery store or restaurant. That’s a public health concern.

SCDHHS Director Tony Keck suggests that major portions of the uninsured will be covered under the Health Insurance Marketplace (what we used to call the Exchange). If South Carolina fails to expand Medicaid, businesses with more than 50 employees could face $30-$46 million in potential shared responsibility liabilities according to Jackson-Hewitt Tax Service as employees making between 100 percent and 138 percent of the Federal Poverty Level, but not covered by their employer, enroll through the new Healthcare Marketplace. If South Carolina expanded Medicaid, those employees would be Medicaid eligible and their employers would not be subject to the shared responsibility tax liability of $2,000 to $3,000 per employee who enrolls through the Marketplace.

That still leaves 80,000 working poor South Carolinians uncovered.

Many uninsured working poor are employed in small businesses. Although those small businesses won’t face penalties for failing to cover employees, the ability to cover lower wage workers through Medicaid relieves financial pressures on the businesses, making it easier for them to provide coverage to their other employees.

The Medicaid Expansion makes sense for South Carolina workers and South Carolina employers.