CHARLESTON, S.C. (WCSC) – South Carolina’s Republican leadership is praising the passage of the One Big Beautiful Bill.

While the benefits could help grow certain sectors of the economy, others are expected to be hurt.

Perhaps the largest hit from the bill is its impact on those who rely on federal health insurance. The nonpartisan Congressional Budget Office estimates nearly 11 million people are expected to be dropped from Medicaid programs by 2034.

In South Carolina, about 37% of insured people are enrolled through Medicaid or Medicare. Maya Pack at the South Carolina Institute of Medicine and Public Health says the good news is that South Carolina is somewhat insulated from the worst parts of the bill.

“Anyone who’s currently enrolled in our state’s Medicaid program, there are no immediate changes, and I think that’s the most important thing for folks to know,” Pack said. “Because our state has not chosen to expand Medicaid as allowed under the Affordable Care Act of 2010, our state is actually not going to receive the negative impacts to our Medicaid programs’ budgets nearly to the same extent that other states are.”

In the long run, however, KFF, an independent health policy resource, estimates South Carolina’s uninsured population will grow by about 230,000 people over the next 10 years.

Health care in rural communities is already strained. Kevin Bennett, the director of the SC Center for Rural & Primary Healthcare at the University of South Carolina School of Medicine, says rural health systems are in a fragile state. Bennett says not only will there be more uninsured people walking through the door, but changes to reimbursements mean providers will be able to collect less money from insurers.

“Larger systems, the Prismas of the world, have more resources to absorb that,” Bennett said. “Smaller hospitals, smaller providers and clinics are going to really suffer. A 2% reduction in revenues might be enough to put them under, and that’s what we’re afraid of.”

Lieutenant Governor Pamela Evette responded to questions on Wednesday about how the state will adjust to make sure hospitals won’t close in rural areas, like Williamsburg County, where nearly 28% of the population is covered by Medicaid.

“In the One Big Beautiful Bill, we’ve heard it talked about that, you know, Medicaid will be cut for illegal immigrants here in this country,” Evette said, dodging the question. “President Trump has been very clear that Medicaid was intended for citizens. Taxpayers want to know that their tax dollars are being spent wisely.”

It was already illegal for undocumented immigrants to receive Medicaid or Medicare. The OBBBA now prohibits benefits for individuals with lawful immigration status. These are legal workers who have paid taxes in the U.S. for decades.

Making the situation worse, inaction in Washington could also spell trouble for those covered by Marketplace plans. Pack says the Affordable Care Act Enhanced Premium Tax Credits are set to expire at the end of the year. Unless Congress passes an extension for those tax credits, Pack says thousands could lose coverage.

She says there are nearly half a million people in this state on a marketplace plan.

“And over 95% of those folks are receiving a tax subsidy to be able to afford their premium costs. And so with the expiration of these tax credits, we fear that many of those people will no longer be able to afford that insurance coverage.”

Pack says there are changes to health insurance every year, making it difficult to predict exactly what will happen. She says we will certainly see more uninsured people in the coming years.

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