A Funders View of Medicaid Extension

Since our inception in 1996, the Sisters of Charity Foundation of South Carolina has invested more than $46 million in direct grants, supporting programs to help poor and underserved communities. In the past 10 years, foundations across the state collectively have invested more than $1.2 billion in philanthropic dollars to improve the health and well-being of individuals, families and communities struggling to overcome impoverished conditions.

As private funders, our work has taught us many lessons about the poor. Generational poverty is not a personal choice but a set of complex challenges that cannot be fixed instantly. Several factors have pushed many middle-class South Carolinians below the poverty line, including unanticipated job losses and a struggling economy. South Carolina’s No. 1 contributor to health disparities is poverty, and it has been for a long time. Individuals and families living in poor communities often lack a health-care provider, which can result in overlooking chronic health problems until they become acute, and then patients must make critical health choices without the necessary resources.

It is not unusual for a poor family to have to choose between buying food, paying the electric bill or purchasing medicine. I remember one woman I met whose family spiraled into homelessness because both of her children had chronic health conditions. The mother was not eligible for Medicaid. Because of the demands of taking care of her children’s medical needs, she lost her job, and as a result she lost her home and quickly fell into poverty.

S.C. politicians, health-care professionals, hospital representatives, businesses and individuals are debating whether our state should expand the Medicaid program under the Affordable Care Act. Had that expanded health coverage been available, that family would have been eligible for Medicaid. That mother would have remained an employed, taxpaying member of our society. That family would not have lost everything.

South Carolina’s philanthropic and nonprofit sector is doing its best to improve the health of the poor in all 46 counties. Our mutual goal is to care for the most vulnerable members of our communities and to promote and defend human dignity.

It is a sad reality that the voices of most people who will be affected by Medicaid expansion are not being heard in this debate. They simply listen to others with more power and influence voice their opinions. Many others who ultimately will benefit from Medicaid expansion are gainfully employed and contributing members of society; they just don’t have the health coverage they desperately need.

Foundations across South Carolina have invested millions of dollars in programs to provide opportunities for children to reach health-care providers, developed much-needed oral-health programs, supported free medical clinics, promoted healthier eating habits and helped families learn how to deal with and prevent illnesses. These efforts are important but pale in comparison to what Medicaid expansion could do for hundreds of thousands of people in the state.

Without an expansion of Medicaid, we will see a new coverage gap. We can argue forever about financial responsibility and the federal government’s role vs. the state’s responsibility. It is the belief of most of us working in philanthropy that there is not a policy decision that has more potential to improve health access and to also improve the health status of our state than extending Medicaid coverage. We have a moral obligation to help the many uninsured families across the state to ensure their voice is heard.