More than 100,000 South Carolinians lost their health insurance coverage in the year since President Donald Trump signed roughly $1 trillion in Medicaid cuts into law through the “Big Beautiful Bill Act,” according to a new analytical report.
The Protect Our Care advocacy group contends those cuts, along with the decision to let Biden-era expanded Affordable Care Act (ACA) subsidies expire in the same bill, are fueling a “health care affordability crisis” that’s pushed more than 5 million people off Medicaid and ACA insurance rolls nationwide since June 2025.
In South Carolina, the report says more than 70,000 people lost Medicaid coverage, while roughly 45,000 have left ACA-subsidized private insurance plans.
Over time as more cuts come, the impact could raise premiums on remaining South Carolina insurees and cause some hospitals to close because of billions of dollars of unreimbursed costs to treat sick people, in-state experts say.
The report’s numbers are based on ACA enrollment figures from the U.S. Department of Health and Human Services and state-by-state Medicaid data compiled by Georgetown University.
More trouble may be ahead
But experts say the insurance bleeding isn’t done. The Congressional Budget Office estimates 15 million Americans will lose their health coverage when the law is fully implemented.
“Just one year after Trump and congressional Republicans made the largest cuts to health care in history to fund tax breaks for billionaires and big corporations on Wall Street, millions have lost the care they depended on to stay alive and healthy,” Protect Our Care President Brad Woodhouse said last month.
In response to critics, the Trump administration has said the changes are necessary to protect both programs from what it characterizes as widespread fraud. In particular, officials argue that insurance brokers systematically enroll millions of ineligible Americans in subsidized ACA plans.
They’ve sourced that claim to a report from the Trump-affiliated Paragon Health Institute that uses Census survey data to argue that sign-ups exceed the eligible ACA population by about 6 million people. But health care experts have questioned the study’s methodology, arguing, among other things, that Census estimates and hard enrollment numbers are apples and oranges that can’t be compared.
“The Trump Administration is taking decisive action to stop these corrupt schemes, recover taxpayer dollars, and hold fraudsters accountable,” HHS Secretary Robert F. Kennedy Jr. said in a June 27 social media post. “This is about protecting Americans from fraud and preventing your tax dollars from flowing to big insurance company profits.”
But Protect Our Care spokeswoman Maddie Twomey was quick to push back on those claims in a June 30 interview, noting that ACA premiums have “skyrocketed” over the past year, leading thousands to drop coverage they can no longer afford.
Specifically, Twomey pointed to Protect Our Care data showing that average ACA marketplace premiums in South Carolina have risen 235% since 2025, with some households facing even steeper increases. For instance, a 60-year-old couple earning $85,000 saw their annual premiums rise from about $7,000 to $29,000 — or more than one-third of their pre-tax income.
“The reality is that people in South Carolina are opening their health care bills and seeing them go up by hundreds or sometimes thousands of dollars,” Twomey said. “And the Trump administration is trying to call people fraudulent for being upset that their health care costs are rising.”
Intended and unintended consequences
South Carolina health care advocates told the Charleston City Paper they weren’t surprised by the report’s findings.
“We started doing outreach right after the bill was signed because it was clear how many people were going to lose their benefits in the first year,” said Sue Berkowitz, policy director of the Appleseed Center and a founding member of the health care advocacy group Cover SC. “That’s exactly what was intended when this bill passed.”
But Berkowitz says it’s the bill’s unintended consequences, including higher insurance premiums and shuttered hospitals, that will ultimately impact every South Carolinian.
The reason? When residents lose their health coverage, Berkowitz explained, they wind up getting their care in hospital emergency rooms that are required to treat them. So the hospitals pass those costs on to insured patients in the form of higher prices, which in turn lead to higher premiums. But there are limits to that strategy — and when hospitals can no longer shift enough of those costs onto private patients, they’re forced to close their doors.
According to Protect Our Care data, S.C. hospitals will lose $5.4 billion in additional uncompensated care costs under the bill between now and 2034, with five Upstate rural hospitals already at-risk for closure.
As for the administration’s claims of widespread ACA fraud, Berkowitz says she hasn’t seen it.
“This whole waste, fraud and abuse crap, excuse my language, is just an excuse to try to justify what they’re doing to kick people off the rolls,” Berkowitz said. “No, I don’t think South Carolina consumers are committing widespread fraud. Let’s start talking about what we can do to actually improve people’s lives.”
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