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Internship Research

By Larissa Richardson

University of South Carolina-Beaufort

Internship Site: Low Country Indivisible





Table of Contents

Chapter 1

Fetal Heartbeat Bill 


Chapter 2

African American Maternal Health


Chapter 3

Medicaid Expansion



Chapter 4

Maternal and Child Mortality


Chapter 5

American Rescue Plan


Chapter 6




Executive Summary

Fetal Heartbeat Bill Summary: The Fetal Heartbeat Protection From Abortion Act was first introduced in January of 2019 in the SC House of Representatives. This bill seeks to amend several sections of the Code of Laws of South Carolina regarding abortion. This act seeks to ban all abortions after a fetal heartbeat is detected. Supporters of this act state that a fetal heartbeat can be detected at six weeks gestation, but this is not accurate for every expectant mother. For individuals who find out they are expecting after six weeks, they have no choice but to continue with the pregnancy. This bill eliminates a woman's right to choose in regards to her reproductive health. For individuals who live in areas lacking maternal health services, many women have to travel over an hour to seek prenatal care and to give birth. Kentucky has a similar stance on this issue, but they have a wide variety of maternal health services. As of January 28, 2021, The South Carolina Senate passed the Fetal Heartbeat bill after three days of deliberation. This bill poses significant risks for expectant mothers. Expectant mothers are covered under Medicaid for 60 days after giving birth, but many women do not qualify for Medicaid due to new regulations. Read all here.

African-American Maternal HealthSummary: In the American healthcare system,  African-American women are at an increased disadvantage.  A long-standing history of discrimination and racial bias has caused many African-American women to forgo seeking prenatal care. Bias on the part of the healthcare provider has been cited as the primary reason for the hesitation in receiving care. “A study published in The American Journal of Public Health examined implicit racial and ethnic bias of healthcare providers effects on healthcare outcomes. The subsection entitled, Health Disparities and Provider Attitudes, stated that “Although overt discriminatory behavior in the United States may have declined in recent decades, covert discrimination and institutional bias are sustained by subtle, implicit attitudes that may influence provider behavior and treatment choices. As a result, patients of color may be kept waiting longer for assessment or treatment than their White counterparts, or providers may spend more time with White patients than with patients of color,”(Hall et al., 2015). This bias can be connected to some incidences of pregnancy-related death in African-American women. Many African-American women feel as if their medical concerns are being ignored by their physicians. African-American women who cannot afford or do not live near any maternal health services are unable to address any postpartum medical concerns. Medicaid does provide healthcare coverage up to 60 days after birth, but women who experience complications after this period will be unable to afford care. “An increasing number of maternal deaths, which are defined as deaths during pregnancy and up to 365 days after, are occurring in the postpartum period. CDC data confirm that one-third of all pregnancy-related deaths occur one week to one year after pregnancy ends. In some states, the number is much higher. In Illinois, for example, 56 percent of pregnancy-associated deaths occurred between 43 and 364 days postpartum,” (Muller, 2020). Extending Medicaid services to a year would allow women to receive care for any postpartum complications they may develop. Read all here.

Medicaid Expansion Summary: Medicaid services offer a variety of individuals access to healthcare services. Women, children, the disabled, and the elderly all benefit from Medicaid services. The services provided under Medicare allow these individuals to seek routine and specialized care. According to the Kaiser Family Foundation, “A large body of research shows that Medicaid beneficiaries have far better access to care than the uninsured and are less likely to postpone or go without needed care due to cost. Moreover, rates of access to care and satisfaction with care among Medicaid enrollees are comparable to rates for people with private insurance. Medicaid coverage of low-income pregnant women and children has contributed to dramatic declines in infant and child mortality in the U.S,”(Garfield & Rudowitz, 2020). In states that have expanded Medicaid services, their citizens are receiving extra coverage for healthcare services. Unfortunately, South Carolina opted out of expanding its Medicaid services. South Carolina officials cited high costs as the reason for denying expansion, but expanding Medicaid services would not be a costly expenditure. “South Carolina will spend $372 million more on Medicaid to cover additional enrollment of currently eligible children and parents through 2022 with or without the expansion. The expansion would increase state spending by $1.2 billion. Altogether, this additional spending is just 7.0 percent more than what South Carolina would have spent on Medicaid in the absence of the ACA,”(How Would the Medicaid Expansion Affect South Carolina, 2013) (How Would the Medicaid Expansion Affect South Carolina, 2013). After refusing to expand Medicaid services, South Carolina officials then imposed work requirements to qualify for Medicaid. This addition disqualified thousands of South Carolinians from receiving Medicaid.

Special Note:  A distinction should be made between individuals on Medicaid due to poverty and individuals on Medicaid due to disability. Individuals who are impoverished and may also be disabled would be considered dual eligibles. Individuals with dual eligibility qualify for both Medicaid and Medicare. My research focuses mainly on impoverished individuals facing maternal health with or without Medicaid coverage. Read all here.

Maternal and Child Mortality Summary: The women and children of South Carolina are not having their healthcare needs met. The maternal mortality rate for South Carolina is 27.1, which is higher than the national average. When seeking to address why the rate was so high, I was again presented with the issue of pregnancy-related death. The 2020 South Carolina Maternal Morbidity and Mortality review revealed that hemorrhage and infection were major contributors to pregnancy-related death. This review also determined that 55% of the deaths surveyed were preventable. Cardiovascular issues have also been cited as a contributor to pregnancy-related death. Patient/family factors have been noted as the largest contributor to pregnancy-related death. Factors, such as home environment and proper nutrition may be part of the issue. The infant mortality rate for South Carolina is 6.8 (per 1,000 live births), while the national rate is 5.7. For child mortality (individuals between the ages of 1-19), the rate for South Carolina is 33.2 (per 100,000 children). For the US, the rate is 25.7.  If the needs of the mother are not being met, then we can assume that the child’s needs are being neglected as well. Birth defects and low birth weight are contributors to this issue. Read all here.

American Rescue Plan Summary: On March 11, 2021, The Biden Administration implemented a new stimulus bill that provides benefits that were not previously included in other stimulus bills. The American Rescue Plan provides states that have not expanded Medicaid services with possible incentives if the state expands its services. This bill would also provide new coverage for pregnant and postpartum women.  Many hope that these new incentives will entice South Carolina officials into expanding Medicaid services. South Carolina officials have stated that the costly expense is the reason for the denial of expanded services, but this new act provides the funding that South Carolina officials say is lacking. For states that have expanded their Medicaid coverage, they will receive a 90% federal enhanced matching rate for individuals with alternative benefit plans  (ABP). If South Carolina decides to expand their Medicaid services, the state of South Carolina would receive the 90% federal matching rate, as opposed to 6.2 percentage points being added on to their current rate. The state of South Carolina could receive up to 790 million dollars in increased funding if they expand Medicaid coverage. This would help address the ongoing coverage gap for South Carolina citizens. Read all here.

Conclusion: In conclusion, all of my topics share a commonality and that is expanded Medicaid services. Our state is experiencing a profound health coverage gap. Over 500,000 South Carolinians are uninsured, but this can be changed. The American Rescue Plan act is a chance for officials to provide their citizens with the healthcare coverage they rightly deserve. Women deserve access to reproductive and postpartum services. Our elderly and disabled have earned the right to receive routine and specialized care. Finally, children should always have the right to seek healthcare. Medicaid expansion is a chance to prolong the lives of everyday people. It’s a chance for people to live a healthier life without worrying about the financial aspect of seeking healthcare. Expanding Medicaid services would help reduce the burden of chronic diseases for many individuals. To promote health is to promote life, and expanding Medicaid would do both. 


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