Date

12-4-2025

Department

School of Health Sciences

Degree

Doctor of Philosophy in Health Sciences (PhD)

Chair

Raymond Chimezie

Keywords

Health Disparities, Poverty, Healthcare Access, Health Outcomes, Healthcare Coverage Gap

Disciplines

Medicine and Health Sciences | Public Health

Abstract

Low-income individuals and families in South Carolina face significant barriers to accessing healthcare, despite the presence of public health programs like Medicaid. Many fall into the healthcare coverage gap, earning too much to qualify for Medicaid but too little to afford private insurance. This study explored the consequences of the healthcare coverage gap by examining the relationships between income, healthcare access, and the ability to afford healthcare services among 500 adults aged 19–64 who participated in the National Health Interview Survey between 2018 and 2023. Utilizing a retrospective quantitative analysis of secondary data from the National Health Interview Survey (NHIS) and the U.S. Census Bureau from 2018 to 2023, the research identifies how income level, insurance status, and the cost of care impact timely access to healthcare and the affordability of services and medications. The study further analyzed demographic variations in access and stress due to medical costs. Findings reveal that individuals in South Carolina earning between 138% and 400% of the federal poverty line consistently face delayed medical care due to cost, difficulty affording prescriptions, and high levels of stress related to medical bills—highlighting a critical need for healthcare affordability reform. The study concluded with evidence-based recommendations aimed at improving healthcare accessibility and reducing adverse health outcomes for low-income residents in South Carolina, including expanding Medicaid eligibility and strengthening employer coverage standards to ensure affordable insurance options for full-time workers.

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