By Katie Chetta, MD
As a physician-scientist and neonatologist at Shawn Jenkins Children’s Hospital, I’m deeply committed to the health and well-being of our children. I would like to share with you how the One Big Beautiful Bill Act, signed into law on July 4, 2025, may impact our state’s children’s hospitals, which serve as lifelines for many families.
This legislation introduces significant changes to Medicaid and Medicare, programs that many of our hospitals rely on to provide critical care for children. Here’s what these changes mean for South Carolina and what we can do to protect our kids’ healthcare.
Medicaid Funding Cuts and Their Impact
The One Big Beautiful Bill Act reduces federal Medicaid funding by nearly $1 trillion over the next decade. In South Carolina, Medicaid covers about 37% of insured individuals, including many children who depend on our children’s hospitals for specialized care, such as neonatal intensive care, pediatric surgeries, and treatments for conditions like cancer or congenital heart defects. With this funding reduction, hospitals may face tough choices: scaling back services, reducing staff, or even closing clinics, especially in rural areas where healthcare access is already limited.
For families, this could mean longer wait times to see specialists, fewer available appointments, or the need to travel long distances for care. Children with chronic conditions, like asthma or diabetes, may face delays in treatment, which could affect their health outcomes. The Congressional Budget Office estimates that these cuts could increase South Carolina’s uninsured population by 230,000 people by 2034, potentially leaving more families struggling to afford care for their kids.
Changes to the Provider Medicare Tax
Another key change in the bill is the introduction of new limits on the Provider Medicare Tax, which affects how hospitals are reimbursed for treating Medicare patients. This tax, designed to help fund Medicare, now includes stricter caps on how much hospitals can claim for providing care to elderly and disabled patients. While Medicare primarily serves adults, many children’s hospitals also rely on Medicare reimbursements for certain services, such as care for children with long-term disabilities who qualify for the program.These new tax limits could reduce hospital budgets further, as facilities receive less reimbursement for complex care. For South Carolina’s children’s hospitals, this might mean fewer resources for advanced equipment, like ventilators for premature infants, or specialized programs, like pediatric oncology. Smaller hospitals, especially in rural areas, may feel the pinch most acutely, potentially leading to service cuts or closures that make it harder for families to access care close to home.
The Rural Hospital Fund: A Partial Solution
The bill does include a $50 billion fund to support rural hospitals, which is a step in the right direction. In South Carolina, where rural communities often rely on small hospitals or clinics for pediatric care, this funding could help keep some facilities open. However, experts warn that this amount is not enough to offset the massive Medicaid and Medicare cuts. Rural children’s hospitals or clinics may still struggle to maintain services like emergency care or specialty consultations, forcing families to travel to urban centers like Charleston or Columbia for treatment.
What This Means for South Carolina Families
The combined impact of Medicaid cuts and Provider Medicare Tax limits could strain our children’s hospitals, reducing their ability to provide the high-quality, accessible care our kids deserve. Families may face challenges like:
- Longer wait times for appointments with pediatric specialists.
- Reduced access to critical services, especially in rural areas.
- Increased costs for families if hospitals pass on financial burdens or if more children become uninsured.
- Travel burdens for families who need to seek care at larger hospitals farther away.
At the South Carolina Mother’s Milk Bank,which is partnered with our NICU, we see firsthand how access to healthcare resources impacts children’s health, from providing donor milk to premature infants to supporting families in need. We’re concerned that these changes could make it harder for our hospitals to meet the needs of our most vulnerable kids.
What We Can Do Together
As a physician-scientist, I’m committed to advocating for solutions to protect our children’s hospitals. We will continue to work with healthcare providers and community partners to ensure that our kids have access to the care they need. But we need your voice, too. Here’s how you can help:
- Contact your local SC lawmakers: Share your concerns about the impact of these funding cuts on children’s healthcare. Ask them to prioritize protecting Medicaid and supporting our hospitals.
- Stay informed: Follow updates from local hospitals and advocacy groups to understand how these changes are affecting our communities.
- Support community efforts: Engage with organizations like the South Carolina Mother’s Milk Bank and HealthyMeHealthySC to ensure families have the resources they need during challenging times.
Together, we can work to safeguard the health of South Carolina’s children. Let’s keep the pressure on to ensure our hospitals remain strong and accessible for every family who needs them.
With hope,
Dr. Katie Chetta
Assistant Professor of Pediatrics
