Sanders focusing on ‘Medicare for All’ in South Carolina

FLORENCE, S.C. (AP) — Health care is the focus of Democratic presidential hopeful Bernie Sanders' second day of campaigning in the critical early-voting state of South Carolina, where lack of Medicaid expansion has left thousands unable to obtain health coverage.

The Vermont senator is in Florence on Friday for a town hall meeting on "Medicare for All ." His signature proposal, relaunched in the Senate earlier this year, would replace job-based and individual private health insurance with a government-run plan that guarantees coverage for all with no premiums, deductibles and only minimal copays for certain services.

Health care and how to reform the nation's system is a critical debate among the candidates vying for the Democratic nomination. It's under intense focus in states like South Carolina, home to the first-in-the-South 2020 primary, which is among the Republican-led states that turned down Medicaid expansion under the Affordable Care Act.

As a result of that decision, according to healthinsurance.org, a health insurance industry watchdog, about 92,000 South Carolinians are in the "coverage gap," without access to insurance. This group of mostly low-income residents doesn't qualify for subsidies on the exchange and is heavily reliant on emergency rooms and community clinics for care.

The lack of expansion has also had institutional ramifications, leading to the closures of hospitals in rural areas, tasked with serving a wide-reaching population and heavily reliant on Medicaid funds. According to the Sheps Center for Health Services Research at the University of North Carolina, 113 rural hospitals have closed since January 2010. Four of those facilities were in South Carolina.

While the overall notion of "Medicare for All" remains popular, some recent polling has shown softening support for the single-payer system, with hesitation at the idea of relinquishing private coverage altogether. Under Sanders' legislation, it would be unlawful for insurers or employers to offer coverage for benefits provided by the new government-run plan.

Nationwide, 55% of Democrats and independents who lean Democratic said in a poll last month they'd prefer building on President Barack Obama's Affordable Care Act instead of replacing it with Medicare for All. The survey by the nonpartisan Kaiser Family Foundation found that 39% would prefer Medicare for All. Majorities of liberals and moderates concurred.

In early states including South Carolina, some voters continue to voice confusion as to exactly what various candidates in the vast Democratic field mean when they advocate for pieces of a "Medicare for All" plan. California Sen. Kamala Harris' new plan would preserve a role for private insurance. New Jersey Sen. Cory Booker is open to step-by-step approaches.

Others including former Vice President Joe Biden have been blunt in criticizing the government-run system envisioned by Sanders.

"I'd like to know what 'Medicare for All' means," retired educator Bobbie Harrison, 77, wondered at a recent event in Great Falls, South Carolina, featuring Biden's wife, Jill Biden. "What does Bernie mean?"

Harrison backed Sanders in 2016 but remains undecided as to whom she'll support in 2020.

Friday's town hall wraps up two days of campaigning in South Carolina for Sanders. More than 900 people attended a town hall meeting on climate change on Thursday night in Myrtle Beach.

Meg Kinnard can be reached at http://twitter.com/MegKinnardAP