Clarendon County, South Carolina – Darlene Whitaker keeps a list of appointments taped inside a kitchen cabinet.
Cardiologist. Columbia.
Dentist. Waiting.
Mammogram. Reschedule.
Counselor for Malik. Still calling.
Darlene lives outside Manning, in Clarendon County, where a doctor’s visit can become a half-day trip before anyone checks her blood pressure. She works part time at a school cafeteria, helps care for her mother and drives her 16-year-old nephew to appointments when his anxiety gets too heavy for school.
“People say, ‘Just go to the doctor,’” Darlene said. “They don’t ask how far it is, who’s open, who takes your insurance or whether you can miss work again.”
That is the quiet crisis underneath South Carolina’s health numbers. The state has major hospitals, medical schools, growing cities and nationally known health systems. But access depends heavily on ZIP code, income, race, transportation and insurance coverage. In rural areas, care can be thin, distant or unavailable.
South Carolina ranked 36th in the 2025 America’s Health Rankings annual report, its best position in that ranking’s history. But the same report showed the state behind national rates on several access measures: 276.1 primary care providers per 100,000 people, compared with 291.4 nationally; 54.2 dental care providers, compared with 66.3; and 247.8 mental health providers, compared with 362.6. The uninsured rate was 9%, compared with 8.2% nationally.
For Darlene, those gaps show up as waiting.
Read also: Rising home premiums and housing costs are pricing South Carolina families out
Rural care is not only about distance
Distance matters in rural South Carolina, but so does scarcity. A clinic can be 25 miles away and still not have the right specialist. A dentist can be listed online and still not accept new Medicaid patients. A therapist can offer appointments, but only during work hours. A rural hospital can keep its emergency room open while cutting services families once counted on.
South Carolina’s Primary Care Office tracks Health Professional Shortage Areas for primary care, dental care and mental health. The maps exist because shortages are not occasional. They are part of the system. Darlene’s mother waited months for a specialist appointment after chest pain sent her to the emergency room. The hospital stabilized her. The follow-up was harder.
“She got treated in the emergency,” Darlene said. “But living with the problem, that’s where we felt alone.”
National rural health researchers have warned that rural hospitals remain financially fragile. Chartis reported in 2026 that more than 40% of rural hospitals operate in the red and that 417 rural hospitals are vulnerable to closure, including 36% of hospitals in non-expansion states. South Carolina is one of the states that has not adopted full Medicaid expansion.
A hospital closure is not only a lost building. It is longer ambulance rides, fewer jobs, less prenatal care, fewer screenings and more pressure on the next closest hospital.
Read also: Horry County residents feel the cost of rapid growth and development on roads, schools and drainage
Coverage gaps become care gaps
Insurance does not guarantee access. Lack of insurance almost guarantees delay. KFF reported in May 2026 that 41 states, including Washington, D.C., had adopted Medicaid expansion and 10 had not. Under the Affordable Care Act, expansion covers most adults up to 138% of the federal poverty level, with the federal government covering most of the cost.
South Carolina remains outside full expansion. Cover SC says the state’s exchange enrollment grew from about 200,000 to more than 600,000 in recent years under enhanced subsidies, but warned that the expiration of those subsidies could leave thousands facing unaffordable coverage and projected 183,000 South Carolinians could become uninsured.
For families, the policy language is less important than the consequence. A person who earns too much for Medicaid but too little for affordable private coverage may skip care until the problem is urgent. Darlene has seen relatives treat blood pressure medicine as optional when money runs short.
“Nobody says, ‘I’m choosing to be sick,’” she said. “They say, ‘I’ll go next month.’ Then next month turns into next year.”
Read also: In the Pee Dee, bad roads and daily traffic are turning short drives into long frustrations
The disparities start early
South Carolina’s health gaps are visible before a child takes a first breath. The March of Dimes gave South Carolina an F for preterm birth in its 2025 report card, with a 2024 preterm birth rate of 11.6%, ranking 43rd among states, the District of Columbia and Puerto Rico. The infant mortality rate was 7.0 deaths per 1,000 live births, compared with 5.6 nationally, also ranking 43rd. The report said 402 babies died before their first birthday in 2023.
The racial gap is stark. The same report found the infant mortality rate among babies born to Black mothers was 1.7 times the state rate. Those numbers do not begin in the delivery room. They are shaped by prenatal care, transportation, chronic disease, stress, insurance, hospital access, nutrition, housing and trust.
Darlene remembers when her niece, pregnant with her second child, had to borrow gas money for appointments in Sumter. The problem was getting there, keeping the job, finding child care and paying what insurance did not cover.
“That baby was loved before he got here,” Darlene said. “Love wasn’t the barrier.”
ZIP codes can predict years of life
Health disparities are not limited to rural counties. In Columbia, life expectancy can change sharply by neighborhood. WLTX, citing state health data, reported that parts of the North Main area had an average life expectancy of 64.3 years, while areas such as Northeast Columbia and Forest Acres were around 80. Eastover was listed at 75.
That kind of gap is not explained by personal choices alone. It reflects access to safe housing, grocery stores, transportation, stable jobs, clean environments, preventive care, education and stress. In South Carolina, those conditions vary from the coast to the Midlands, from the Upstate to the Pee Dee.
Chronic disease needs regular care, not heroic care
South Carolina’s biggest health problems are often chronic: heart disease, diabetes, hypertension, obesity, kidney disease, cancer, depression and substance use. These conditions do not wait politely for the next available appointment. They require monitoring, medication, testing, counseling and trust. But regular care is exactly what shortage areas make difficult.
A patient who cannot get a primary care appointment may use the emergency room. A patient who cannot find a dentist may live with infection. A teenager who cannot get counseling may reach crisis before treatment. A pregnant woman who misses early care may enter delivery with risks that could have been managed sooner.
Darlene says the health system often seems designed for people with flexible schedules, reliable transportation, good insurance and time.
“That’s not most families I know,” she said.
What’s up for grabs
South Carolina’s health access crisis is not one problem. It is a workforce problem, an insurance problem, a rural hospital problem, a transportation problem and a poverty problem. It is also a trust problem.
The state can recruit clinicians to shortage areas, expand loan repayment, support rural hospitals, invest in telehealth and broadband, grow mobile clinics, strengthen maternal health programs and make insurance coverage easier to keep. It can also treat Medicaid expansion as part of the access debate rather than a separate political argument.
None of that will erase disparities overnight. But delay has a cost. Darlene keeps the list inside the cabinet. She crossed off one appointment last week after driving 62 miles round trip. Two more remain. One has no date beside it because no one has called back.
“In this house,” she said, “health care is not one appointment. It’s a calendar, a car and a prayer that nothing gets worse before somebody can see you.”
