South Carolina Governor Nikki Haley has called for the removal of the Confederate flag from the State House. Yet, she remains adamantly opposed to accepting the federal dollars set aside to extend Medicaid coverage to low-income South Carolinians. In last week’s New Yorker, former South Carolina state representative and Community Catalyst Board member Anton Gunn points out: “If you take the flag down tomorrow, what is going to substantively change in the lives of black people and people affected by inequality in South Carolina?” 

Last week’s Supreme Court decision on the Affordable Care Act benefits South Carolinians by allowing more than 200,000 of them keep federal tax credits to support their health coverage. However, nearly the same number of South Carolinians fall into the “coverage gap” because of Governor Haley and the legislature’s refusal to expand Medicaid. 

Closing the gap would substantially change the lives of black people in South Carolina. It would provide health coverage to 178,000 uninsured South Carolinians – disproportionately made up of people of color. Nationally, over a quarter of the potential beneficiaries are black. Our Close the Gap campaign is working on closing the coverage gap in the 21 states that have not done so. The racial dynamics of the campaigns cannot be overlooked – most of those states were slave states. Of the states that were part of the Confederacy, only Kentucky and Arkansas have expanded Medicaid. 

We characterized the Close the Gap campaign largely as a struggle of the “Old South” versus the “New South.” Governor Haley’s change of heart regarding the flying the Confederate flag over the Capitol is a victory for the “New South” and could provide a roadmap for how to close the coverage gap in former slave states. Combining moral outrage and grassroots activism with an appreciation of the economics of the situation has changed the political dynamics around the Confederate flag. Five hundred people demonstrated in front of the South Carolina Capitol protesting the flag. Companies like Walmart and E-bay saw the potential impact on their bottom lines and decided to stop selling Confederate flags. Tourists threatened to boycott Charleston.

Closing the coverage gap will require the same combination of moral outrage, grassroots organizing and hard thinking about the economics. But moral outrage over refusing to close the coverage gap is growing, and business groups are increasingly demanding that states accept the federal funds set aside for this coverage. Since the federal government is paying 100 percent of the costs of coverage that will help millions of people and address a long history of inequality, this should be an offer that states such as South Carolina cannot refuse.