South Dakotans will vote on Tuesday on whether to expand Medicaid coverage to low-income adults through a ballot initiative that garnered approval from key players in the healthcare industry. Mount Rushmore State health care or not.
The Association of South Dakota Health Care Organizations and the South Dakota State Medical Association are among the public supporters of the initiative, along with Sanford Health and Avera Health, both based in Sioux Falls and Monument. Health of Rapid City.
Advocates argue that expanded adoption under the Affordable Care Act would reduce the uncompensated care burden on South Dakota providers, increase the revenue that providers create and allow community health centers to expand.
“In South Dakota, like in other states, rural hospitals are losing money in part because they provide care to people without health insurance,” said State Senator Michael Diedrich (R), co. Former Vice President of Government for Monument Health said. . “Expanding Medicaid will protect access to health care in rural communities because it will help save rural hospitals or clinics from having to close.”
Although Medicaid generally offers low reimbursements compared to Medicare and private insurers, those with low incomes who would qualify under the ballot measure tend to be uninsured and therefore more likely to be uninsured. ability to pay for the medical care they receive, leaving providers with unpaid bills.
Kelly Hall, executive director of the Fairness Project, a progressive organization that supports grassroots campaigns for policymaking at the ballot box.
An estimated 42,500 South Dakotans with incomes below 133 percent of the federal poverty level — or about $18,000 a year for an individual — will be eligible for Medicaid benefits starting July 1 if the revision The constitution attracted majority support, according to the South Dakota Legislature’s nonpartisan budget analysis office.
Analysis of Kaiser Family Foundation Census data shows that 9.4% of people in South Dakota are uninsured in 2021, compared with 8.6% nationally. In 2019, 16,000 South Dakotans fell into the “Medicaid gap,” meaning they were ineligible for both Medicaid and the ACA’s premium tax credits for private health insurance, a KFF analysis said. separate show.
The ACA called for a nationwide expansion of Medicaid, but the Supreme Court ruled in 2012 that states could opt out. But because the law also only allows those earning a salary below the poverty line to qualify for premium tax credits, it leaves millions in non-expanding states unable to access Medicaid or insurance. subsidized from a health insurance exchange.
Research shows that Medicaid expansion is associated with fewer hospital closures. “States that did not expand Medicaid experienced a large increase (0.429 closures per 100 hospitals) from 2008-12 through 2015-16 in unadjusted closure rates. In contrast, rates closures fell by 0.33 per 100 hospitals in the expanded states,” according to a University of Colorado study published in the journal Health Affairs in 2018.
Community health centers, health systems and healthcare associations are pouring money into the ballot initiative and voicing support for the expansion campaign, led by a coalition called is South Dakotans Decide Healthcare.
In addition to several major health systems and healthcare industry groups, the Medicaid expansion measure is supported by dozens of organizations including the South Dakota Nurses Association, the South Dakota Farmers Association, and the Greater Sioux Chamber of Commerce. Falls, certified by the American Cancer Society. , American Heart Association, American Diabetes Association, and AARP South Dakota.
Governor Kristi Noem (R), conservative lawmakers and organizations like Americans for Prosperity oppose the measure, saying it would cause high costs for the state.
Fifty-three percent of South Dakotans support a constitutional amendment that expands Medicaid, according to the results of a South Dakota State University survey released last month. In June, 67% of voters rejected a GOP-led initiative that aims to cut the Medicaid vote by requiring a 60% threshold to enact ballot initiatives.
“The voting measures are how we got through the log on this issue,” Hall said.
Kim Malsam-Rysdon, vice president of public policy for the health system, said Avera Health, which operates 17 rural hospitals, would benefit from more people getting coverage. “What Medicaid will bring is better financial stability for rural hospitals. If they are serving a population that tends to be more uninsured, they will have more uncompensated care,” she said. Malsam-Rysdon previously served as South Dakota’s Secretary of Health under Noem.
The expansion will also allow Avera Health to maintain services that are at risk right now, Malsam-Rysdon said. The health system will be able to continue to deliver regionalized cancer care in rural communities instead of having to move people away from their homes, she said, and also provide more behavioral health services.
“We want to expand that service across our entire footprint, and that’s going to be another thing that I don’t see we can do without addressing things like expanding Medicaid,” she said.
Shelly Ten Napel, Executive Director of the Community Health Care Association of the Dakotas, a trade group and voting measure advocate. Furthermore, rural clinics have fewer patients than urban clinics, she said. “All those economic factors make it hard to make a living,” she said.
The Black Hills Community Health Center in Rapid City is financially dependent on Medicaid payments, said Dr. Douglas Lehmann, an internist and pediatrician who practices at the clinic. Making more people eligible for Medicaid will generate several hundred thousand dollars a year and allow the community health center to hire more mental health providers, he said. “The service expansion will be a big thing for us,” he said.
Six Republican-led states have expanded Medicaid eligibility by vote since the ACA became law in 2010. South Dakota is one of twelve remaining states that have yet to do so. wide. Then-Gov. Dennis Daugaard (R) conceived the plan through the Medicaid expansion in 2015 but abandoned it after failing to win enough support from Republicans.
According to the ACA, the federal government funds 90% of the costs to cover newly eligible beneficiaries in states that expand Medicaid. Additionally, President Joe Biden signed a bill into law last year that would suggest states that have not expanded Medicaid eligibility for two years, give a 5% increase to the federal share of their total Medicaid costs if they apply extension.
Due to reduced spending on state health care programs and additional federal money, expanded adoption of Medicaid would result in savings of $162.5 million for South Dakota over five years, according to the office. budget of the Legislature.
Elected Republicans in Idaho, Maine and Utah delayed implementing or attempting to change the details after successful ballot measures to expand Medicaid, though all eventually opened. Enrollment is open to those who are newly eligible.
Despite her objections, Noem – who is seeking re-election Tuesday against South Dakota House Minority Leader Jamie Smith (D) – has vowed to implement the law if voters support the amendment. constitutional change.
“We have done everything we can to build a legally robust voting initiative, put in place protections, and we will continue to work with our partners at the agency. state legislature and at the Department of Social Services to ensure that the implementation of Ten Napel said.
