Advocacy Rises as South Dakota Voters Decide on Medicaid Expansion

CUSTER, SD – A silver pickup truck decorated with a large sticker that reads “Love Your Neighbor Tour” recently circled South Dakota.

Catholic nuns, Protestant pastors, a synagogue president, and a Muslim nonprofit expert were among the interfaith leaders who lined up in a rented six-seater or caravan rear act.

Trip mission: register voters and urge them to support the expansion of the state’s Medicaid program to cover thousands of lower-income adults.

“If we are living our faith, then we have a serious obligation to love our neighbor and show it in very practical ways,” said Sister Teresa Ann Wolf, a Benedictine nun. at one of the convoy’s stops. “And one very simple, concrete thing we can do to help our neighbors — like our 40,000 neighbors in South Dakota who need health care — is vote yes for Tu. Judge D.”

Brenda Handel-Johnson, a Lutheran deacon, said many South Dakotans are people of faith and may find this argument by religious leaders convincing.

South Dakota is one of 12 states that haven’t expanded eligibility for their Medicaid programs, and the only state that voters will decide in November whether to do so.

Medicaid, the nation’s premier public health insurance program for low-income Americans and people with disabilities, covers more than 82 million people and is funded and operated by the federal and state governments. The Affordable Care Act of 2010 allowed states to provide coverage to more people, with the federal government paying 90% of the cost.

More than a dozen interfaith leaders participated in the recent Love Your Neighborhood Tour. Team members traveled more than 1,400 miles through South Dakota, a vast but sparsely populated state with fewer than 900,000 residents. The group visited 25 towns over five days, meeting people in restaurants, grocery and convenience stores, libraries and churches.

One stop is at an upscale center in Custer, a small town in the Black Hills that is crowded with tourists in the summer but home to only about 2,000 year-round residents.

Tour members and a small group of locals sat in a circle as they exchanged stories of loved ones and acquaintances who lacked insurance. Some emphasize what Medicaid expansion will look like help rural residents and health care services. One attendee, the local Republican chairman, said it was inappropriate to include a policy issue like expanding Medicaid into the state constitution.

The South Dakotans will decide on November 8, when they vote on the proposed constitutional amendment. Proposal to provide Medicaid coverage for an estimated 42,500 South Dakot people have low income ages 18 to 64.

About 16,000 won some of these people are not currently eligible for any government assistance with health insurance even though their income falls below the federal poverty level.

Some are parents who earn too little eligible for federal aid to buy private insurance on the Affordable Care Act market but earn too much to eligible for South Dakota’s Medicaid program. Others are adults without children or disabilities who are not allowed to enroll in Medicaid no matter how low their income.

Nationally, people of color are disproportionately represented in the “Medicaid coverage gap,” according to KFF analysis of census data. About half of the people in the void are working; others include students and carers.

Jennifer Green, a mother of three in Rapid City, lives below the federal poverty line and has no health insurance. The 46-year-old said she did not have a public insurance option and could not afford the premiums for insurance at her husband’s workplace.

Green said she has two hernias that keep her from lifting more than 10 pounds, and a back injury from a car crash that causes her pain when sitting for long periods of time.

“Given my situation, I am not lazy. I know a lot of people think I can, but I don’t. It’s because I’m in a lot of pain.… In fact, my legs are numb now,” Green said as she stood outside her rental home. “I’ll work if I can.”

Green would qualify for Medicaid under the proposed expansion. She said she would use insurance for hernia and back surgery.

Americans for Prosperity, a conservative, liberal organization that has campaigned against expansion proposals across the country, was the main fundraiser in an earlier effort to stave off change in South Dakota.

The group has backed an effort to create a 60% approval threshold for constitutional ballot questions with an implementation cost of $10 million or more, which would include the expansion of Medicaid. In June, voters overwhelmingly defeated that proposal, so the expanded amendment would need only a simple majority to pass in November.

Keith Moore, director of Americans for Prosperity in South Dakota, said he opposes expanding Medicaid because the taxpayer-funded program has victims of billions of dollars of fraud and errors. Moore also points out the states that have ended spend more than expected on extended coverage.

The Medicaid expansion campaign is supported by the Progressive Equity Project, which has supported expanded voting campaigns across the country. But the biggest donors are South Dakota-based health care organizations, AARP, and the National Farmers Union. Other advocates include Indigenous groups and state chambers of commerce, teachers’ unions, and city federations.

Supporters cite studies shows that Medicaid expansion increases the number of people covered, improves health outcomes, and saves money. The expansion could have a profound impact on indigenous communities in the state. Native Americans in South Dakota are three times more likely uninsured as a statewide population.

Expansion advocates have campaigned through Tours of Your Neighborhood, TV commercials, documentary screenings, and other methods. The opposition is less visible but includes some Republican lawmakers, Americans for Prosperity and the Farm Bureau, which provides health plans.

John Wiik, a Republican senator, said opponents had expected voters to pass a June proposal to raise the approval threshold for constitutional amendments. After the ballot measure failed, he said, some opponents questioned whether spending money trying to defeat the proposed Medicaid expansion was worth it.

“I mean, let’s face it. We are David versus three Goliaths encased in media armor,” he said in a phone interview.

Wiik says everyone in the opposition thinks someone else will lead the campaign against expansion. Recently, he took charge by signing up for a committee to raise money for a cause. The committee was formed after early voting began and nearly two years after the campaign for the expansion began raising funds.

Opponents argue that it is unfair that, during the expansion, some people satisfied with their federally subsidized private insurance will forced into Medicaid instead of.

“You’re going to cut the quality of their care really badly in a rural state like South Dakota, because we don’t have enough providers that still accept Medicaid,” Wiik said.

Campaign for extending the decision to propose a constitutional amendment, rather than a statute, and inserted a deadline in the text to make sure it’s done. They want to make it more difficult for South Dakota lawmakers to block ballot measures, as has happened in previous issues. Governor Kristi Noem, a Republican running for re-election, opposes expanding Medicaid but says the state will do what voters want.

KHN (Kaiser Health News) is a national newsroom specializing in the production of in-depth coverage of health issues. Along with Policy Analysis and Exploration, KHN is one of the three main activities in KFF (Kaiser Family Foundation). KFF is a nonprofit organization privileged to provide information on health issues to the nation.

Current health insurance options for low-income South Dakota adults

South Dakotans 18-64 years old with dependent children are eligible for Medicaid if they earn up to 46% of the federal poverty level. That means $12,765 for a family of four.

Adults without dependent children or with a certified disability are generally not eligible for Medicaid, no matter how poor they are.

Many moderate-income adults – with or without children – may be eligible for the Affordable Care Act benefit to purchase private insurance if their income is at or above the federal poverty level. state ($27,750 for a family of four or $13,590 for one).

How will the expansion affect Medicaid eligibility?

Adults, with or without children, who earn up to 138% of the federal poverty level can apply for Medicaid. That’s $38,295 for a family of four or $18,754 for an adult.

Many immigrants, including those without permanent legal status, will still be barred from insurance.

KHN (Kaiser Health News) is a national newsroom specializing in the production of in-depth coverage of health issues. Along with Policy Analysis and Exploration, KHN is one of the three main activities in KFF (Kaiser Family Foundation). KFF is a nonprofit organization privileged to provide information on health issues to the nation.


This story can be republished for free (details).


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