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YANKTON, SD — Judal Carr knows what it’s like to live without health insurance. Two months before he became eligible for Medicaid on disability starting in 2019, Carr was paying out of pocket for a variety of health issues, mostly from severe back problems and a neck injury he suffered on the job.
He says the fear of medical costs is a constant topic of conversation among affordable housing residents in Yankton.
“Many of my friends don’t even go to the doctor because they can’t afford it. “I know you can’t afford it, but we’re getting older and you have to check your blood pressure and make sure everything’s OK,” Carr told the Forum news service on Sept. 20. “Because they don’t want those kinds of bills hanging over them,” he said.
Courtesy of Susan Smith, Marketing with Horizon Healthcare
During those years, Carr relied on the Yankton Community Health Center, one of several community health centers owned by Horizon Healthcare.
These community health centers, which can offer lower rates to uninsured and underinsured populations due in part to federal funding, are key providers of basic medical and dental services to lower income patients in rural and urban areas throughout South Dakota.
This year they are also part of the sponsorship package.
in the state.
“There’s a long-term viability of our financial sustainability and rural resources, but there’s also the fact that these are our patients, our friends or our neighbors. Regardless of the impact on the bottom line, people need the health care they need,” Shelly Ten Napel, CEO of the Dakotas Community Health Care Association, told the Forum News Service. It’s hard to see them struggle every day with not being able to get care.
Community health centers said Medicaid expansion would increase access to rural health services.
Michelle Krall, a community health worker and patient support investigator at the health center in Yankton, said she saw South Dakota as one of the 13 states in the country facing the harsh realities of expanding Medicaid, where coverage was first offered to people ages 19-64. In the year 138% below the federal poverty line in 2014.
She told the story of grandparents who raised their four grandchildren from foster care. Although the children were eligible for Medicaid while living in Nebraska, three of the four children passed out when they moved to South Dakota.
“They were more than eligible for Medicaid. And they can’t get affordable coverage in the marketplace because both grandparents have Medicare, so the kids don’t qualify for the tax credit,” Kral said.
Aside from the certainty Medicaid expansion could provide for families in similar situations, Horizon Health Care CEO Wade Erickson said another part of the reason to support the expansion is the economic impact of lower out-of-pocket costs for thousands of patients.
Of the 42,500 people who fall into the Medicaid “coverage gap” — meaning they would be eligible for Medicaid if Amendment D passes — Erickson said about 7,000 live in the Horizon Health Centers system. He added that moving these patients from the current out-of-pocket sliding scale to Medicaid would reduce unreimbursed costs for Horizon and other community health centers in the region.
Courtesy of Horizon Health Care
“Having Medicaid expansion reduces uninsured bad debt, and those people can use that money in the community,” Erickson said. “They’ll have coverage that will allow them to spend that money locally and really stimulate the local economy.”
The Community Health Association of the Dakotas (CHAD), which represents community health centers in North and South Dakota, has seen the benefits of Medicaid expansion in a naturalistic experiment, as Tenn.
North Dakota in 2013.
Ten Napel points to the low insurance rates in North Dakota as a relevant factor in the expansion’s effectiveness.
Health and Human Services
As of this year, the uninsured rate among those in the “coverage gap” in North Dakota is estimated to be 20.4% in 2020, compared to 35.4% in South Dakota that same year.
“When you have that strong payer mix, there’s only going to be more resources to provide the kind of care that you know your patients need,” Ten Nappel said. “So whether that’s transportation, whether that’s support with medication or behavioral health, there’s just more resources to do that.”
Opponents say Medicaid is failing to deliver on its promises
Among opponents of Medicaid expansion, there is a feeling that the program is being sold without paying enough attention to the potential harms.
Keith Moore, director of Prosperous Americans in South Dakota, told The Forum News Service that “the numbers don’t measure up in the states where Medicaid expansion happens. Once expanded, states enroll twice as many individuals as they were supposed to, so they get twice the cost.”
While Erickson acknowledges there is a problem with enrolling thousands of people in Medicaid, he said he is not surprised to exceed the 42,500 estimate.
“It’s going to take time, but I think we can easily get past that,” Erickson said.
However, this does not mean that overall costs will increase. while one
The Center on Budget and Policy Priorities found that about half of states enrolled more than expected, and concluded that “savings from Medicaid expansion,” including reductions in other state health care costs, “will continue to exceed state expansion costs.” In the next decade.”
An
The Legislative Research Council in South Dakota estimates that the expansion will cost the state less than $4 million in the first five years, though most of the savings will come from federal incentives in the first two years, and it will cost $22 million annually after no change. the program.
Still, Moore and other expansion opponents, like John Wick, a Republican state senator from Big Stone, have plenty of other reasons to fear the implications of expanding Medicaid.
Among the unintended consequences that Moore has tracked in other states are the loss of private plans for low-income workers and the ability of people who can afford them to get health care without working.
Wick also told the South Dakota Newspaper Association that he is concerned about the growing demand for labor shortages, saying, “We cannot guarantee that we will have enough suppliers to maintain the level and quality of service that we can provide to those who need it most right now.”
Although Erickson recognized that Horizon Healthcare felt an economy-wide labor shortage, he thought the industry could meet the growth in demand.
“The savings and economic stimulus it will bring to the state will create new jobs in the health care industry,” Erickson said. This will ultimately reduce costs and improve the overall health and quality of life of every South Dakotan.
Jason Harvard of
A corps reporter who writes about state politics in South Dakota. Find him at
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