29-05-2025
Health care advocates form coalition urging Republicans to take their ‘Hands Off Medicaid'
Shelly Ten Napel, CEO of the Community HealthCare Association of the Dakotas, participates in a debate on Sept. 19, 2024, at Dakota Wesleyan University in Mitchell. She is part of a new coalition opposing cuts to Medicaid. (Joshua Haiar/South Dakota Searchlight)
A group of South Dakota health care advocates launched a 'Hands Off Medicaid' coalition Thursday, pleading with the state's all-Republican congressional delegation to avoid proposed cuts.
Medicaid is a federal-state health care program for low-income people. A U.S. House-approved budget reconciliation bill would reduce the program by $625 billion over 10 years under an estimate by the Congressional Budget Office.
Shelley Ten Napel, CEO of the Community HealthCare Association of the Dakotas, is a member of Hands Off Medicaid.
'The proposed cuts will be especially harmful to rural South Dakota,' Ten Napel said. 'When coverage rates fall, rural health centers lose critical funding – putting access to primary care, maternal care, dental services and behavioral health at risk for everyone in those communities.'
U.S. Rep. Dusty Johnson, R-South Dakota, voted for the bill last week. It's now under consideration by the Senate.
'This bill is a strong conservative work product, and one that is long overdue,' Johnson said last week in a press release. 'It delivers a historic spending reduction and roots out abuse of federal programs. These changes are a meaningful attempt to turn our fiscal house in the right direction.'
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Hands Off Medicaid's introductory press conference included Democrat Earl Pomeroy, who served as a U.S. representative for North Dakota from 1993 to 2011. He said millions of Americans could lose care.
'This bill represents a complete retreat from decades of bipartisan progress in expanding access to health care,' Pomeroy said. 'It will drive up the number of uninsured South Dakotans and leave rural hospitals drowning in tens of millions of dollars in uncompensated care.'
That fear is shared by retired family physician Tom Dean. Born and raised near Wessington Springs, he retired after 43 years of practice and still lives in the small South Dakota town.
'I'm really frightened about the impact it will have on nursing homes,' Dean said.
About 147,000 South Dakotans are enrolled in Medicaid. The advocates said 49% of seniors and people with disabilities receive nursing home and community-based care through Medicaid. They also say one out of four births in the state is covered by Medicaid.
'Medicaid is a major payer for prenatal, delivery and postpartum care,' Dean said. 'And that's a major concern, especially in rural areas, but across the country. This country has an alarmingly high maternal mortality rate.'
The U.S. maternal mortality rate in 2022 was 22.3 deaths per 100,000 live births, according to a report from the Commonwealth Fund, compared to zero in Norway, 1.2 in Switzerland, 3.4 in Japan, 3.5 in Germany, and 8.4 in Canada.
Shannon Bacon is the director of external affairs at Community HealthCare Association of the Dakotas. She said access to obstetric care is declining across the state because fewer facilities are offering those services, in part because it 'typically is a money-loser for hospitals, and especially for small rural hospitals that are already financially stressed.'
'And if we lose Medicaid coverage, it will make that problem even worse,' Bacon said. 'And as a result, it will have a direct impact on outcomes.'
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The bill includes a policy change that would require Medicaid enrollees who are between the ages of 19 and 65 to work, participate in community service, or attend an educational program at least 80 hours a month.
The language has numerous exceptions, including for pregnant women, parents of dependent children, people who have complex medical conditions, tribal community members, those in the foster care system, people who were in foster care who are below the age of 26, and individuals released from incarceration in the last 90 days, among others.
Meanwhile, South Dakota officials are considering imposing their own work requirements on adult Medicaid expansion enrollees who don't qualify for a list of exceptions. South Dakotans voted in 2022 to expand Medicaid to adults with incomes up to 138% of the poverty level, a decision that allowed the state to capitalize on a 90% federal funding match.
The first of two public hearings on the state's Medicaid expansion work requirements proposal is at 10:30 a.m. Friday at the state Department of Social Services in Pierre.
States Newsroom's D.C. Bureau contributed to this report.
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