Rural health centers say expanding Medicaid is key to providing better care and a growing economy

YANKTON, SD — Judale Carr knows what it’s like to live without health insurance. From 2019 until he qualified for Medicaid through disability two months ago, Carr was paying out of pocket for a variety of health issues, mostly due to chronic back problems and a neck injury sustained at the work.

He says fear of medical bills is a constant topic of conversation among residents of the affordable housing complex where he lives in Yankton.

“Many of my friends don’t even go to the doctor because they just can’t afford it. I’m saying I know you can’t afford it, but we’re getting older and you need to get your blood pressure checked and make sure you’re okay,” Carr told Forum News Service on Sept. 20. “But it’s like pulling teeth, because they don’t want to have those kinds of bills hanging over them.

Judale Carr visits Amanda Thoms, his provider at the Yankton Community Health Center.

Courtesy of Susan Smith, who works in marketing at 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 a sliding scale of lower rates to uninsured and underinsured populations due to partial federal funding, are a key provider of basic medical and dental services to low-income patients in rural and urban areas of South Dakota.

This year, they are also part of the coalition in favor of

Medicaid expansion

in the state.

“For us, there’s financial viability and long-term sustainability of rural resources,” Shelly Ten Napel, CEO of the Community Healthcare Association of the Dakotas, told Forum News Service. “But there is also the fact that they are our patients, our friends or our neighbours. Regardless of the impact on our results, it is difficult to see people struggle every day not being able to afford the health care they need.

Community Health Centers Say Medicaid Expansion Would Strengthen Access to Rural Health Care

Michelle Kral, community health worker and patient support navigator at Yankton Health Center, says she’s seen the harsh realities of South Dakota being one of 13 states nationwide not to expand Medicaid since the coverage was first offered to people aged 19 to 64. who were below 138% of the federal poverty level in 2014.

She told the story of grandparents who had adopted their four grandchildren from foster care. Although the children qualified for Medicaid while living in Nebraska, that eligibility expired for three of the four children when they moved to South Dakota.

“They were just above qualifying for Medicaid. And they can’t get affordable coverage in the marketplace because both grandparents have Medicare, so the kids don’t qualify for tax credits,” Kral said.

Outside of the certainty that Medicaid expansion could offer families in similar situations, Horizon Healthcare CEO Wade Erickson said another part of his rationale for supporting the expansion was the economic effects of lower out-of-pocket costs for thousands of patients.

Of the estimated 42,500 people who fall into the Medicaid “coverage gap” — meaning they would become eligible for Medicaid if Amendment D passes — Erickson says some 7,000 reside in the Horizon system of health centers. health. He added that moving these patients from the current sliding scale to Medicaid would reduce uncompensated costs for Horizon and other community health centers in the state.

Wade Erickson, CEO of Horizon Healthcare

Courtesy of Horizon Healthcare

“Expanding Medicaid would reduce uninsured bad debt, allowing these people to use that money in the community,” Erickson said. “They would have coverage that would allow them to spend that money locally and really boost that local economy.”

According to Ten Napel, the Community Healthcare Association of the Dakotas (CHAD), which represents community health centers in North and South Dakota, has seen the benefits of Medicaid expansion in what is essentially a natural experiment, since that Medicaid has been

expanded by voters

in North Dakota in 2013.

Ten Napel pointed to the lower rate of uninsured in North Dakota as a relevant metric for judging the effectiveness of the expansion.

A Health and social services


as of this year estimated the uninsured rate among those in the “coverage gap” at 20.4% in North Dakota as of 2020, compared to 35.4% in South Dakota the same year.

“When you have this stronger payer mix, there are just more resources to provide the kind of care you know your patients need,” Ten Napel said. “So whether it’s transportation, support with medication, or behavioral health, there are just more resources to do that.”

Opponents say Medicaid would not deliver on its promises

Among opponents of Medicaid expansion, there is a sense that the program is being sold without enough focus on potential downsides.

“In states where Medicaid expansion has taken place, the numbers don’t measure up,” Keith Moore, state director for Americans for Prosperity in South Dakota, a group, told Forum News Service. centre-right defence. “Once it is expanded, states enroll more than twice as many individuals as expected. So you have twice the cost.

Although Erickson admitted the difficulty of enrolling thousands of people on Medicaid, he said going over the 42,500 estimate wouldn’t surprise him.

“It will take time, but I think we could very easily get past that,” Erickson said.

However, this does not necessarily mean that costs will increase overall. While a


by the Center on Budget and Policy Priorities shows that about half of states enrolled more than expected, it also concluded that “savings from Medicaid expansion,” which include decreases in other health care costs of the state, “will continue to outpace the costs of expanding the state into the next decade.



of the Legislative Research Council of South Dakota estimates the expansion would cost the state less than $4 million in the first five years, though much of those savings would come from federal incentives in the first two years, and every year after that would cost about $22 million without changes to the program.

Yet Moore and other opponents of the expansion, such as John Wiik, a Republican senator from Big Stone City, have several other reasons to fear the effects of the Medicaid expansion.

Among the unintended consequences Moore had tracked in other states was a loss of private plans for low-income workers and the ability for able-bodied people to access health care without working.

Additionally, Wiik told the South Dakota Newspaper Association that he is concerned about increased demand due to a labor shortage, saying he “cannot guarantee that we have enough providers to keep up with the level and quality of service we are able to provide to those who desperately need it right now.

Although Erickson admitted that economy-wide labor shortages have certainly been felt by Horizon Healthcare, he believed the industry could respond to a potential spike in demand.

“The savings that will be brought to the state and the economic stimulus it will create will lead to the creation of new jobs in the healthcare sector,” Erickson said. “This will ultimately reduce costs and improve the overall health and quality of life for every South Dakota.”

Jason Harvard is a

Report for America

Corps reporter who writes about state politics in South Dakota. Contact him at



[email protected]

About Antoine L. Cassell

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