Who South Dakota’s Medicaid expansion vote will impact the most

CHJ · Who South Dakota’s Medicaid Expansion Vote Will Impact The Most - PBS News Weekend

On Election Day, South Dakotans will have the option on their ballot to expand Medicaid coverage, which would likely have outsized benefits for the state’s most vulnerable people. Ali Rogin speaks to Laura Santhanam, who recently returned from a reporting trip there, to learn more.

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• Geoff Bennett:

  Finally, tonight, voters across the country will not only choose candidates on Tuesday, but also consider major policy changes in their states. In South Dakota, voters will decide whether to expand government funded health coverage for some of the state's most vulnerable people. Ali Rogin has more.

• Ali Rogin:

  The Affordable Care Act gave states the option to expand Medicaid which covers low-income people and people with disabilities. 38 states and the District of Columbia have done so changing the income threshold for eligibility so that more people can enroll. South Dakota is one of 12 states which hasn't expanded Medicaid but on Tuesday residents there will vote on whether to change that.

  My colleague Laura Santhanam just returned from a reporting trip there and joins me now. Laura, thank you so much. What does it mean for South Dakota to potentially be expanding Medicaid?

• Laura Santhanam, Health Reporter:

  For years since the Affordable Care Act went to place, South Dakota and a lot of ways was kind of frozen in time with respect to access and affordability to health care. So, if the state's voters decide to change that, to expand Medicaid, what it means is that a lot of people will be able to access healthcare, won't have to worry about being stuck with big bills that they can't afford. And a lot of health issues that otherwise could become catastrophic, much costly or more complicated to treat, can be caught sooner.

• Ali Rogin:

  Approximately how many South Dakotans would this affect?

• Laura Santhanam:

  Right, in the first year, approximately 42,000 South Dakotans would be eligible for Medicaid.

• Ali Rogin:

  And so, Election Day is just a couple days away, you just spend a couple days in the state, what's the political atmosphere like there really?

• Laura Santhanam:

  According to some of the latest polling that we've seen, about half of South Dakota voters are in support of Medicaid expansion. And then about a quarter of South Dakotans hadn't made up their mind at that point, another 18% largely Republicans were opposed to Medicaid expansion.

• Ali Rogin:

  And one of the things you picked up on was the Medicaid coverage gap. That's where people can't get on Medicaid, but they can't afford private insurance because they make too much money to be on Medicaid and not enough to afford private insurance. That seems like it's a particularly big issue in South Dakota?

• Laura Santhanam:

  That's exactly right. What that means is that a lot of people who work in frontline are essential workers, I get hospitals, gas stations, grocery stores, they make too much to qualify for Medicaid, but they don't make enough to be able to afford health insurance themselves. And so, what that means is that a lot of people, thousands of South Dakotans are, you know, in a position where they have to choose between, you know, fear of financial ruin, or gambling with their health. And a lot of them, you know, we're seeing devastating effects. And as those are a lot of the stories I've been hearing.

• Ali Rogin:

  And South Dakotans of color seem to be even more affected, even though 80% of the state is white. Why is that?

• Laura Santhanam:

  A history of racial and ethnic disparities in health care is true across much of the country in South Dakota is no exception looking at forced assimilation, particularly with indigenous populations in the state that's had negative impacts with respect to access to health care, looking also at food insecurity, housing insecurity, all of those have massive ripple effects when it comes to communities of color, being able to access the health care they need when they need it. And again, you know, it puts people in a position where they choose between paying this medical bill or getting food on the table.

• Ali Rogin:

  And pregnant women also seem to be particularly vulnerable here. You spoke to a lot of them, what are they feeling? What are they going through right now?

• Laura Santhanam:

  There were several women who I talked to who made too much to qualify for Medicaid but still couldn't afford their medical bills. One woman her application for Medicaid was rejected. She was crossing all the T's and dotting all the I's. But then a medical emergency happened when she was 37 weeks pregnant. And she ended up having to be medivac from a hospital on Pine Ridge Reservation back to Rapid City, and then received a bill for $5,000. And that was something that was, like devastating for her when she initially got the bill. I mean, she's like, there's no way I can afford that. You know, and so you layer all of those sorts of complications on top of the normal stress of being pregnant making a home for a new child. And it just makes life very difficult for people who are trying their best.

• Ali Rogin:

  Laura, there is a way that pregnant women can get Medicaid coverage during their pregnancy and a little bit beyond. There are a lot of exceptions. And it only though last 60 days, the Biden administration has urged all states to extend it to a full year and so far, 36 states have extended that coverage, but South Dakota obviously has not. What's the argument for extending it.

• Laura Santhanam:

  A lot of the issues that healthcare providers and patients told me about when I was here in South Dakota, is that, especially with pregnant postpartum people is consistent access to care, both before pregnancy, during pregnancy and afterwards, right? And anyone who's delivered a child knows that, you know, oftentimes one's body has not finished healing, you know, on a clock, right? 60 days, often is not enough time. And so, what I was hearing from providers is that, you know, they would have patients who are, you know, trying to schedule surgeries, appointments, things like that, while they still had Medicaid coverage, and oftentimes the clock would just run out on them.

• Ali Rogin:

  It's going to be a very interesting election day in South Dakota. Laura Santhanam, thank you so much for your time.

• Laura Santhanam:

  Thank you for having me.

• Geoff Bennett:

  And we should point out that Laura's reporting was produced as part of a project for the USC Annenberg Center for Health Journalism's 2022 National Fellowship.