CUSTER, S.D. — A silver minivan decorated with a big sticker reading “Love Your Neighbor Tour” recently circumnavigated South Dakota.
Catholic nuns, Protestant pastors, a synagogue president and a Muslim nonprofit skilled were among the many interfaith leaders who packed into the rented six-seater or caravanned behind.
The road trip’s mission: to register voters and urge them to support expansion of the state’s Medicaid program to cover 1000’s more low-income adults.
“If we reside our faith, then now we have a serious obligation to like our neighbor and to indicate that in very practical ways,” Sister Teresa Ann Wolf, a Benedictine nun, said at one in all the convoy’s stops. “And one quite simple, concrete thing we will do to assist our neighbor — like 40,000 neighbors in South Dakota who need health care — is to vote yes for Amendment D.”
Many South Dakotans are people of religion and might find this argument from religious leaders convincing, said Brenda Handel-Johnson, a Lutheran deacon.
Medicaid, the nation’s leading public medical insurance program for low-income and disabled Americans, covers greater than 82 million people and is jointly financed and operated by the federal and state governments. The 2010 Reasonably priced Care Act allows states to supply coverage to more people, with the federal government paying 90% of the prices.
Greater than a dozen interfaith leaders participated within the recent Love Your Neighbor Tour. Group members traveled greater than 1,400 miles across South Dakota, an expansive but sparsely populated state with fewer than 900,000 residents. The group visited 25 towns in five days, meeting with people in restaurants, grocery and convenience stores, a library and a church.
One stop was at a senior center in Custer, a small town within the Black Hills that teems with tourists through the summer but is 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 about family members and acquaintances who lack insurance. Some stressed how Medicaid expansion would help rural residents and health care services. One attendee, the chair of the local Republican Party, said it’s inappropriate to insert a policy issue like Medicaid expansion into the state structure.
About 16,000 of those people don’t currently qualify for any government assistance with health coverage regardless that their income falls below the federal poverty level.
Nationally, people of color are disproportionately represented inside this “Medicaid coverage gap,” based on a KFF evaluation of census data. About half the people within the gap are working; others include students and caregivers.
Jennifer Green, a Rapid City mother of three, lives below the federal poverty level and has no medical insurance. The 46-year-old said she has no public coverage options and might’t afford the premiums to purchase her husband’s workplace insurance.
Jennifer Green lives under the federal poverty level but has no medical insurance. She is going to qualify for Medicaid if South Dakotans vote to expand eligibility.(Arielle Zionts/KHN)
Green said she has two hernias, which prevent her from lifting greater than 10 kilos, and a back injury from a automobile crash that makes it painful to take a seat long.
“With my situation, I’m not lazy. I do know loads of people think I is likely to be, but I’m not. It’s due to the amount of pain I’m in. … In reality, my leg goes numb now,” Green said while standing outside her rental house. “I’d work if I could.”
Green would qualify for Medicaid under the expansion proposal. She said she would use the insurance for hernia and back surgery.
Americans for Prosperity, a conservative, libertarian organization that has campaigned against expansion proposals nationwide, was the lead fundraiser in an earlier effort to stop the change in South Dakota.
The group supported an effort to create a 60% approval threshold for constitutional ballot questions that cost $10 million or more to implement, which might have included Medicaid expansion. In June, voters overwhelmingly defeated that proposal, so the expansion amendment will need only an easy majority to pass in November.
The Medicaid expansion campaign is backed by the progressive Fairness Project, which has supported expansion ballot campaigns across the country. But the most important funders are South Dakota-based health care organizations, AARP and the National Farmers Union. Other endorsers include Indigenous groups and the state’s chamber of commerce, teachers union and municipal league.
Supporters cite studies showing that Medicaid expansion increases the number of individuals covered by insurance, improves health outcomes and saves money. Expansion could have a profound impact on Indigenous communities within the state. Native Americans in South Dakota are greater than 3 times as likely to be uninsured as the general state population.
Expansion supporters have been campaigning through the Love Your Neighbor Tour, TV ads, documentary screenings and other methods. The opposition has been less visible but includes some Republican lawmakers, Americans for Prosperity and the Farm Bureau, which offers health plans.
John Wiik, a Republican state senator, said opponents had expected voters to pass the June proposal to lift the approval threshold for constitutional amendments. After that ballot measure failed, he said, some opponents doubted it was price spending money to attempt to defeat the Medicaid expansion proposal.
“I mean, let’s face it. We’re David versus three Goliaths wrapped in media armor,” he said in a phone interview.
Wiik said everyone within the opposition assumed another person would lead the campaign against expansion. He recently took charge by registering a committee to lift money for the cause. The committee formed after early voting began, and nearly two years after the pro-expansion campaign began raising money.
Opponents say it’s unfair that, under expansion, some people who find themselves pleased with their federally subsidized private insurance can be forced onto Medicaid as a substitute.
“You are going to cut into their quality of care really bad in a rural state like South Dakota because we do not have enough providers that also accept Medicaid,” Wiik said.
The professional-expansion campaign decided to propose a constitutional amendment, moderately than a statute, and inserted deadlines into the text to make sure it’s implemented. They desired to make it harder for South Dakota legislators to dam the ballot measure, as has happened on previous issues. Gov. Kristi Noem, a Republican running for reelection, opposes Medicaid expansion but said the state will implement the desire of the voters.
Current Health Insurance Options for Low-Income South Dakota Adults
- South Dakotans 18-64 years old with dependent children qualify for Medicaid in the event that they earn as much as 46% of the federal poverty level. That translates to $12,765 for a family of 4.
- Adults who don’t have dependent children or certified disabilities generally don’t qualify for Medicaid, regardless of how poor they’re.
- Many moderate-income adults — with or without children — can qualify for Reasonably priced Care Act subsidies to purchase private insurance if their incomes are at or above the federal poverty level ($27,750 for a family of 4 or $13,590 for a single person).
How Expansion Would Affect Medicaid Eligibility
- Adults, with or without children, who earn as much as 138% of the federal poverty level could enroll in Medicaid. That’s $38,295 for a family of 4 or $18,754 for a single adult.
- Many immigrants, including those lacking everlasting legal status, would still be barred from coverage.