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SDPB Radio Coverage of the South Dakota Legislature. See all coverage and find links to audio and video streams live from the Capitol at

Committee Hears Consequences Of No Health Insurance

Supporters of Medicaid expansion filled a committee room in the Capitol Wednesday, along with onlookers and probably opponents who did not come forward to speak. This was the first hearing of the recently formed Bipartisan Medicaid Expansion Exploratory Committee. Twenty-one people came forward to speak in favor of expansion, and only two spoke against it. The state’s leadership has to decide whether to take part in this aspect of the federal Affordable Care Act.

In committee room 412, all the chairs are full, and there are people lining the walls, crowding the doorways, and spilling out into the hall. At the podium is a sign-up sheet filled with the names of those who want to speak.
One after another they come forward to sit before a microphone and tell the committee their experiences. Some of them testify by phone, their voices loud and tinny, filling the room.
First up is John Mengenhausen, CEO of Horizon Health Center of Howard. He’s one of many health professionals who tell of patients who need help.
“There’s a gentleman that holds down two fulltime jobs,” he says. “He works at a grocery store fulltime. He probably earns about ten dollars an hour. He leaves the grocery store, and he goes and manages a small restaurant and bar. His wife runs a fulltime daycare center.”
Mengenhausen says this couple with four children can’t afford health insurance, but they make too much money to qualify for Medicaid.
Mengenhausen supports raising the maximum income level for Medicaid in South Dakota. By doing so, according to most testimony, the state would add another 48,000 people to its Medicaid rolls.
“And it will then allow the people to seek the primary and preventive care that is needed to prevent them from going to the next level of care, utilizing that emergency room as their primary care physician, which happens all too often, and we’re all aware of that,” Mengenhausen tells the committee.
“They’re usually laborers working as clerks in stores or waitresses or truck drivers,” says
Dr. Mike Holland, a Pierre physician. He describes a group of people referred to over and over again in testimony as the working poor: “These are hardworking people trying to get ahead but fall through the cracks in our current system.”
Holland says prevention costs less than crisis management, but when people don’t have insurance, they often don’t seek help until the condition is critical. Then they have huge bills they can’t pay, which sometimes shifts costs to the people who do have insurance.
“And sometimes they’re turned over to collections, and now they can’t pay their bill, they can’t buy insurance, and they really are faced with bankruptcy as an option,” Holland says.
“The people of South Dakota deserve a better life than one where they have to decide whether to fill a prescription or fill a grocery basket,” says Karl Kroger, a United Methodist minister. He carries a cowboy boot as a prop to illustrate to committee members that the poor can’t pull themselves up by their bootstraps if they don’t have boots.
“And the residents of our land deserve better than having to miss out on important preventative care, the absence of which will likely shorten the time they have on earth with their families,” he says.
Kroger is one of several religious leaders who have come to the hearing. There are several nuns in the room, and one who testifies from a distance.
“The Catholic tradition avers that healthcare is a basic right flowing from the sanctity and dignity of human life,” says Sister Mary Thomas, who is employed by Avera McKennan. She speaks to the committee by phone.
“This prolife tradition means more than just opposing the intentional destruction of life before birth. It calls for affirming life at all times and at every stage,” she says.
According to Sister Mary Thomas, the United States Council of Catholic Bishops is on record as favoring Medicaid expansion.
A young woman talks to the committee about her observations when she worked as a clerk in a drugstore for five years.
“My name is Katherine Ruggles, and I’m representing the poor people of South Dakota,” she says.
Ruggles tells medical horror stories about uninsured customers who tried over-the-counter fixes for serious medical conditions: “There were people who had skin rashes that were open, weeping, and infected. One woman had a knee problem which left her in excruciating pain. Every day she walked a long way to her low-wage job, stood for eight hours, and then on her way home would stop at the store exhausted from the pain.”
Ruggles says the working poor who came into the store were one medical emergency away from financial ruin.
“We all have heard many stories that tug at the heartstrings, but we have to be realistic,” says Florence Thompson from Caputa. She is one of two people who came forward to oppose expansion of Medicaid.
“The problem with socialism is that sooner or later you run out of other people’s money. This was said by Margaret Thatcher,” Thompson says. “Obamacare, Medicaid, all these things are a form of socialism, and our government is, in fact, bankrupt.”
Thompson says attempts at central control distort the free market through price controls and regulation.
Stephanie Strong from Rapid City says she opposes Medicaid expansion because she wants limited government, and she expresses distrust of current insurance and healthcare practices.
“You go for trip to the doctor and it costs your elderly people a thousand dollars for a blood draw,” Strong says. “I think that the administration of the government is stealing from South Dakotans and other folks out there that are taking this fallacy about Medicaid’s going to fix you.”
There is no legislative action in the works on this issue for this session. Governor Dennis Daugaard has expressed distrust of relying on the federal government to pick up the tab for the first three years, and to contribute meaningfully after those initial three years, when the nation is so far in debt.
The legislators who started this exploratory committee say they need to learn more about the pros and cons before making a decision.