Health care advocates hoped the last week of South Dakota’s legislative session would usher in changes for the state’s Medicaid program. That hope is dwindling. The federal government says South Dakota has to expand Medicaid to the full extent under federal law or not at all. State lawmakers say progress this week isn’t likely. The expansion decision impacts thousands of South Dakotans who live in poverty.
Down a creaky staircase at the Mitchell Carnegie Resource Center, Ronald Fuchs points out materials significant in South Dakota’s history. He spends a few hours a day here.
"I volunteer. I come down here to a place that’s a historical center," Fuchs says. "I’ll scoop snow for a while, but then I’ll have to stop because I’m tired or exhausted, get short of wind or whatever."
Fuchs is a 1972 graduate of Dakota Wesleyan University, and he’s lived in Mitchell most of his life. He does not have a job. The 63-year-old draws early social security – about $650 a month – and he has no health insurance.
He’s not exactly a picture of wellness, either.Fuchs says he went through an alcohol treatment program in the ‘90s, and he’s been sober for more than two decades. But he says he’s had three heart attacks.
"I was uninsured. I got an airlift out of Mitchell here. I went to the heart hospital at the old McKennan campus. That became a big bill," Fuchs says. "Then in 2005, I had another heart attack, so there was another bill."
Fuchs says he also has digestive issues, a rapidly changing mole, and severe arthritis is his back that cripples him in pain when he overexerts himself.
He says he tried to pursue disability, but the government repeatedly denied his applications. Fuchs describes himself as elated by the Affordable Care Act. He tried to apply for the federal health insurance exchange online, and it denied him. So he found a health care navigator.
"I sat in front of her, told her my income. And she looked at me and said, ‘You’re not eligible for the Affordable Health Care Act.’ And it was just like somebody pulled the rug out from under me," Fuchs says.
At the start of the 2014 legislative session, Governor Dennis Daugaard said he wasn’t saying no to Medicaid expansion – he said not now. A week before the session ends, he said those in critical need already have health care coverage.
"Children who are at any incomes up to 200 percent are covered, by either Medicaid or the children’s health insurance plan," Daugaard says. "So I think it’s important that everyone recognize, everyone of those persons who is in that category that would be covered by the expansion is an adult. They’re not disabled. They’re not frail elderly."
There’s the clash. State leaders say adults who are disabled already have health coverage. So is it even possible that Ronald Fuchs could be unable to work – disabled – but not have the disability label?
"Of course. I mean, that happens quite often in South Dakota. Qualifying for disability is a very defined process," Dave Hewitt, president of the South Dakota Associations of Healthcare Organizations, says. "Certainly people can suffer from chronic conditions where they do not qualify for disability, but in fact it severly limits their ability to work."
The outspoken supporter of Medicaid expansion says preventative health care is key to wellness and overall savings.
"A portion of this population now can at least go on the public health insurance exchange and seek coverage regardless of their medical history, and that’s a good thing. But we still have a group of people between 52 percent and 100 percent of poverty who qualify for nothing," Hewitt says.
The number of South Dakotans stuck in that coverage gap runs about 26,000. Governor Dennis Daugaard says qualifying for the federal health insurance exchange is now an incentive for people with low incomes.
"What I’m hoping will happen is we’ll see many people in South Dakota’s relatively strong employment economy, we’ll see many people work to get themselves up above that 100 percent level and get health insurance that they have a little bit of their own dollars into. Most of the dollars would be federal dollars," Daugaard says.
Certainly some people can do that – work more to attain health coverage. Ronald Fuchs says he can’t get subsidized health coverage by picking up an extra shift.
"I think it’s kind of interesting in the course of this discussion, argument, whatever you want to call it, that some people think that low-income people have someplace to go to or that there’s some kind of magical answer for us," Fuchs says.
He says the only advantage he has now is his age. He’s 63.
"So, I can spend another year and a half to two years uninsured, hoping that I don’t get sick, that I don’t have to use the emergency room. Hoping against hope," Fuchs says.
When Ronald Fuchs turns 65 years old, he’ll qualify for Medicare. He says younger people struggling in poverty can’t simply wait it out for their health care.
Lawmakers can still amend the general bill to include Medicaid expansion. Democrats say they plan to try, but they are the minority. Republican leaders say they don’t see resolution to the health care debate happening yet this week.