(1) Under the Affordable Care Act (ACA), Medicaid eligibility was extended to all individuals with incomes up to 138 percent of the federal poverty level beginning in 2014— $26,347 for a family of three and $15,417 for an individual. At the ten year mark since the passage of the (ACA), a substantial body of research has emerged demonstrating the positive effects of the Medicaid expansion on coverage; access to care and related measures (including utilization, quality of care and health outcomes, provider capacity, and affordability and financial security); and various economic measures.
(1) Medicaid expansion covers families and individuals below the 138 percent federal poverty level, including groups who are currently left out of public health coverage such as low-income, able-bodied parents, low-income adults without children, and many low-income individuals with chronic mental illness or disabilities, who struggle to maintain well-paid jobs but don’t currently meet disability standards for Medicaid.
The expansion of Medicaid eligibility also cuts the rate of uninsured veterans and Native Americans in half and provides early treatment to people struggling with Opioid addiction. Unfortunately, many of the most vulnerable citizens in states that decide not to expand Medicaid are victims of the coverage gap. This includes seniors and struggling farmers in rural communities. This is because when the Affordable Care Act was written, federal policymakers assumed those with the lowest incomes would be covered under the expansion. Consequently, they did not set up further ways for these groups to obtain health care coverage such as the federal subsidies that those with slightly higher incomes will receive under the law.
(1) As of September 15th, 2020 thirty eight of fifty states have expanded Medicaid under the Affordable Care Act.
(1) Medicaid expansion has expanded access to health care in rural communities, reduced rural hospitals’ uncompensated care costs, and helped rural health providers keep their doors open by allowing states to expand Medicaid coverage for adults up to 138 percent of the federal poverty line. Medicaid expansion allowed 1.7 million rural Americans to gain coverage who had not previously been eligible. Unsurprisingly, following the passage of the Affordable Care Act, the uninsured rate in rural parts of expansion states decreased by a median of 44 percent. Significantly greater than their none-expansion state counterparts.
For example, in 2015 Montana Governor Steve Bullock expanded Medicaid. As a result, the Montana reduced its rate of uninsured by nearly fifty percent, from approximately 15 percent in 2015 to 7.4 percent in 2016 according to the Office of Montana State Auditor. By comparison, South Dakota, a state that didn’t expand saw more modest reductions in the rate of uninsured reducing their number by 20 percent, from 11.3 percent in 2013 to 8.7 percent in 2016, according to the U.S. Census Bureau.
(1) North Dakota opted to accept federal funding to expand Medicaid under the Affordable Care Act extending health services to 22,000 North Dakotans as of 2019 . Medicaid expansion was passed by the North Dakota Legislature and signed into law by former Governor Jack Dalrymple in April 2013. Dalrymple was the fourth Republican Governor to throw support behind the expansion of Medicaid in early 2013. Enrollment began in October 2013, with coverage effective January 2014. Dalrymple received praise for his bipartisan efforts from Democrats and Republicans alike including for North Dakota Insurance Commissioner and Congressman Earl Pomeroy.
(1) Numerous studies conclude that the expansion of Medicaid directly reduced costs to the state and enabled the state to draw down billions of dollars in additional federal funding that supported jobs and maintained the state’s healthcare infrastructure. Indeed, according to the North Dakota Hospital Association, between NDFY 2015-2019 bringing over $946 million North Dakota tax dollars home, at a 12:1+ ROI for North Dakota taxpayers.
(1) Medicaid expansions injections hundreds of millions of dollars year into North Dakota’s largely rural economy providing a big lift to its rural hospitals who also benefit directly from Medicaid expansion funding. Indeed, according the North Dakota Rural Health Association President Keith Johnson, “before Medicaid Expansion, rural hospitals and clinics were often left with the bill when patients without coverage could not pay. Under Medicaid Expansion, there was a large drop in their uncompensated care costs. These uncompensated costs are left to the hospital if people cannot pay their bills. States that expanded Medicaid saw a 47 percent drop in uncompensated costs, while states that did not expand Medicaid only saw an 11 percent drop. In order for rural citizens to access quality health care, rural hospitals and clinics need to remain open. By increasing the numbers of rural people with insurance, Medicaid Expansion has pumped about $27 million more into rural health infrastructure. This helps keep facilities open, improves the health of rural North Dakotans, and helps the rural economy.”
(1) Montana Governor Steve Bullock led a bipartisan effort to successfully expand Medicaid In Montana in 2015 successfully extending health services to over 90,000 Montanans by 2018. Bullock led an additional bipartisan effort to reauthorize Montana’s participation in Medicaid expansion in 2019.
(1) Numerous studies conclude that the expansion of Medicaid directly reduced costs to the state and enabled the state to draw down billions of dollars in additional federal funding that supports jobs. Indeed, according to one University of Montana Study, between 2018 and 2019, Medicaid expansion brought over $1.2 billion in federal dollars back to Montana, creating over 13,000 jobs, and a multiplier of $700 million in annual income for Montana residents.
(1) Numerous studies conclude that the expansion of Medicaid directly reduced costs to the state and enabled the state to draw down billions of dollars in additional federal funding that supports jobs and helped keep its rural hospitals open. According to the Montana Foundation for Health, Medicaid Expansion led to a decrease in uncompensated care cost of 47% for the states rural hospitals allowing them to keep their doors open.
(1) South Dakota is now one of twelve (12) states that has yet to expand Medicaid under the Affordable Care Act. Numerous studies show that participating in the Medicaid expansion not only provides health insurance coverage to tens of thousands of low wage workers, but also provides an enormous boost to the state’s economy and health infrastructure.
As part of a bipartisan group of western governors including Steve Bullock (D-MT) and Jack Dalrymple (R-ND), former Governor Dennis Daugaard supported Medicaid expansion but could not get the SD Legislature to support it. South Dakota’s current Governor, Kristi Noem (R-SD) has expressed her opposition to the expansion of Medicaid.
(1) The South Dakota Healthcare Solutions Coalition, a bipartisan group commissioned by Governor Dennis Daugaard (R-SD) estimated the expansion of Medicaid would extend health services to over 50,000 South Dakotans.
(1) The South Dakota Healthcare Solutions Coalition endorsed the expansion of Medicaid in South Dakota citing widespread economic and public health benefits including an additional 1.8 billion in federal spending in the state between 2017-2021.
(1) The expansion of Medicaid would inject hundreds of millions of dollars into South Dakota’s rural health system which would reduce their uncompensated care cost by as much as 50 percent helping them improve health services and keep their doors open.
(1) On July 17, 2020, the South Dakota attorney general filed explanations with the SD Secretary of State for two 2022 Medicaid expansion ballot initiatives. According to the Associated Press, Both measures are sponsored by TakeItBack.Org Co-Founder, and former South Dakota Senate Candidate, Rick Weiland, as part of the health advocacy organization Dakotans for Health. One is an initiated constitutional amendment (which requires 33,921 signatures to get on the 2022 ballot) and the other is an initiated state statute (which requires 16,061 signatures). Sponsors have until November 2021 to collect and submit their signatures.
(1) Visit Dakotans for Health on the web at to volunteer, donate, and sign up for their email and text message alerts.
(1) Dakotans for Health is a healthcare advocacy network dedicated to improving healthcare and health outcomes in North and South Dakota. They are the lead organizers for the effort to expand Medicaid in South Dakota in 2022.
(1) Dakotans for Health is a network of public health officials, healthcare professionals, patient advocates, elected officials, and concerned citizens organizing around health issues in North and South Dakota. Notable participants include former U.S. Senator Byron Dorgan, former North Dakota Insurance Commissioner and Congressman Early Pomeroy, former Acting Assistant Secretary for Health and Human Services Mary Wakefield, and former South Dakota Senate Candidate Rick Weiland.
(1) Dakotans for Health believes that the availability of affordable healthcare faces dangerous challenges from a political system that is increasingly partisan and unresponsive. Dakotans for Health will use all of its' energy and resources to support leaders, candidates, causes and ballot initiatives to directly confront these problems.