Medicaid Expansion for SD

Update after the Nov. vote:  Sorry to report, SD Voters approved the cruel and disrespectful Amendment F allowing the state to attach work requirements to Medicaid expansion. 

Now it will be important for South Dakotans to be watchful of  Congressional and state legislative attempts to attach such a harmful requirement.

Comments before the vote:

Update 9/5/24

There is nothing helpful in it, no job, no job training, no childcare.
No help for employers either. It is only punitive.  

• A work requirement does not promote the objectives of Medicaid, which is health coverage for low-income people who lack it. It's a blow to public health.

• Evidence shows it does not expand employment or improve wages.  

• It disrespects our low-income workers. Almost all Medicaid expansion participants are already working!
      Let's get this through our heads: These low-income SD'ans are already working!! Look how low the unemployment rate is here! These are our lowest-paid workers. Those not employed are between jobs, caregivers, in training, etc. Some are retirees whose health is spent.  

      Yet all would have this new bureaucracy burden on them, a new layer of bureaucracy on South Dakotans who are doing our lowest-paid jobs.  

• A work requirement creates bureaucratic cracks which people would fall through and lose healthcare. Low-income people often miss out when it comes to paperwork, even for programs that benefit them. In Arkansas, 18,000 lost healthcare, almost one-fourth of all those in the program. Of those 95% should not have lost it, because they were already working or should have been exempt.

• A work requirement that can take away healthcare takes away a stepping stone to work!

• Threatening to take away healthcare is a cruel and inhumane way to treat our lowest-income neighbors.

• Amendment F has no detail on a potential work requirement. This would allow the state to enact the most harsh rules. It could take away healthcare from a 64-yr-old trying to retire. It could take away healthcare from a student by not counting college classes as work. (Isn't it cruel enough that SNAP doesn't?) It could take away healthcare from a worker trying to balance 2 jobs and a family with little time to remember to report hours to the state. It could take away healthcare from a worker staying home with Covid symptoms. It could take away healthcare from parent unemployed due to lack of childcare. It could take away healthcare all sorts of caregivers. 

• It's the legislature once again interfering with our vote.  We, the people of South Dakota, passed Medicaid expansion, specifying no added conditions, for our lowest-income uninsured neighbors. Now we must Vote NO on the added condition allowed in the Legislature's ballot measure, Amendment F.

Vote NO on potential work reporting for Medicaid to help to secure the blessing of South Dakota’s voter-approved Medicaid for the lowest-income South Dakotans and for the public health of the state.

Love Your Neighbors. Protect their healthcare.

Be sure to vote:  F - NO!

Amendment F does nothing good. It only hurts.

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More info: 

Work Rule - Too Extreme and Inhumane for Medicaid Expansion

---    In 2022, the voters of South Dakota passed Medicaid expansion specifying no added conditions. Now a majority of the State Legislature is forcing SD voters to re-vote on Medicaid expansion. [They can put measures on the ballot without gathering signatures.] They want to let SD, if the feds allow it again, to take away Medicaid from those not reporting enough hours of work or verifiable disability.

---     The punishment, losing healthcare, is too extreme. Some state legislators think a work requirement is ok for Medicaid, because SNAP and TANF have one. A work requirement for Medicaid is fundamentally different from one for SNAP or TANF. If you lose SNAP or TANF, others can share their food or cash with you. But they cannot share their prescriptions, treatments, surgeries, ....  Taking away Medicaid costs lives. 

---     Taking away Medicaid expansion would not be a savings for the state nor for SD taxpayers. It would mean clinics would not get paid. Individuals would lose care or gain medical debt. Employees and the public would be less healthy. With these losses and no improvement in employment, NO ONE would be better off under Amdt.F. 

---     Amdt.F is vague on what a work program would entail. Also it is poorly worded on exemptions. Many disabled people have Medicaid expansion while they apply for official disability designation, a lengthy process. They would be vulnerable to losing their Medicaid. 

   A diagnosis, mental or physical, generally names the condition or disease, not a degree of disability. (See fuller explanation below.)

---     The pro-life position is:

Medicaid saves lives and health.

Save Medicaid expansion for all who need it.

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How do we know that a Medicaid work requirement would take away healthcare from some participants?
1. The requirement has been tried and studied by researchers. It caused a significant portion of participants to lose their Medicaid coverage. 

   The (pre-Covid) experience in Arkansas, before it was ruled as being against the purpose of Medicaid, was well studied. About ¼ of the people involved lost coverage, of whom 95% should not have been dropped.  (Their participants were ages 30-49, a group more likely to manage work reporting than the 19-64 age group that would be impacted in South Dakota by Amendment F.) 

https://www.hhs.gov/sites/default/files/national-work-requirements-fact-sheet.pdf 

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.00538

https://healthlaw.org/top-10-reasons-why-work-requirements-are-bad-for-medicaid/ 

https://www.cbpp.org/research/poverty-and-inequality/expanding-work-requirements-would-make-it-harder-for-people-to-meet

https://www.cbpp.org/health/states-experiences-confirming-harmful-effects-of-medicaid-work-requirements 

https://www.commonwealthfund.org/blog/2020/did-medicaid-work-requirements-achieve-their-goals-arkansas 

2. The finding that work requirements cause people to lose Medicaid is consistent with other research on work requirements in the Supplemental Nutrition Assistance Program (SNAP), which also found that such policies can lead to widespread loss of benefits. [https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2019.305232?journalCode=ajph ]

3. Lessons from SD’s failed Food Tax Refund Program

  Low-income people are least able to keep up with the bureaucracy for programs designed to benefit them. Here’s an example:

  In 2012, after 8 years of SD’s Food Tax Refund Program, despite the publicity and simple application, the majority of those who were eligible were missed, largely because reporting to the state was involved. Most were working low-wage jobs.

Low-income people, working or not, are more likely to have poor health, fluctuating incomes, low functioning ability, and the overwhelming realities of life at low income. They struggle daily for life’s basics, many preferring to manage without government help.

   In short:

The majority of Medicaid expansion participants are working already, and many more should be exempt from required work. Many of them would miss work reporting and lose their Medicaid. Vote No on Amdt.F to protect the lowest-income SD’ans from losing their healthcare.

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“It cost the state an enormous amount of money.
A bunch of people lost their healthcare,
and we have nothing to show for it.”
-Arkansas Advocates for Children and Families 

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Disabilities are supposed to be exempt. But are they?:

Amendment F has imprecise language that would go into the State Constitution, which can only be changed with another vote of the people.

One problem: “Disability” is not a “diagnosis”.  You might be diagnosed with a physical or mental disorder, such as Parkinsons, PTSD, schizophrenia, bipolar, heart condition, kidney disease, broken arm, etc.  The diagnosis itself does not say “disability.” You may be able to work for a while, or not. If the condition leads to a disability, that will then be determined by a doctor or administrative law judge.  Please Vote NO in order to keep undefined terms out of our state constitution.

  What would happen: The work requirement would apply to disabled people in the lengthy process of applying for disability. A benefit of Medicaid expansion is that it covers them in that process. The process has mountains of paperwork already. Under Amdt.F, they would have paperwork for the state besides federal paperwork to prove their disability. Then a state employee would have to decide whether to grant an exemption or leave them subject to the work rule (and losing coverage) until the federal designation of disability. There is a Catch: If you try to work, that would indicate you are not disabled. If you don’t work or haven’t proven your disability, you would lose your Medicaid. If anyone needs Medicaid, it’s these very-low income folks. Vote NO on F to avoid the chance they’ll lose Medicaid health coverage.

  Further problem: Do we want bureaucratic red tape for short-term disabilities? Currently, Medicaid expansion covers people off work for a short time, no report to the state needed. For examples, If you’re out with the flu, should you have to worry about your work report to the state in order to keep your health coverage? Or, if you’re having gall bladder surgery? Or, if a hotel worker has a broken arm? Or a construction worker with a broken leg? Do we want people coming to work with Covid symptoms?  Vote NO on F to keep Medicaid for low-income people with short-term situations.

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    In general, it is not wise to make policy based on the exception but which will then apply to the whole group. That is why work reporting for Medicaid expansion has so many problems, if the goal is to incentivize work.

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Amendment F is based on myths and stereotypes. It assumes that people covered by Medicaid expansion are not working. It assumes compelling people with the threat of taking away health coverage will get more people into the workforce. These are wrong. There is evidence to the contrary. Studies show most are working or doing some other activity that society needs (like family caregivers sparing the public a big nursing home expense) and that the requirement does not increase employment. Policies should be based on evidence.

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If passed, Amendment F would apply unnecessarily in two ways. (a) All the Medicaid expansion group would have the reporting burden. It would apply to the vast majority who are already working or in a situation that would likely be exempted. Low-income lives are generally complicated already. This added burden would not help them at all.

(b) Additional burdens would be on state workers to keep track of the majority who are working along with those who are not. Even more of a challenge would be determining the exemptions that would be needed and then tracking those who would be exempted or not. That would be a lot of additional tracking of our citizens’ activities by state employees.

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Amendment F would not incentivize work. If work is the purpose, this goal has been studied, and the results are in: There is no overall benefit to the workforce. Example: Like many reports on Arkansas’ experience, the journal Health Affairs Sept.2020, reported “work requirements did not increase employment over eighteen months of follow-up.”

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.00538 

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It is sad that Amendment F is on the ballot, and that people are having to live with this threat to their healthcare. Because the initiative does not have specifics, they can not know now if they would still qualify for Medicaid. Until a potential work rule would be implemented, people cannot tell what would happen to them in these situations, for which the state would need to develop policies:

Caretakers of all sorts

Part-time and seasonal workers

Post-secondary students

Workers between jobs

Domestic violence situations

Grandparents raising grandchildren

Gig workers and other Self-employed

Other jobs with unpredictable work hours

Various unstable health or housing situations

Conditions requiring ongoing medical care but able to work at times

Areas short of employment opportunities

and more.

     The initiative does not recognize, but we must, that life and work for low-income people are precarious. As good neighbors, we surely want to be understanding and supportive, like the help we are offering with Medicaid expansion.

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The Legislature had many years to accept Medicaid expansion and do so on its own terms. But not having done so, we can now vote NO and stick with the will of the voters and continue Medicaid expansion without the threat of this added condition.

   Voters approved Medicaid expansion explicitly banning additional requirements. Did voters know that meant work requirements? Yes. Medicaid work requirement proposals and reports had been in the news throughout several years before the vote in November 2022. News media covered states submitting requests for “waivers” to allow them. News media reported on court cases. News media covered the experience in Arkansas.
    For example, a Feb.18, 2020, KFF article notes that Medicaid work requirements were being covered in widely accessed media: The New York Times, the Associated Press, The Hill, NBC news, the Washington Post, Wall Street Journal, NPR, Bloomberg News, and CNN.

   Also, South Dakotans knew our state had submitted to the feds a proposal for a Medicaid work pilot program for Sioux Falls and Rapid City. Many SD'ans had submitted public comments opposing it.

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All our faith traditions teach that every life has inherent worth and should be treated with dignity; that we are meant to care for all our neighbors without exception; and that we do so by practicing compassion and working for justice. [SD Faith in Public Life]

Love Your Neighbor. 

To protect healthcare for the lowest-income South Dakotans,
make your vote on F a NO!

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Download the items below using the little button that will appear in the upper right corner.

  -- Income limits for Medicaid expansion (and children's Medicaid and Healthcare.gov) & how to sign up

  -- Background info on Amendment F
  -- the SD Synod ELCA Resolution on Protecting Health Coverage for the Vulnerable People in South Dakota 

  -- Mini-handout for Lutherans. It's excerpts from their resolution.

  -- Mini-handout for all voters on Voting NO on Amdt.F