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South Dakota's Seat at the Table
By: Dennis Daugaard, Governor - 03/15/2017

"Action is not a choice, it is a necessity." Those were President Trump's words on Obamacare to Congress. As the President mentioned in that speech, one-third of America's counties now have only one insurer. A number of insurance companies have left the market. Others have been forced to raise premiums or narrow their networks, leaving South Dakotans and consumers nationwide with fewer options, which for many, are unaffordable.

Prior to Obamacare, as many as 17 separate insurance companies were offering individual health insurance plans in South Dakota. As Obamacare was adopted in 2010, companies began leaving the market. Last fall, one of South Dakota's largest carriers, Wellmark, announced that it would no longer offer individual health insurance plans in South Dakota. This affected 8,000 South Dakotans, whose plans were terminated on Dec. 31. DakotaCare has also ceased offering health insurance plans. The company could no longer sustain the costs. Avera, which now owns DakotaCare, and Sanford are now the only two insurance options for individuals in South Dakota today.

Governors know that as Congress and the President consider the repeal and replacement of Obamacare, they will be reconsidering the expansion of Medicaid. This also offers an opportunity fundamentally to reform the Medicaid program. If Medicaid is to be sustainable, attention must be given to controlling Medicaid cost growth, for both the federal government and the states. As Medicaid cost control is considered, states should neither be rewarded nor penalized for having expanded or not expanded Medicaid eligibility under Obamacare.

Many states want the authority to require Medicaid beneficiaries, if they are able, to work, look for work or be trained for work. States also want the flexibility to require beneficiaries to engage in preventative care and wellness behaviors.

I recently traveled to Washington, D.C., to attend National Governor's Association meetings, where I heard from Republican and Democrat congressional leaders. Republican leaders shared their belief that repeal and reform will take place on three fronts: a reconciliation bill, requiring just 51 votes in the Senate; administrative acts by U.S. Health & Human Services Secretary Tom Price (using existing authority); and a further bill, which will require at least 60 votes in the Senate.

While in D.C., S.D. Secretary of Health Kim Malsam-Rysdon and I joined state Senate Majority Leader Blake Curd at a private meeting with Secretary Price. At that meeting, we discussed South Dakota's concern over IHS failures and the shift of Native American healthcare costs onto the state.

Thanks to Sen. John Thune's office, we also had the chance to discuss IHS problems with Senate Majority Leader Mitch McConnell's chief health policy advisor. We also met with House Energy and Commerce Committee staff members, and with the chief counsel for the Senate Finance Committee. These committees will have jurisdiction over healthcare reform legislation.

It is clear that much work remains to determine how Congress will move forward on Medicaid and health care reform. Although I have no vote in this process, I am working to educate Congress and the Trump administration about South Dakota's particular circumstances. As the debate continues, I will remain engaged. I will work to ensure South Dakota's Medicaid program can meet the needs of the most vulnerable people in our state. I will also do what I can to bend the future cost curve so the program is sustainable over the long term.

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