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Lakota Country Times: Indian health at center of Medicaid debate

South Dakota Gov. Dennis Daugaard (R) discussed Indian health and Medicaid expansion plans during his State of the State address on January 12, 2016. Photo from South Dakota State News

Lakota at heart of Medicaid debate
By Brandon Ecoffey
Lakota Country Times Editor

PINE RIDGE— Under a newly proposed plan from Gov. Dennis Daugaard, South Dakota is set to expand Medicaid to cover more of its residents. The only hold up, however, is determining who will pay for the medical costs of Lakota people.

When President Obama’s signature Affordable Care Act was signed in to law in 2010 nobody fully understood just how the law would play out. Republican lawmakers have consistently attempted to revoke the law through legislative action despite the fact that the rate of non-elderly uninsured Americans is the lowest it has been in history and more than ten million people now have new healthcare insurance polices.

One specific portion of the law mandated that that federal Medicaid funding provided to individual states be contingent upon their willingness to expand coverage to most people under the age of 65 with incomes at or below 138% of the federal poverty level. This provision was challenge in federal court and was struck down by the Supreme Court. Instead, each state has the option to make its own decision regarding their participation in Medicaid expansion. South Dakota had been one of the twenty states refusing to opt in until now if the federal government will do their part to pay for the healthcare of tribal citizens.

Under the current Medicaid system in South Dakota, when a Native person uses a healthcare provider that accepts Medicaid other than Indian Health Service, that provider will only be reimbursed by Medicaid for a percentage of what the total cost of the visit was. The remaining balance is footed by the state. Had that same person went to IHS federal dollars would cover the remaining cost.

The Pine Ridge Hospital on the Pine Ridge Reservation in South Dakota. Photo from Dean Kurtz Construction

As part of the deal that Gov. Daugaard has proposed for Medicaid expansion, the federal government will be required to cover the costs of Native patients in a move that he says will save the state $67 million a year. Daugaard plans to then turn around and use the savings to pay for the costs of expanding Medicaid to approximately 48,000 residents of the state —mainly the working poor.

In an interview with the Rapid City Journal, Gov. Daugaard said that healthcare for Native people is a treaty responsibility of the federal government.

“The federal government is open to consider relieving us of a burden I think they unfairly placed on our (individual states) shoulders when they pushed Medicaid-eligible Native Americans to be covered for their health care by the state and the federal government, sharing about 50-50 those costs when federal treaty obligations would place that burden entirely on the shoulders of the federal government,” said Gov. Daugaard.

“I think it’s important the federal government keep its treaty obligations and they are open to reconsidering how they cover health care for Native Americans. If they do so in a way that relieves us of that burden, I’ve agreed that those dollars could then be used for the state to cover the cost to the state of Medicaid expansion, not just next year’s cost, not just in ’18, ’19 or ’20, but costs all the way up to fiscal year 2021,” he added.

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The terms of Daugaard’s deal are being packaged in a way that allows for the governor to save face with fiscal conservatives that have been critical of states being forced to pay for costs of the expansion. However, Daugaard’s proposal would cover the costs of expanding coverage without the state having to come up with additional funds.

“I’m not departing from my conservative, frugal approach to budgeting in my Medicaid proposal. As I mentioned to the Legislature in my budget address, I will not support Medicaid expansion unless we can cover the cost of the expansion to the state with budget dollars that are already appropriated,” said Gov. Daugaard to the Rapid City Journal.

In his state-of-the-state address on January 12, Gov. Daugaard made it a point to distance himself from the Affordable Care Act, but added that his proposal would fix longstanding problems with IHS reimbursement and help to defray medical expenses of inmates housed by the state.

Although, the costs of healthcare for Native Americans is guaranteed through treaties and the trust-relationship that exists between tribal nations and the federal government, each year tribal citizens pay millions in state taxes despite the misconception that money from the reservation is not leaked in the surrounding region’s economy.

Federal officials are traveling to the state capital to meet with state and tribal officials about the expansion.

(Contact Brandon Ecoffey at

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