WEBVTT

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Finally, tonight, voters across
the country will not only
choose candidates on Tuesday,

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but also consider major
policy changes in their
states. In South Dakota,

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voters will decide whether to
expand government funded health

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coverage for some of the
state's most vulnerable
people. Ali Rogin has more.

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ALI ROGIN: The Affordable Care
Act gave states the option
to expand Medicaid which

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covers low-income people and
people with disabilities.
38 states and the District

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of Columbia have done
so changing the income
threshold for eligibility so

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that more people can enroll.
South Dakota is one of 12
states which hasn't expanded

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Medicaid but on Tuesday
residents there will vote
on whether to change that.

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My colleague Laura
Santhanam just returned
from a reporting trip there
and joins me now. Laura,

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thank you so much. What
does it mean for South
Dakota to potentially
be expanding Medicaid?

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LAURA SANTHANAM, Health
Reporter: For years
since the Affordable
Care Act went to place,

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South Dakota and a lot of ways
was kind of frozen in time
with respect to access and

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affordability to health
care. So, if the state's
voters decide to change
that, to expand Medicaid,

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what it means is that a lot of
people will be able to access
healthcare, won't have to worry

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about being stuck with
big bills that they can't
afford. And a lot of health
issues that otherwise

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could become catastrophic, much
costly or more complicated to
treat, can be caught sooner.

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ALI ROGIN: Approximately
how many South Dakotans
would this affect?

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LAURA SANTHANAM: Right, in
the first year, approximately

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42,000 South Dakotans would
be eligible for Medicaid.

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ALI ROGIN: And so, Election
Day is just a couple days away,

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you just spend a couple days in
the state, what's the political
atmosphere like there really?

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LAURA SANTHANAM: According
to some of the latest
polling that we've seen,

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about half of South Dakota
voters are in support of
Medicaid expansion. And

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then about a quarter of
South Dakotans hadn't made
up their mind at that point,

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another 18% largely
Republicans were opposed
to Medicaid expansion.

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ALI ROGIN: And one of the
things you picked up on
was the Medicaid coverage

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gap. That's where people
can't get on Medicaid, but
they can't afford private

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insurance because they make too
much money to be on Medicaid
and not enough to afford

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private insurance. That seems
like it's a particularly
big issue in South Dakota?

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LAURA SANTHANAM: That's exactly
right. What that means is
that a lot of people who work

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in frontline are essential
workers, I get hospitals,
gas stations, grocery stores,

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they make too much to qualify
for Medicaid, but they don't
make enough to be able to

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afford health insurance
themselves. And so, what that
means is that a lot of people,

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thousands of South Dakotans are,
you know, in a position where
they have to choose between,

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you know, fear of financial
ruin, or gambling with
their health. And a
lot of them, you know,

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we're seeing devastating
effects. And as those
are a lot of the stories
I've been hearing.

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ALI ROGIN: And South
Dakotans of color seem
to be even more affected,

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even though 80% of the
state is white. Why is that?

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LAURA SANTHANAM: A history of
racial and ethnic disparities
in health care is true

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across much of the country in
South Dakota is no exception
looking at forced assimilation,

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particularly with indigenous
populations in the state
that's had negative impacts

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with respect to access to health
care, looking also at food
insecurity, housing insecurity,

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all of those have massive
ripple effects when it comes to
communities of color, being able

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to access the health care they
need when they need it. And
again, you know, it puts people

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in a position where they choose
between paying this medical bill
or getting food on the table.

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ALI ROGIN: And pregnant women
also seem to be particularly
vulnerable here. You spoke

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to a lot of them, what are
they feeling? What are they
going through right now?

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LAURA SANTHANAM: There were
several women who I talked to
who made too much to qualify

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for Medicaid but still couldn't
afford their medical bills.
One woman her application for

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Medicaid was rejected. She
was crossing all the T's and
dotting all the I's. But then a

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medical emergency happened
when she was 37 weeks
pregnant. And she ended
up having to be medivac

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from a hospital on Pine
Ridge Reservation back
to Rapid City, and then
received a bill for $5,000.

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And that was something
that was, like devastating
for her when she initially
got the bill. I mean,

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she's like, there's no way I
can afford that. You know, and
so you layer all of those sorts

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of complications on top of the
normal stress of being pregnant
making a home for a new child.

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And it just makes life
very difficult for people
who are trying their best.

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ALI ROGIN: Laura, there
is a way that pregnant
women can get Medicaid

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coverage during their
pregnancy and a little bit
beyond. There are a lot

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of exceptions. And it only
though last 60 days, the
Biden administration has

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urged all states to extend
it to a full year and
so far, 36 states have
extended that coverage,

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but South Dakota obviously
has not. What's the
argument for extending it.

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LAURA SANTHANAM: A lot of the
issues that healthcare providers

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and patients told me
about when I was here in
South Dakota, is that,

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especially with pregnant
postpartum people is
consistent access to care,
both before pregnancy,

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during pregnancy and afterwards,
right? And anyone who's
delivered a child knows that,

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you know, oftentimes one's
body has not finished
healing, you know, on a
clock, right? 60 days,

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often is not enough time. And
so, what I was hearing from
providers is that, you know,

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they would have patients
who are, you know, trying
to schedule surgeries,
appointments, things like

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that, while they still
had Medicaid coverage,
and oftentimes the clock
would just run out on them.

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ALI ROGIN: It's going to be a
very interesting election day

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in South Dakota. Laura
Santhanam, thank you
so much for your time.

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LAURA SANTHANAM: Thank
you for having me.

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GEOFF BENNETT: And we should
point out that Laura's reporting
was produced as part of

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a project for the USC Annenberg
Center for Health Journalism's
2022 National Fellowship.