SIOUX FALLS, S.D. - Boosting health-care access and tapping into federal aid often are cited as reasons to expand Medicaid, but a new report says South Dakota also would see new jobs and more revenue.
The nonpartisan Commonwealth Fund analyzed the nearly dozen states that haven't expanded their Medicaid programs. If South Dakota acted, the report said, the state could see more than 4,000 new jobs and nearly $10 million in economic activity.
Shelly Ten Napel, executive director of the Community HealthCare Association of the Dakotas, is backing one of two Medicaid ballot initiatives in the state. She cited benefits from the care that already is provided free of charge to uninsured patients.
"Adding Medicaid to that picture would just make those services more financially viable," she said, "able to extend hours, extend services to those who need it - or just to maintain services in communities that are small and kind of losing population over time."
More than a decade ago, the Affordable Care Act incentivized states to expand Medicaid, with the federal government picking up most of the tab. The new American Rescue Plan offers added incentives. Generally, conservatives cite budget concerns, and Gov. Kristi Noem has been a staunch opponent of Medicaid expansion. These ballot campaigns are aimed at the November 2022 election.
Ten Napel suggested that policymakers sometimes get too bogged down with the financial ramifications, and may forget about what's at the core of the idea.
"Do we want to make sure that our neighbors are able to get care when they need it? I think people really respond to that," she said.
Beyond economic factors, a new American Cancer Society study said cancer patients in states with lower Medicaid income-eligibility limits had worse long-term survival rates. Supporters hope these findings convince enough South Dakotans to back the initiatives. The Legislature added a wrinkle by passing a proposed constitutional amendment for the June 2022 primary. It would raise the approval threshold for future ballot questions to 60%, meaning Medicaid expansion would need more than a simple majority to pass.
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Earlier this month, a new Arizona Public Service rate hike went into effect and one senior advocacy group said those on a fixed income may struggle to now pay their energy bills.
According to the utility, the average residential customer will see an expected bill increase of about 8%, which translates to about $10.50 a month. They said it is all in an effort to continue to provide Arizonans with reliable and resilient power and make "critical investments" in their system.
Aimee Cvancara, associate state director of AARP Arizona, contended the possible effects could be significant.
"Folks who are on a fixed income, whether that is a retirement income or even a working income with limited mobility, it is difficult to absorb a $10 to $12 cost in your monthly bill that was unanticipated," Cvancara pointed out. "Particularly because it's not the only increase that folks are seeing right now."
Cvancara emphasized consumers are feeling the weight of increased prices on everything, from groceries to gas, rent and now power. Arizona Public Service rooftop solar customers could also see an additional $2 to $3 a month on their bills but the Arizona Solar Energy Industries Association and Attorney General Kris Mayes are both demanding for a rehearing on the case with the Arizona Corporation Commission to challenge the rate hike.
Cvancara noted moving forward, a significant concern for Arizona consumers is going to be something called the system reliability benefit mechanism, which allows Arizona Public Service to recover costs between rate cases for new, utility-owned generation resources.
"This is a new thing for APS customers," Cvancara explained. "It is going to allow the utility to file for up to 3% rate increase and they can do that five times before they have to file for another rate increase."
Some ratepayers and environmental groups oppose the system reliability benefit mechanism, as they argued it will only raise rates and increase demand for fossil fuels. Cvancara said the Arizona Corporation Commission should always strive to balance investments for reliable energy versus the cost consumers will face.
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A 2023 study from the University of Nebraska Medical Center concluded the number of Nebraskans with a mental health or substance abuse disorder has probably increased over the pre-pandemic level of 20%. It also observed 88 of Nebraska's 93 counties have a shortage of behavioral health professionals.
Nonetheless, the state budget now awaiting Gov. Jim Pillen's signature cuts $15 million from the Division of Behavioral Health's funding for the state's six Behavioral Health Regions, which distribute those funds to providers. Many advocates believe the cut is based on an incorrect conclusion.
Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations, said because $15 million remained in the budget for the Regions, it was concluded the money was not needed. In fact, she said much of it was for projects and proposals awaiting Department of Health and Human Services approval.
"The problem is not that it's not needed; there's a problem with getting it out the door and into services quickly," Dubas explained. "Because we know the demand is there. And if it's not being spent, let's figure out why. That's what we want the governor to sit down and talk to us about, so we can figure out where the holdups are."
The $15 million will be shifted to the Lincoln Regional Center for hiring nurses and other staff. Dubas questioned how realistic it is for the center to spend this amount of money on staffing, especially when the state is facing a nursing shortage of more than 5,000 by 2025. She also questioned what will happen to any money left unspent.
Dubas stressed the Division of Behavioral Health is not the only agency losing money through this budget process.
"This administration has gone into a lot of different funds, cash funds, etc., and kind of swept out money that they perceive is not being used or is not being spent, to use to help with their property tax relief," Dubas asserted.
The Pillen administration is paying Epiphany Associates from Utah $2.5 million annually for up to four years, to find savings of up to 25% across state agency budgets.
Chase Francl, CEO of the Mid-Plains Center for Behavioral Health, which receives about 40% of its funding from Region III, said cutting programs that save the state money cannot be considered cutting "waste."
"Mental health and substance use treatment really is a prevention service," Francl contended. "If we can get this right, then people are going back to work and maybe aren't ending up in corrections. And you start restricting here, you usually are just going to be creating a greater need for more costly services down the road."
Mid-Plains served 3,200 people in Grand Island, Kearney and Lincoln last year. Francl added they currently have about 60 people on a waitlist for therapy services.
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Congress just avoided a partial government shutdown by approving a budget through the end of September, but a new blueprint is renewing debate about a key safety net program and advocates in North Dakota and elsewhere are worried.
For the 2025 fiscal year, a House caucus of more than 170 Republican lawmakers has issued a proposed outline. It includes raising the retirement age for Social Security eligibility "to account for increases in life expectancy."
Nancy Altman, president of the advocacy group Social Security Works, said, like past suggestions from the caucus, it should be considered a non-starter, arguing it essentially amounts to a benefit cut.
"You never catch up," Altman asserted. "Even if you work till age 70, your benefit's going to be about 7% lower than it is under current law."
There was no specific higher age outlined, but AARP North Dakota has also sounded the alarm about the plan, urging its members to demand "no cuts." Social Security faces financial headwinds a decade from now, but Altman supports President Joe Biden's calls for raising payroll taxes on the wealthy to help ensure the program stays fully funded. His skeptics argued it would not be enough.
However, Altman and other advocates think it is a good first step. The GOP framework also calls for reducing benefits for higher earners. No income threshold was provided but Altman suspects it would still hurt a lot of people who are not exactly wealthy in their retirement.
"It's not what many people would think," Altman contended. "They're certainly not Jeff Bezos and Bill Gates, and the billionaire class."
She predicted the people targeted for cuts would be more aligned with the middle class. Republicans insist the changes would not cut or delay benefits for any senior currently in or near retirement. North Dakota's lone Congressman, Rep. Kelly Armstrong, R-N.D., is part of the caucus behind the proposal.
Disclosure: AARP North Dakota contributes to our fund for reporting on Civic Engagement, Community Issues and Volunteering, Health Issues, Senior Issues. If you would like to help support news in the public interest,
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