July 5, 2022

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Today, South Dakota voters decide whether to make Medicaid expansion harder

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Good Tuesday morning, everybody. Here’s an unnerving graphic detailing the 200 mass shootings so far this year. 

Today’s edition: The need for mental health care is high in Uvalde, Tex., but limited resources coupled with a lack of insurance could keep care out of reach for many. The White House slammed the latest antiabortion bill from Louisiana. But first …

It could become harder for South Dakota to be the 39th state with Medicaid expansion

In South Dakota, it’s a big day for the fate of Medicaid expansion. 

Voters are heading to the polls today to decide whether to require certain ballot initiatives pass with 60 percent support instead of a simple majority. The adoption of such a rule would make it much harder for South Dakotans to approve a ballot measure expanding Medicaid come November. 

Since 2017, advocates have used voter referendums to extend the safety net program in six states with steadfast Republican opposition. They’ve never failed. But only once — in Idaho — have they won with over 60 percent approval. 

  • “Just based on precedent that would give us concern about the possibility of Medicaid expansion being successful” in South Dakota, said Karen Knudsen, the head of the American Cancer Society and its advocacy affiliate, which has spent roughly $150,000 to oppose the 60 percent threshold.

A dozen mostly GOP-led states have long refused Medicaid expansion, which was originally included in the 2010 Affordable Care Act but made voluntary for states by the Supreme Court. South Dakota has the highest chance of adopting Medicaid expansion this year than any other holdout state. 

But if today’s ballot measure passes, Medicaid supporters will face an uphill climb to extend the health insurance program to roughly 42,000 South Dakotans. The push to get the 60 percent vote threshold — known as constitutional “Amendment C” — on the June ballot was, in part, a GOP effort to stymie Medicaid expansion. 

The rule, if passed, would apply to measures that raise taxes or require $10 million or more from the state over the next five years. Medicaid expansion would do the latter.

One high-ranking Republican, state Sen. Lee Schoenbeck — who was instrumental in expediting the Amendment C vote — has acknowledged he was motivated by the Medicaid expansion campaign, the Associated Press reported last year. Schoenbeck declined to comment to The Health 202.

Here’s the argument from Amendment C supporters: It should be difficult to raise taxes, and boosting the threshold brings the issue closer in line with the requirements of the state legislature, where two-thirds support among lawmakers is needed to increase taxes. 

  • “It’s about taxpayers just gaining some control over that out-of-control tax and spending that we see nationwide,” state Rep. Jon Hansen (R), who helped author the ballot measure, said in a recent virtual town hall. “Here in South Dakota, we can put a little more protection in place for taxpayers.”
  • The issue has the backing of a powerful conservative group. Americans for Prosperity — the main political arm of the influential Koch network — has donated hundreds of thousands of dollars in mailers and postage, digital and media ads, and canvassing efforts.
  • Gov. Kristi Noem (R) has said she’ll vote for the amendment but isn’t officially endorsing it, according to the Argus Leader.

But those who oppose the effort have accused lawmakers of changing the rules of the game. They argue it’s a veiled attempt to make it harder to expand Medicaid after seeing the success of other statewide voter referendums. 

  • “Everyone understands that this is both a fight for direct democracy, but it’s also a proxy election for the issues that voters will face in the ballot box in November,” said Kelly Hall, the executive director of the Fairness Project, an advocacy group that has supported Medicaid ballot measures in Republican-led states.
  • The Fairness Project is pumping in significant cash to try to tank today’s vote. So is Sanford Health, a major health system headquartered in South Dakota. Bill Gassen, the system’s president and CEO, told The Health 202 Medicaid expansion would be at “significant risk” if Amendment C passes.

Either way, the Medicaid expansion campaign says it’s readying a fight, while acknowledging the challenge of a higher threshold. Supporters are making the case that Medicaid expansion brings federal taxpayer dollars back to the state, while also focusing on telling stories of those who could gain coverage.

“We are in this campaign to bring Medicaid expansion and all of those benefits to South Dakota, and we’re not going to let this or anything else stand in our way,” said Zach Marcus, the campaign manager for South Dakotans Decide Healthcare.

Need for mental health care is high in Uvalde following shooting

Two weeks after a gunman opened fire at an elementary school in Uvalde, Tex., experts are raising alarm bells about limited mental health resources and insurance access in the area that could keep the community from receiving the care it needs, The Post’s Paulina Villegas reports. 

Therapists flooded the town offering their services in the days following the mass shooting that left 19 students and two teachers dead, but many will leave in the next few weeks or months. Yet, mental health professionals say it will take years of sustained attention for the community to recover. 

While there are some clinics that offer mental health services locally, experts say the town needs more psychiatrists specializing in children and adolescents. There is also a lack of inpatient treatment options.

Lack of insurance also compounds the issue. Nearly 1 in 4 residents in Uvalde County don’t have health coverage, according to the Census Bureau. Texas leads the country in both the number and percentage of uninsured residents, but the state has repeatedly resisted expanding Medicaid eligibility to cover more uninsured Texans. 

Texas Gov. Greg Abbott (R) has pledged significant support to address the “magnitude” of mental health challenges facing Uvalde, but ramping up state resources could be difficult in Texas. The state currently ranks last in the nation on access to mental health care, according to a recent poll by the nonprofit Mental Health America.

More from Gov. Greg Abbott (R): 

White House criticizes Louisiana antiabortion bill

The White House yesterday sharply rebuked “extreme” legislation in Louisiana that would ban almost all abortions in the state and impose criminal penalties for physicians who perform the procedure. It includes no exceptions for rape or incest. 

The bill, authored by state Sen. Katrina R. Jackson (D), won final passage in the state legislature on Sunday, and now sits on the desk of Gov. John Bel Edwards. The Democratic governor — who opposes abortion — is expected to sign the legislation, which would go into effect if the Supreme Court decides to overturn Roe v. Wade this summer. 

President Biden is “committed to protecting the constitutional rights of Americans afforded by Roe for nearly 50 years,” press secretary Karine Jean-Pierre said in a statement. “An overwhelming majority of the American people agree and reject these kinds of radical measures.”

  • Bear in mind: The justices on America’s highest court could overturn Roe any day now. The ruling is poised to be announced as support for abortion rights nationwide has exceeded or matched pervious highs, according to several new polls conducted after the draft decision was leaked, The Post’s Aaron Blake notes.

Vice President Kamala Harris:

U.S. has wasted more than 82M doses of coronavirus vaccine

The Centers for Disease Control and Prevention estimates the country wasted more than 82 million doses of coronavirus vaccines from December 2020 through mid-May, or just over 11 percent of the shots distributed by the federal government since the start of the pandemic, NBC News reports.

  • Retail pharmacy chains CVS and Walmart were together responsible for over a quarter of the doses thrown away across the country during that time period.
  • Five other pharmacies and dialysis centers — including DaVita and Costco — report wasting more than a quarter of the doses they received.
  • Among states, Oklahoma tossed 28 percent of its doses and Alaska threw away almost 27 percent of the doses it received.

The millions of wasted doses include some that expired before they could be used, others that were spoiled when they couldn’t be kept under appropriate conditions and numerous that were tossed at the end of the day when there wasn’t a demand for the last few doses in an opened vial, NBC’s Joshua Eaton reports.

Covid update: Reported infections are up roughly 15 percent over the past week. But the virus is showing signs of abating in parts of the Northeast, where cases originally started ticking up again following the winter omicron surge. 

Supreme Court: Medicaid can recoup settlement funds intended for medical expenses

The Supreme Court ruled 7-to-2 that state Medicaid agencies can seek reimbursements from funds won by beneficiaries in personal injury litigation allocated to cover the costs of future care, Reuters reports. 

The federal Medicaid statute forbids local agencies from placing a lien on an accident victim’s property in most cases. But it requires programs to seek reimbursements from third-party settlements.

Dissenting Justice Sonia Sotomayor, joined by Justice Stephen G. Breyer, said the ruling could allow Medicaid programs to recover settlement funds for “future medical care for which Medicaid has not paid and might never pay.”

Caitlin Shortell, civil rights lawyer: 

  • Attorney Jessica Cisneros will request a recount of the runoff election between her and Texas Democratic Rep. Henry Cuellar, the House’s last remaining antiabortion Democrat, our colleagues Mariana Alfaro and Felicia Sonmez report.
  • Transportation Secretary Pete Buttigieg announced yesterday that he tested positive for the coronavirus and is experiencing mild symptoms, The Post’s Michael Laris writes.
  • On the move: Katie Glenn will lead the expansion of Susan B. Anthony Pro-Life America’s state affairs team as the organization’s new state policy director. She previously worked as government affairs counsel at Americans United for Life.
  • The Department of Health and Human Services has requested Danish biotech company Bavarian Nordic send 36,000 doses of its monkeypox vaccine to the United States this week, adding to more than 36,000 doses already available in the strategic national stockpile.

AARP’s Billion-Dollar Bounty (By Fred Schulte | Kaiser Health News)

A Mental Health Clinic in School? No, Thanks, Says the School Board (By Ellen Barry | The New York Times)

A mother’s desperate bid to save her anguished teen ends in gunfire (By Justin Jouvenal | The Washington Post)

Thanks for reading! See y’all tomorrow.