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Noem Rejects Tribes’ Call to Expand Medicaid

Rosebud Sioux Tribe President Rodney Bordeaux told the Legislature Thursday that expanding Medicaid would help South Dakota’s tribes deal with healthcare shortfalls.

He said broadening Medicaid eligibility would cover more people and bring jobs and other economic benefits to South Dakota. It would also provide more access to care and bring in more revenue for the Indian Health Service, he said [James Nord, “Rosebud President Urges Medicaid Expansion, Collaboration,” AP via Sioux City Journal, 2019.01.10].

Our neighbors are seeing Medicaid expansion pay for itself, but let’s not hurry to help Indians. Instead, let’s default to knee-jerk anti-government tropes:

At a State-Tribal Relations committee hearing after the speech, Republican Sen. Lance Russell pushed back against the idea, which had been raised under former Gov. Dennis Daugaard’s administration but faces opposition from Noem and many GOP lawmakers.

“My concern with the Medicaid expansion is that you’re again relying on a government that has failed in the IHS realm,” Russell said [Nord, 2019.01.10].

Governor Kristi Noem, who somehow didn’t fix Indian Health Service during eight years in Congress, says she doesn’t like Indian Health Service or Medicaid.

South Dakota has the highest rate in the nation of low-income rural people going without health insurance, yet her State of the State Address Tuesday said not one word about helping more people get health insurance. The only health care services Noem mentioned expanding are mental health services for meth addicts. And her prescription for the tribes is to say that the two major federal programs we could use to help, Medicaid and Indian Health Services, are both bad and thus shouldn’t be used.


  1. Rorschach 2019-01-13 09:37

    How ironic that someone who has arranged her whole adult life to live off of government money and to maximize the amount of government money coming to her entire family does not want to use government money to help her fellow citizens.

  2. jerry 2019-01-13 09:43

    Tribes need to get real and start by planting legalized hemp, processing it and selling CBD. What are they waiting for? Clear that the whitey tighty’s in Pierre don’t give a damn about them and never really have. Make the move and fund what you need in urgent care from CBD and then send patients to off reservation hospital emergency rooms for treatments as well. If you cannot be a part of the system then break the system. trump has shown you the way.

  3. mike from iowa 2019-01-13 09:43

    Wingnuts will claim she removed a source of crony corruption and therefore we should be grateful. She did not do it out of concern for corruption. She and all other wingnuts do this as a form of punishing the least among us.

    Besides, she will find other ways to enrich her family and friends. They always seem to.

  4. Ken 2019-01-13 10:26

    She was worthless when she was in Congress. Why would anything change now that the STUPID voters elected her Governor? As long as Republicans run the state, you’re never going to see expanded Medicaid or legal marijuana, EVER.

  5. Porter Lansing 2019-01-13 11:20

    Native Americans paid “up front” with millions of acres of land ceded to USA in return for food and healthcare in perpetuity. Democrats have little issue paying the debts incurred in these fully legal treaties with our neighbors, the Indians. Republicans, however look the other way, knowing full well there ain’t a damn thing Indians can do about near worthless healthcare and food stamps with nowhere better that Liz May’s overpriced, gouging grocery store to use them.
    “The grocery store she owns in Kyle makes a killing by selling truck loads of sugary and corn syrup based processed foods to a community that has some of the highest rates of diabetes in the entire country. The grocery store that May owns also sells tobacco. We know that tobacco causes cancer. We also know that Native people suffer from addiction to tobacco at rates higher than the national average.
    If May really cared about these kids living in the community she represents, wouldn’t it make sense to also stop selling these products that are known to eventually kill them?”

  6. bearcreekbat 2019-01-13 11:29

    Let me understand – is the concept of using the government to assist people in need to access health care, or insurance to pay for health care, a government function to which Noem and like thinkers object?

    If that is the case, then will she also advocate for the radical solution of eliminating all state laws designed to provide such government funded assistance, including laws that have been in force since statehood?

    Or does she simply object to using Medicaid and IHS as delivery systems for the health care needed by so many South Dakotans? If that is the case, what are the current alternative delivery systems she supports, or what new delivery system does she advocate?

    If government assistance for health care is an important goal, then we need solutions rather than carping about two current major delivery systems. Simply asserting Medicad or IHS is “bad” tells voters nothing meaningful.

  7. Jason 2019-01-13 11:43

    The Federal Government pays 100% for enrolled tribal members health care.

    Why would South Dakota want to start paying for it?

    Rodney is an idiot.

    I have linked tot he actual numbers before showing it doesn’t save a State money.

  8. Roger Cornelius 2019-01-13 12:33

    Jason is an idiot and knows not of what he speaks.
    During this past summer I suffered a major health crisis and was diagnosed with lung cancer.
    My initial treatment was from Sioux San hospital in Rapid City. After the severity of the cancer was found and that Medicaid would be covering most of the costs, Sioux San would no longer provide any coverage to me because I am an enrolled tribal member outside of their service area.
    As my treatment has progressed we have had to find alternative ways to pay the costs, without Indian Health Service and the treaties.
    After the initial radiation and chemo treatments, I am now entering a second year long chemo treatment and IHS is nowhere in sight.

  9. jerry 2019-01-13 12:45

    Roger just noted something that few people know of, service areas for the IHS. Whites think that a Native has it soft and comforting because of all the benefits they get. Healthcare is not one of them. Some great treaty rights…that is total nonsense “for as long as the grass grows and the river’s flow”. Show me a treaty that the United States government has entered into and I will show you the failure as time progressed.

    Hearing from Roger, it is always good to see his words of truth on this blog.

  10. Porter Lansing 2019-01-13 12:55

    Damn, Roger. I’d never heard of Sioux San (for sanitorium) Hospital until now. What a horrifying and telling history of white people’s abuse of Native Americans.

  11. leslie 2019-01-13 13:19

    Roger my best wishes in your recovery. Very sorry to hear your diagnosis and struggle with health care. I certainly missed your incisiveness while

    Why would SD?

    The 1851 1868 treaties and 1877 “agreement covered most of SD ND WYO MT and ND. Those state populations, vastly white are the primary beneficiaries of that wealth. Deadwood gold alone is worth $Billions. Past threads contain thosenumbers. Jason you have no business injecting your uniformed knee jerk opinionated bigotry or your “history” lessons

  12. Roger Cornelius 2019-01-13 13:25

    Jerry and Porter

    Sioux San has a long and painful history with the Sioux.
    Initially built as a Indian boarding school in the 1900’s and then as a TB sanitorium in the 1930’s and later (1960’s) as a full service hospital until present.
    My mother was a 5 year old forced to attend the boarding school and in the 1930’s was a patient there after contracting TB. As a patient at Sioux San she was hired as an occupational therapist.
    Today Sioux San is a shell, they are no longer a full service hospital and only serve urgent care and a daily clinic. All emergencies are referred to Rapid City Regional Hospital with IHS picking up the tab.

  13. Debbo 2019-01-13 15:23

    Doesn’t totally fit here, but I thought y’all might want to know, “The Rider” won BEST PICTURE by the National Society of Film Critics.

    That’s not small spuds, but doesn’t get the notice because they don’t have a glitzy awards show with glamor and booze.

    The Minneapolis Strib reprinted the article from the LA Times: “An achingly beautiful weave of narrative and documentary filmed on the Pine Ridge Reservation in South Dakota.”


  14. Jason 2019-01-13 15:31

    Expanding Medicaid pays for itself. It really begs the question … why do some Republican governors (like Noem) refuse to offer this human right to their citizens?

    It is a sign of a sick society. It is a signal of a warped ideology. For Indigenous Peoples it probably feels like normal treatment. The United States of America has systematically attempted to exterminate Native Americans from the very beginning. Noem continues that sordid tradition.

  15. John Roether 2019-01-13 15:32

    Then what is the governors plan to address health care in South Dakota?

  16. mike from iowa 2019-01-13 15:39

    Good news like that is welcome, I would think, anywhere on Cory’s blog, Debbo. Thank you for that tidbit.

  17. Robin Friday 2019-01-13 15:55

    Roger, I am so sorry to hear of your illness. I am living in disbelief as to what has happened to health care for our Native people and for all of us. I was once told that “Wakan Tanka” (I hope I have that right) meant “Great Mystery” before it was Christianized into “Great Spirit”. I believe in Great Mystery more than in Great Spirit, so I’m wishing may Wakan Tanka be with you.

  18. Porter Lansing 2019-01-13 16:07

    Likewise, Roger. Keep your spirits up, buddy. The late Mrs. Lansing lived for 27 years after first diagnosed with breast cancer. A few courses of chemo, which are tough to tolerate. Love ‘ya, man.
    Good news, Debbo. Loved that film. Low budget and high entertainment. Hope it’s nominated for Oscar. Not that it matters but I also liked “Roma” , “The Favourite” and “Leave No Trace”. Watching “Green Book”, tonight.

  19. bearcreekbat 2019-01-13 16:58

    Roger, I too am glad you are back! Akisni ecani.

  20. Francis Schaffer 2019-01-13 17:38

    So if other state governors expand Medicaid in their states while our governor does not, does that mean my tax dollars are helping people in other states and not those in my home state of South Dakota? I hope this same logic isn’t applied to ethanol subsidies or money for DOT funding for roads improvements.

  21. Cory Allen Heidelberger Post author | 2019-01-13 17:45

    Probably, John R, the same as her plan was last year when she voted to repeal the Affordable Care Act: take insurance away from as many people as possible and return to the savage pre-Obama system where insurers could drop people with pre-existing conditions to protect their profits. What’s Kristi care? She’s got government health insurance, her older daughter and her soon-to-be son-in-law have state jobs with state coverage—Kristi doesn’t have to think about anyone else.

  22. Cory Allen Heidelberger Post author | 2019-01-13 17:46

    Francis, yes. States that decline to expand Medicaid don’t get a tax refund. We also aren’t saving anyone any money, because when we invest in health coverage, we’re keeping working people healthier and saving the economy much higher costs in lost productivity and sicker patients.

  23. Debbo 2019-01-13 18:16

    Noem and the SDGOP don’t recognize the great value of the state’s American Indian people. It’s not only their votes, not only the worth of their lands. These South Dakotans have so much to teach about how we see ourselves, our planet, our lives. They can show us how to save the Earth.

    The shortsightedness, even the cruelty of the GOP leadership locally and nationally is shameful. Watch this 9 minute short film to learn a better way. In fact, the way the Zuni think about their land? . . . Some SD farm and ranch families are very similar.

  24. Porter Lansing 2019-01-13 19:02

    @Debbo … thanks Great story. Cool guy and outstanding maps he makes. Culturally significant and far beyond things we white people value.
    ~ When I lived and worked at a restaurant at the Grand Canyon (1971) there was turquoise jewelry for sale made by Navajo, Hopi and Zuni artists. Zuni was my personal choice. Even after I left the canyon I wore a Zuni inlay turquoise ring until I got married in ’79. Wish I still had it. Things disappear, huh?

  25. Moses6 2019-01-13 19:47

    To care for human life is priceless why would she care about the less fortunate.Amazing the two windbags in the senate are for not caring for all people there either.Photo op Thune, And slick Mike are only concerned about their own welfare.Do you know it takes thirty years general income in South Dakota to get Social Security check of 1350.While congress is elgible for 17000 at age 62 for one six year term.When you see Photo op Thune and and slick Mike ask them what they will make in retirement .I bet they won’t answer you Because Thune worried only about power and Slick Mike the same way..

  26. jerry 2019-01-13 20:13

    Natives, the elderly, and the disabled are now all rolled into one without Medicaid Expansion. Nursing homes across South Dakota are closing their doors. Not only in rural areas but in Rapid City as well. What is NOem and her phony legislators gonna do about the misery they are causing? Who will shoulder their responsibility to care for those who have all worked to build this state? Did anyone notice there was not a peep about this from NOem or from Nelson or from anyone, just silence.

  27. Porter Lansing 2019-01-13 20:17

    During Obama, when the Medicaid expansion was first offered, the SDGOP’s line was, “We can’t take that. Who’s going to pay for it?” As if someone was going to heap praise on South Dakota for not running up the debt. Now that Trump’s spending money and increasing the debt at record levels, SDGOP has no excuse. Expand Medicaid, Pierre. Don’t think of it as helping people (which is completely contrary to your platform), think of it as another opportunity to skim some off the top. Get your share before Trump spends it all.

  28. Debbo 2019-01-13 22:09

    I wonder how many Bill’s like this the SDGOP will introduce this session?

    “I still remember a long-ago conversation with a student in one of my graduate classes, who happened to be a State Representative. He had just voted for a bill requiring schools throughout the state to post the Ten Commandments. I knew he was fully aware that such a law would violate the Establishment Clause, and I asked him why he had voted for something he knew to be unconstitutional. He replied that the “folks back in Mayberry” would be angry if he’d voted no, so he’d decided to “let the courts take the heat.”

    “There are a number of problems with that strategy. It rewards moral cowardice, and it feeds hostility to the judiciary among people who don’t understand the constitution, the function of the courts, or checks and balances.”

    That comes from the wise Sheila Kennedy’s blog and well describes much of what the SDGOP does every year. Moral cowardice indeed!

  29. bearcreekbat 2019-01-14 01:28

    Debbo, your anecdote is a perfect example of a representative taking an action that ought to be recognized as a knowing and intentional violation of his sworn oath of office to support the U.S. Constitution. That’s what I’m asking about.

  30. Jason 2019-01-14 07:06

    Roger C.

    IHS would have paid for it if Medicaid didn’t right?

    Why are you eligible for Medicaid since you are an enrolled member?

  31. jerry 2019-01-14 09:04

    Jason/trump is now an enrolled member that knows IHS like a book. Soon he will be discussing his lady parts to all the women posters.

  32. MD 2019-01-14 11:25

    The governor expressed a need to address methamphetamine addiction as a policy priority in her state of the state speech.
    HHS and the American Society of Addiction Medicine (among many others) have made it clear that addiction is a chronic relapsing brain disease. Chronic diseases need access to health care and evidence based treatment to enter into remission and regain quality of life.

    Methamphetamine and opioid addiction are not solved by a single 28 day treatment stays, it requires a combination of appropriate psychosocial treatment (which can happen on an outpatient basis for most), peer support, and for opioid addiction, medications. Inpatient or residential treatment is only effective for those with the most serious levels of addiction, and then they must be able to graduate down to outpatient and aftercare.

    If you want high quality addiction care, expanding medicaid is paramount, as it opens the doors to addiction treatment for treatment for groups that are at increased risk for addiction, such as the working poor, young adults, etc.

    I work in Grand Forks, ND solving the local opioid crisis. We are finally seeing reductions in our opioid overdoses and increases in treatment numbers. I attribute this positive change to 1) healthcare availability 2) providers willing to add treatment capacity because reimbursement is available and consistent, and 3) the legislature providing a gap filling program (substance use disorder voucher) to cover any gaps for under covered services or while they are getting on medicaid/medicaid expansion.

    ND is almost just as conservative as SD, yet policymakers in ND saw it important for the long-term health of the state to have access to care. It seems that policymakers in SD are more focused on paying lip service to issues, and using inefficient “government sounding” interventions to solve problems. Yes, Medicaid Expansion may cost more, but the return on investment will be much higher.

  33. Roger Cornelius 2019-01-14 12:00

    As a U.S. taxpayer that has paid into Social Security and Medicare all of my working career I am eligible for Medicare like every other citizen, including you, regardless of my tribal affiliation.
    I.H.S. still wouldn’t be required to pay for my treatment if I didn’t meet their guidelines, what would likely have happened would the government would have put me on Medicare.
    Even when Indians use Sioux San or other I.H.S facilities they are required to produce their Medicare and Medicaid cards and I.H.S. bills those programs for services.

  34. Roger Cornelius 2019-01-14 12:05

    To all my Dakota Free Press, thank you for all your good wishes for a speedy recovery.

    My family has a long history of cancer and I know how to fight the dreadful disease. By following the doctors orders, doing my weekly chemo and doing my physical therapy I feel optimistic.
    Again, thank you for caring and for your support.

  35. Jason 2019-01-14 12:35


    I am not asking about medicare.

    I am asking about medicaid.

    Why should the State of SD be on he hook for part of the payment with medicaid?

  36. Roger Cornelius 2019-01-14 12:41

    I have two corrections to make in my comments:
    1. If I had no other means to pay my medical, the government could put me on Medicaid, not Medicare.
    2. I neglected to add “friends” to my comment thanking Dakota Free Press friends.

  37. Roger Cornelius 2019-01-14 12:46

    Let me make this clear, all citizens and residents of the United States and of the state of South Dakota are eligible for Medicare and Medicaid insurance if they qualify.
    I was not eligible for Medicaid and had to find an alternative source for insurance coverage.

  38. Jason 2019-01-14 12:49

    I am saying that enrolled members should not be eligible for medicaid since SD has to pay some of the bill. The Federal Government should be on the hook for 100% of the cost.

  39. Roger Cornelius 2019-01-14 13:15


    That is called discrimination.

  40. Debbo 2019-01-14 13:29

    I am saying that small, petty people like Jason should not be eligible for anything they’d like to deprive of others.

  41. Roger Cornelius 2019-01-14 14:19

    Jason sees himself as a grand inquisitor except that he is woefully short on facts. Following one of the definitions of a Russian troll Jason inserts what he feels is a fact into a question or a comment.
    By Jason’s questioning the rights of Indians to be eligible for Medicaid in the state of South Dakota he shows his white privilege.

  42. Porter Lansing 2019-01-14 14:29

    Jason – Indians are owned by America, aren’t they? Like slaves.

  43. jerry 2019-01-14 15:11

    MD, thank you for the informative post. Also thank you for the incredible work that you and your team are focusing on. As you note, addictions cannot be solved by a simple remedy, you have to have the persistence to see it through. Thanks for pointing out what a worthless governor’s chair we continue to elect, along with a legislature that is so stupid it hurts.

    How are your success rates for the long term opioid treatments?

  44. Porter Lansing 2019-01-14 15:48

    Canada has had socialized healthcare for a long time and Randy Paul hasn’t ever gone before. Canada now has legal cannabis and Paul now needs to go North? Hmmmm?

  45. MD 2019-01-14 17:48

    Jerry – with medications in the treatment of opioid addiction, success rates run between 50-70% at one year. Success being having a urine drug screen negative for opioids (aside from treatment medications). Combined with psychosocial treatment, those numbers can get into the 80s.
    Abstinence based treatment alone has a much lower success rate, in the range of 10% at one year. This rate can be much higher among sub groups that are very well supported in their recovery, such as physicians and airline pilots. Despite the success of some of these subgroups, they are the exception, not the rule.

    Methamphetamine is much more challenging to treat because we have no FDA approved medications to treat it (compared to 3 for opioid use disorder). Therefore, we are left with psychosocial treatment and peer support as the main modalities. It is much more difficult to have success with these alone, because you do not have medications to surpress cravings and prevent withdrawal

  46. jerry 2019-01-14 18:01

    MD, it may be cold up in that further north country, but your state has a warm heart in dealing with the illness of drug addition and a better control over spending money. We here in South Dakota will never ever achieve that or those kinds of numbers, even though we produce a lot of the issues your state suffers from no matter what our lamebrained governor and her legislative branch bray about.

    Thanks for what you do.

  47. Porter Lansing 2019-01-14 18:06

    MD … I’ve had experience with hard drug users in SD since the late 60’s. When rating recovery rates it’s important to acknowledge the two distinctly different mindsets of people who choose to self medicate with either uppers or downers. [And, I was in bed for two years (2000-2002) with level eight pain and went through oxycontin withdrawal every six or seven weeks, depending on Doctor’s orders.] People who choose downers are generally looking to escape tedium where people who choose speed are generally seeking something they’ve rarely had. It’s easier (in treatment) to make tedium tolerable than to replicate a feeling of euphoria. I believe that’s why opioid addicts recover at a higher rate, more quickly, than meth heads.

  48. jerry 2019-01-14 21:05

    “In the United States, the probability of dying from opioids has for the first time surpassed the likelihood of being killed in a car crash, according to a new report by the National Safety Council.

    Published on Monday and based on National Center for Health Statistics’ 2017 data, the report found that opioids overdose was the fifth most probable cause of preventable death, with a one-in-96 odds. The odds of dying in a vehicular crash were one-in-103.”

    Pretty impressive numbers, but nothing to get alarmed about until one of these legislators kid or grand kids overdoses and dies. Then…maybe, but what will the Koch’s say?

  49. CUB4 2019-01-15 14:30

    Interesting reading. Prayers for Roger. Governor Noem needs better advise than repeating same methods that prove futile.

    Sioux San has a troubled history with Indians, as does IHS. Hopefully, IHS will pay more of their bills when they refer patients out for services..a long-time problem.

  50. Leah Fyten 2019-01-16 22:36

    This does not surprise me at all. It’s a lame ass excuse tho

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