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Rounds Anti-Health Care Policy Undermines Rural Hospitals, Women, and Babies

U.S. Senate candidate Dan Ahlers says South Dakota struggles to provide affordable health care. He’s right: as reported here last year, our failure to expand Medicaid has denied our rural hospitals the benefits that rural hospitals in more sensible states have enjoyed.

Supporting this position is Sanford chief medical officer Dr. Allison Suttle, who writes in Modern Healthcare that “rural populations are suffering substantial institutional losses”:

On closer scrutiny, what seems a sudden acceleration in rural hospital and clinic closures over the past few years is actually concentrated in a select group of 14 states. They are all holdouts that have declined to fund the expansion of Medicaid that was made possible by the Affordable Care Act, which took effect in January 2014.

As a result, rural hospitals in the states that have refused to participate—hospitals already operating their public healthcare systems with the slimmest of margins and resources—are now collapsing and closing at an quickening rate [Dr. Allison Suttle, “Rural America Faces a Healthcare Access Crisis,” Modern Healthcare, 2019.09.21].

Sr. Suttle says that if you love babies, you have to support insuring more South Dakotans:

The best outcomes for patients ultimately depend upon whether or not they are insured. The challenges we face in delivering care to a rural population, insured or not, are steep. I’m a board-certified obstetrician and gynecologist and have spent most of my career serving this population.

I have seen women show up for their first prenatal visit when they are already well into their second trimester. This can prove dangerous for the mother and baby. Early prenatal care is critical in identifying, treating and managing health conditions, thereby reducing the risk of complications during pregnancy and delivery and improving maternal and birth outcomes.

The nonpartisan Medicaid and CHIP Payment and Access Commission has confirmed what should be obvious: Women without health insurance are far less likely to receive adequate prenatal care than women with coverage [Suttle, 2019.09.21].

Yet Senator Mike Rounds has supported overturning the Affordable Care Act and throwing millions of Americans off the insurance rolls.

Dan, campaign on that issue—doctor’s orders!


  1. Realist 2019-09-27 07:42

    So the premise of the beginning your argument is that “hospitals” are missing out on benefits of Medicaid Expansion? Therefore we must insure more people? The focus should be on patient access, not hospitals lining their pockets as a result of a policy change. That doesn’t necessarily require more government intervention in healthcare.

  2. Debbo 2019-09-27 15:50

    Prolife GOP?

    Doesn’t SD have a particularly high rate of maternal and fetal mortality among the states?

    Anti-life GOP.

  3. Debbo 2019-09-29 14:25

    Roundy’s and the SDGOP’s political game of not using Democratic originated tools to help South Dakotans is, in fact, leading directly to their deaths. This study removed any doubt of that. It’s especially deathly for elderly people and SD has a plethora of them. From the Strib:

    “Elderly patients are more likely to die when the nearest rural hospital closes and they have to travel farther for treatment of time-sensitive conditions such as heart attacks and strokes, according to a study by a new University of Minnesota health economist.”

    ” ‘When I zoom in to look at patients with time-sensitive health conditions, I find that they do worse when their [nearest] hospitals close,’ said Caitlin Carroll, who conducted the research for her doctorate at Harvard University. She was recruited to the U’s School of Public Health this summer.”

    “Carroll’s research undercut some theories, including the proposition that rural patients might do better after a hospital closes because they would travel farther for higher-quality care.”

    “Deaths increased only among those who lost their closest hospitals, reflecting the fact that many were in their 80s and struggled to travel longer distances for medical care.

    ” Carroll then looked specifically at patients who had to travel an additional 15 miles or more for time-sensitive care after their closest hospitals shut down. The death rate increased 10% in this group.”

  4. Cory Allen Heidelberger Post author | 2019-09-29 19:52

    No, “Realist” (a name adopted for irony’s sake, it seems), the premise is that by failing to expand Medicaid, we make it more likely that small rural hospitals have a harder time staying open to serve the rural folks who already disproportionately lack access to health care, not to mention affordable health care.

  5. Realist 2019-09-30 07:48

    Cory – you just confirmed my post and reaffirmed the false premise – that’s the true irony of it. Expanding Medicaid shouldnt be used as a mechanism to keep hospitals open. Expanding Medicaid doesnt necessarily get more people in the doors, it just means more people hypothetically are insured. What you’re talking about is funding rural hospitals through medicaid expansion. That would only work if people with medicaid expansion went to those hospitals, it wouldnt directly fund those hospitals. If people with Medicaid Expansion go elsewhere, the hospital is in the same position. I see opportunity to telemedicine and other innovative ideas to have access to healthcare in rural areas, not just expanding medicaid to keep doors open.

  6. jerry 2019-09-30 09:11

    Realist, try having a bleeding ulcer when you’re miles away from a hospital. That tele-medicine guy will surely get that bleeder to stop by just telling you to do what? Go to a hospital, correct? Very comforting while you bleed out.

    We’re also talking nursing homes and having a hospital close to care of those in these places. Get informed, Skype will not solve the problems of health deserts in rural areas. Many have already died due to lack of treatment.

  7. mike from iowa 2019-09-30 09:26

    People without insurance are less likely to see a doctor until a real emergency occurs. Fact of life.

    People with Medicaid will be encouraged to see doctors before a problem becomes insurmountable. Another fact of life.

    Medicaid/Medicare ensure government payments to hospitals that they otherwise might have to eat when their emergency rooms are flooded. Even another fact of life.

  8. Realist 2019-09-30 09:53

    Jerry – I agree – rural healthcare brick and morter buildings likely need to remain, but I see opportunity for behavioral health, common colds, flus, where symptoms and vitals can be taken remotely and care rendered. Not every issue requires an in-person physician to diagnose and treat, which in exchange could cut costs and still keep doors open. I just dont view as Medicaid Expansion as the answer – especially with Federal Match dollars probably in question over the next 5-10 years, which would make the program unsustainable in such a rural state with small tax base. Also, Federal/State reinsurance programs also in question over the same time period, thereby increasing greater financial risk to an already unstable healthcare market. I think a more appropriate answer is actually looking at the cost of healthcare and room for improvement, not simply relying on taxpayers.

  9. o 2019-09-30 10:26

    Realist: “I think a more appropriate answer is actually looking at the cost of healthcare and room for improvement, not simply relying on taxpayers.”

    Just to be clear, you are proposing government cost fixing? Who els gets to control prices of an industry?

  10. jerry 2019-09-30 11:15

    Yet we have billions of dollars wasted on the military industrial complex that was just shown that a million dollar investment in drones can defeat a Goliath. Take a portion of that wasteful pig and put it into rural areas for healthcare.

    For all the talk about how we are the breadbasket to feed America, we are treated like moldy stale bread regarding our infrastructure and in particular, our healthcare. The closing of nursing homes should shame us all into demanding more from Rounds, Thune and Dirty…they do nothing but continue to be anti health. Irony alert, Rounds sells health insurance, but the payoff from others must be so much better.

  11. jerry 2019-09-30 11:23

    South Dakota is a medical desert and the only thing that will save it is Medicaid Expansion. The facts are in folks, demand better from the crooks and liars we send to Washington.

    “Across the country, greater access to Medicaid under the ACA has translated into improved health for groups including poor people with asthma and diabetes, smokers and patients with advanced kidney disease. Despite these findings, the law’s future is, once again, at threat.” Washington Post 09.30.2019

    There ya go folks, stand up for your freedom, demand better. Your neighbors and you deserve better and it’s already available. One of these days it could well be you in that nursing home. All it takes is a bump on the melon or falling asleep at the wheel or whatever, we are damn fragile.

  12. Robert McTaggart 2019-09-30 11:50

    Obviously we should be smoking more marijuana….that is bound to have a positive health care outcome and lower costs for everybody……..

    Wait a minute….

    Maybe instead we should be avoiding unnecessary costs and tackle the real cost drivers for health care.

    Then those monies that are available to spend on health care (both personal and public monies) will go a lot further.

  13. bearcreekbat 2019-09-30 12:13

    Perhaps rather than advocating continued draconian criminal penalities for marijuana involvement based on some unsupported speculation that decriminalization will cause increased health problems, it might be useful to actually consider whether incarceration potentially causes an even greater increase in health problems and the cost to hospitals and society.

    Studies have indicated that incarceration can actually help some people by assuring they obtain treatment for existing health issues and removing them from environments that are detrimental to their health. Unfortunately, it seems incarceration is two edged sword that also causes considerable new heath problems to those incarcerated.

    . . . the prison environment may have adverse effects on health as discussed in the background paper (Rich, Dumont, Allen, 2012). The nutritional value of meals is far from ideal, because energy-dense (high-fat, high-calorie) foods are still common in prison meals. Smoking also remains a serious problem, despite the trend toward smoke-free correctional facilities. Poor ventilation, overcrowding, and stress may exacerbate chronic health conditions. More evidence is available regarding the effects of incarceration on mental health. Two conditions are especially associated with a serious degeneration of mental health: overcrowding and isolation units. The association between crowding and suicide or psychiatric commitment has been noted at least since the 1980s. Strains on staffing and facilities have particularly serious repercussions on wait times and holding conditions for the mentally ill. Case studies have also revealed widespread and serious reactions to segregation units, in which inmates are restricted to isolation cells for 23 hours a day. The restriction of movement and deprivation of human contact triggers psychological responses, ranging from anxiety and panic to hallucination. A review of health effects of incarceration also must consider sexual assault and intentional injury, either self-inflicted or resulting from assault.

    Prison health conditions and impacts were further discussed at the workshop. Jamie Fellner (Human Rights Watch) described prisons as “toxic environments” with a negative impact on inmate health. She underscored the damage that can result from isolated confinement: “We know that [solitary confinement] is bad for people who are mentally ill and can cause adverse symptoms for those who didn’t have prior symptoms of mental illness.” Fellner also shared research findings on other aspects of prison experience, including violence (noting that one in ten state prisoners is injured in a fight) and sexual abuse (about 9.6 percent of former prisoners self-report that they were sexually abused by staff or inmates [Bureau of Justice Statistics, 2012]; those abuses were frequently accompanied by physical injuries in addition to any injury that came from penetration itself). Excessive use of force by staff is also a problem, she noted, from “old-fashioned beating” to the use of tasers and pepper sprays that can cause serious injury, particularly depending on inmates’ physical conditions. “Obviously brutality has declined markedly in U.S. prisons in the last 20 years,” Fellner observed, “but it still exists and it still has health consequences.” Fellner also reviewed a range of other conditions in prisons that can be detrimental to inmate physical and mental health, including poor diets, poor sanitation, infestations with bugs and vermin, poor ventilation, tension, noise, lack of privacy, lack of family visits, and cross-gender pat searches (traumatizing especially for the high percentage of women in prison who have been previously sexually abused). Fellner offered these as “just some of the examples of the kinds of conditions, some caused by inattention and poor management by prison staff, and some caused by prison policies” that can be harmful to inmate health.

    Short sighted fear mongering arguments speculating about the increased health problems from decriminalization of martijuana ought to be evaluated in light of the measurable identified health problems described in this research. If cost is your motivating factor, then which health problems are likely to cost society more? if human compassion is your motivating factor, then which policy inflicts more damage to human beings?

    The answers to such questions seem worth considering before making any claim about the health benefits of continuing criminalization and incarceration of people involved with marijuana.

  14. Robert McTaggart 2019-09-30 13:24

    As a rural health care policy that impacts women and babies, smoking anything is not a good policy.

    Decriminalization is pertinent as a discussion for adults over 18. It is moot for children from -9 months to 2 years old.

  15. bearcreekbat 2019-09-30 13:33

    I will also speculate that the likelihood of health insurance coverage for most folks when they are released from prison after being convicted of a marijuana offense seems about nil, which can only exacerbate the financial losses of rural hospitals that end up treating these folks in emergency rooms for whatever new medical issues they have developed during incarceration.

  16. Robert McTaggart 2019-09-30 14:29

    I speculate that marijuana smokers should pay more for health insurance like tobacco smokers do.

  17. bearcreekbat 2019-09-30 14:52

    If marijuana were decriminalized then it would be feasible for “marijuana smokers [to] pay more for health insurance like tobacco smokers do.” As long as it is criminalized, however, there is little, if any, practical means to identify marijuana smokers for charging increased premiums.

  18. jerry 2019-09-30 15:56

    North Dakota, our neighbor to the North is getting to the point that they are really looking out for their citizens in all ways. In addition to the hemp, they now have enacted an insurance program that will result in about 20% less premium costs for individuals. Booyah! Here in South Dakota, we are stuck with an ineffective state government with their hands out and a dopey governor. Who would’ve thunk it that North Dakotan’s were so damn progressive?

    “BISMARCK, N.D. – Insurance Commissioner Jon Godfread today praised the signing of Insurance Department legislation House Bill 1106, relating to the establishment of an invisible reinsurance pool for the individual health insurance market, by Governor Doug Burgum. The bill was passed by a unanimous vote from the North Dakota House of Representatives and passed with a 46-1 vote from the Senate.

    “I want to applaud the Governor and our Legislature for taking this step to help ease the heavy burdens our health insurance market is facing. Under this legislation, we will be able to provide some necessary health insurance premium relief to the individuals and families who need it most,” Godfread said. “HB 1106 is the result of a collaboration between the Department, North Dakota insurance companies and our legislative leaders working toward the betterment of our consumers.”

    Here, it’s just another day waiting for the next EB5 payoff for state officials.

  19. Robert McTaggart 2019-09-30 17:14

    Yes, if the risk to health goes up (i.e. the risk for using more care or having more expensive care), the amount paid needs to go up.

    We need more research to help quantify the health effects.

  20. jerry 2019-09-30 17:19

    Do you even know what drives healthcare costs doc? What in your mind drives those costs?

  21. Robert McTaggart 2019-09-30 18:20

    We are one of the drivers. The more we can reduce smoking and alcohol abuse, the better. Reducing particulate matter from energy production or transportation would also help.

    There are other things with regard to how our health care is delivered and how those companies compete with each other that also has an impact.

  22. Debbo 2019-09-30 21:27

    I want to reassert a point from the article I quoted earlier about the benefits of keeping local hospitals open.

    “Carroll then looked specifically at patients who had to travel an additional 15 miles or more for time-sensitive care after their closest hospitals shut down. The death rate increased 10% in this group.”

    Local hospitals closing increases the death rate 10%. Did you get that? TEN PERCENT

    If Medicaid will keep those hospitals open lives will absolutely be saved. It’s not just an intellectual exercise here boys. Lives are on the line.

    If you didn’t read my previous comment, you should.

  23. jerry 2019-10-01 11:37

    “We are one of the drivers”. Every once in a while, doc comes up with something I can agree with. Yes, we are the drivers for many of the high dollar costs and it has to do with our heredity. As noted, blindness, diabetes and many other illnesses are hereditary in many many cases. Before you start on that breeding schedule, check yourself out and understand your past, same goes for your partner. If love is the real deal, then stop complaining about the high cost of medical care, you drove it to where it is.

    “A new gene therapy to treat progressive blindness will cost $850,000, the company that makes it said Wednesday.

    But the company has laid groundwork for innovative ways to pay for the drug though deals with an insurance company, a pharmacy benefit manager and negotiating with the federal government. The company hopes its $425,000-per-eye treatment may eventually lead to new ways to pay for extremely expensive new therapies.”

    So then doc, if your kid was going blind, would you demand this treatment? Would you then understand that healthcare is solidarity with all of us for the best results for us all. That is why government intervention, just like current Medicare, is so critical.
    Disease, no matter the cause, knows no party lines, no religious lines, and no gender lines, we are all equal hosts.

  24. Robert McTaggart 2019-10-01 16:48

    You cannot cover everybody for everything if you do not cover catastrophic health care.

    And if you must choose one area to focus public monies on…it would be for the catastrophic events.

  25. jerry 2019-10-01 20:18

    That”s nonsense doc, in Europe, they don’t turn anyone away. Your Social Security pays for your healthcare, your disability, family leave, unemployment all. Glasses and dental are privately paid. Also, you can buy private insurance if you want to.

    Americans are fooled into thinking we can’t afford to be provided healthcare. North Dakota has the right idea on control of costs. South Dakota could learn a lot from our neighbors to the North. Instead we are focused on potty bills, anything to take away the stench of failure. This dopey governor and most of the fraud republicans in the legislature could do us all a favor and just tell us how much they want as a bribe to just move on.

  26. Robert McTaggart 2019-10-01 20:35

    Last I checked we will not be able to count on Social Security like we used to.

    Monies that could be spent on other things in healthcare are being spent on treating avoidable diseases such as those from smoking and alcohol abuse.

    So you need to get Social Security on a path to solvency, and avoid unnecessary costs.

  27. jerry 2019-10-01 20:42

    Social Security was always on the path of security. The problem is that there is not a separate Social Security from the treasury like there is in Europe. In Europe, no politician would dare screw around with Social Security. The politicians here have robbed Social Security blind and then claim there’s no money there. Kind of like the fraudulent tax cut that these republican crooks and liars said would make us all better off.

  28. Robert McTaggart 2019-10-01 20:50

    I agree it is time to address Social Security and get that on a better path.

  29. Debbo 2019-10-01 21:08

    Social Security has been robbed. Social Security is not the problem. Even so, I would like to see the cap on taxable income lifted.

    The USA has enough $ to meet our needs. The problem is that it’s in the hands of greedy money grubbers. We need to restructure our tax and government system to equitably serve the entire US population.

    Im referring to the federal government and to state and local governments individually.

  30. jerry 2019-10-01 21:13

    Social Security is the problem and that’s why they rob it. Social Security was supposed to have a “lock box” to secure it. That has never happened. Social Security needs to be a separate treasury that is paid into by the people for the people, not government.

    When will someone demand from Rounds an explanation of where the tax cut money went? We take care of those giveaway’s to the rich and healthcare would be a cinch.

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