KELO-TV’s report on the grassroots effort to expand Medicaid in South Dakota claims that “there’s now two groups working to get Medicaid expansion on the 2022 ballot….” That statement is ungrammatical (I’m in that mood this morning): if there are two groups, one should say are. But the statement may also be unfactual: while there are two groups, it seems only one, Dakotans for Health, is actually working toward clearing the legal hurdles the South Dakota Legislature has thrown in the way of these Medicaid initiative petition drives and voter participation in general:
In addition to promoting Medicaid expansion, Dakotans For Health is in two active legal battles over the ballot initiative process in South Dakota. The group recently filed a lawsuit against Gov. Kristi Noem, the attorney general and the secretary of state asking a judge to stop Senate Bill 180 from being enforced.
“It’s just more sand in the gears to make it harder,” Rick Weiland said. “It’s like death by a thousand cuts. They continue to try and slow down the people’s right to petition their government and to pass public policy that they want passed that their Legislature won’t do.”
Dakotans for Health is also fighting a recently passed resolution in court. House Joint Resolution 5003 narrowly passed in the Senate 18-17 and 51-17 in the House. It calls for South Dakotans to vote at the 2022 primary election on amending the Constitution to require the Medicaid initiative and all future initiatives that would spend or tax significant sums pass by a 60% vote threshold instead of a simple majority.
Rick Weiland said the super majority requirement is aimed directly at Medicaid expansion.
“We’re fighting it,” Rick Weiland said. “I believe the Supreme Court will make a decision or ask for oral arguments” [Eric Mayer, “Dakotans for Health Aiming to Let Voters Decided on Medicaid Expansion,” KELO-TV, updated 2021.04.08].
The hospital lobby’s biggest effort seemed to be way back in December, when it announced the formation of a coalition to back its Medicaid expansion petition drive. But the hospital lobby has done little in public since then, creating the impression that it’s December gambit was more about poaching supporters from Dakotans for Health and dampening enthusiasm for that grassroots organization’s initiative petition drive. While the hospital lobby sits on its coalition and its petition, Dakotans for Health is out expanding its coalition. Last week, Dakotans for Health tribal spokesman Remi Beautiful Bald Eagle announced endorsements of their petition drive from tribal leaders from the Rosebud, Yankton, Lower Brule, and Crow Creek Sioux:
Beautiful Bald Eagle’s efforts have received widespread praise including from Rosebud Sioux Nation President, Rodney Bordeaux who heralded the former combat engineer as a ‘bridge builder,’ citing the grassroots group’s ‘reliability’ and deep commitment to Indian Country:
“I would like to thank Dakotans for Health for taking on this very important effort to expand Medicaid. We know they can be relied on to be a strong voice for Indian Country. We are excited to be part of this team and look forward to working with Remi, Rick, Pam, Adam, and the entire Dakotans for Health network on this important task.”
Other leaders echoed Bordeaux’s sentiment, including Yankton Sioux Tribal Chairman Robert Flying Hawk, who, along with Bordeaux, was an early supporter of the effort:
“The work of expanding Medicaid is critical to the long-term success of Indian Country and I would like to thank Dakotans for Health for taking it on. People’s lives literally depend on it.”
Lower Brule Sioux Tribal President Clyde Estes lauded Flying Hawk’s sentiment, citing the critical importance of health insurance and the tribes’ familiarity with Bald Eagle and the organizers for Dakotans for Health:
“The folks involved at Dakotans for Health have lived in or worked with Indian Country their entire lives. We know they can be trusted to do what is right and are proud to support their important campaign to expand Medicaid.”
Crow Creek Sioux Tribal Chairman Peter Lengkeek, who, like Bald Eagle, is a former combat veteran, agreed with Estes:
“Dakotans for Health has a deep commitment to the earth and to the well being of Indian Country. I am grateful for their efforts to improve our healthcare systems” [Dakotans for Health, press release, 2021.04.08].
On top of that, Dakotans for Health is recruiting students to circulate its petitions.
The two camps have indicated they expect that they’ll eventually be working together. But right now, it looks like Dakotans for Health is doing all of the work on its own. Hospital lobby, you can do a lot of work; why not put your money where your December mouth was, give Dakotans for Health a call, and offer to help with that work.
Little concerned about mixing treaty provisions on healthcare with other non treaty healthcare initiatives. On reservation tribal members are taking their non treaty healthcare dollars to privately or publicly owned clinics or hospitals leaving the treaty obligated IHS with less of those dollars. In time, the IHS might figure out a clever way to minimize and maybe get out of the treaty obligations by transferring healthcare to others.
Heck IHS was forced to shut down the ER at several reservation based health care facilities due its ineptness, neglect and inability to provide safe ER services. Without tribal leadership intervention IHS probably would have left the ER closed in the quest to minimize treaty healthcare provisions.
Another example, is when a tribal member living on the reservation on Medicaid due to disabilities or reaches 65 is referred out from IHS to off reservation clinics or hospitals. Medicaid paid most of the billing, the tribal member gets a standard form letter telling her/him IHS does not have funds to pay the outstanding balance. I seen letters were the outstanding balance is from $1.10 to hundreds of thousands of dollars. Often when the decisions are appealed, IHS pays; sometimes late impacting the person’s credit.This is common with Tribal members living on the reservation on Medicaid. Unfortunately. IHS is using all means to minimize their treaty obligations.
It is appreciated that tribal leaders are carefully balancing healthcare sources for all tribal members on and off the reservations.
RST Tribal Member, this is my recollection oif Medicaid coverage,,,,,
Otherwise, the program provides 100 percent coverage for most medical expenses and does not require payment of premiums or deductibles. In addition, health care providers who accept Medicaid cannot bill the patient for any additional charges after Medicaid has adjudicated the claim, as they can with Medicare.
I was on Medicaid for several years and made beau coup trips from NW iowa to iowa city and never got billed for any of the care. I had to provide my own transportation, meals and lodging if I stayed overnight in iowa city.
Does it work differently for members on the Res?
Let’s get it done! Ask for and carry a petition!
Here is the response to Mike from Iowa question:
To set the premise IHS is a payer of last resort, its facilities are expected to seek reimbursement from third-party insurers when applicable.
American Indians and Alaska Natives with Medicare with no supplemental coverage, which means they are exposed to Medicare’s out-of-pocket cost sharing requirements unless receiving services from IHS, tribal entities, or Urban Indian Health Programs.
This is were things go south as the funding for IHS healthcare and contract services might not be sufficient to cover the costs at IHS facilities or out-of-pocket costs (that could range from pennies to thousands of dollars).
Thanks for inquiry Mike..
Thanks for the explanation, RST Tribal Member.
Insurance does the same thing; sidesteps all liability hoping Medicare will pick up in the interim while delaying/confusing, and uncovered costs will land in the injured/sick person’s lap unnoticed.
This is how complex capitalism has become. Another highest profile example:
@steve_vladeck
One more time, my objection isn’t to the *existence* of a “shadow docket”; it’s to how often #SCOTUS is using it to make *new* law, like Friday night’s ruling.
That’s not about nationwide injunctions, and it’s not what emergency relief is for under the Court’s *own* precedents:
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It’s not just that it’s busier than ever before; it’s not just that more of these rulings are changing the status quo *during* litigation; it’s that the Justices are using these emergency orders to change doctrine across *all* cases.
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Friday’s ruling…makes important *new* First Amendment law. But emergency injunctions are only supposed to issue to protect rights that were already “indisputably clear.”
Others observe:
there’s a whole `nother realm of the law that’s more abstract than statutes passed by legislation. I don’t understand them; they’re to jurisprudence as derivatives are to securities.
And:
religiously extremist ideologues, members of secret societies, are prioritizing their secretive religious views over law.
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The “Religious Right” has been trying to rule doctrine & policy since Ancient Rome. They’re not quiet about it.