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Sanford President: Amendment C Limits Voter Rights, Puts Medicaid Expansion at Risk

Sanford Health employees heard from their boss yesterday that they should get out today and vote against Amendment C. Sanford president Paul Hanson emailed all staff Monday and said requiring a 60% vote to pass ballot measures that raise taxes or spend $10 million or more a year “would significantly limit the power and constitutional rights of voters to bring change through ballot measures.” It also would endanger Sanford’s and other hospitals’ chances of finally expanding Medicaid in South Dakota:

Hanson addressed Amendment C’s relation to Medicaid expansion.

“Furthermore, Amendment C would put the SD Medicaid expansion effort, slated for vote in November, at significant risk,” he wrote. “Medicaid expansion is a critical initiative that ensures access to high quality health care for our patients and residents in all stages of life” [Jonathan Ellis, “Sanford Health Asks Employees to Vote Against Amendment C, Says Medicaid Expansion ‘Critical’,” Sioux Falls Argus Leader, 2022.06.06].

Sanford has around 12,000 employees in Sioux Falls. Guessing wildly from the Sanford’s cited 47,757 employees systemwide and the fact that roughly 40% of Sanford’s locations are in South Dakota, I estimate Sanford has maybe 19,000 employees across South Dakota. If all of those Sanford employees go to the polls today and vote No on Amendment C, they would provide a about a third of the 59K worth of No votes above the usual primary election turnout that I estimate we need to beat C. If our other big hospitals’ bosses send similar guidance to their employees, Avera Health could turn out another 15,000 Nays and Monument Health could turn out another 5,100.

That would still leave us with another 20,000 Nays we need to turn out from folks who usually wouldn’t show up at the polls on Primary Day. Sanford can’t protect our constitution or pass Medicaid expansion all by itself; get out today and Vote NO on C!


  1. Algebra 2022-06-07 14:28

    Sanford wants Medicaid expansion because if more people go on Medicaid, Independently owned clinics, hospitals and nursing homes will go under. Already small independent nursing homes are closing because so many of their residents are on Title XIX.
    Medicaid reimbursements don’t keep the lights on. Private practice physicians (if there are even any left) are being pushed into joining the big three hospital systems and reduced to the status of corporate employees.
    One of the things that has the Big Three freaked out is the number of private surgical centers which are popping up. These places are profitable because they only take patients on private pay. They don’t have to take patients on Medicaid; since they don’t offer emergency services the Hill-Burton Act never applied to them.
    Sanford’s interest in Medicaid expansion is in the closure of these independent providers. When a nursing home closes, the residents are moved to one of their facilities. When a doctor’s practice closes, the doctor becomes a corporate employee and the patients’ care is transferred to Sanford, and so it goes. Follow the money.

  2. larry kurtz 2022-06-07 14:46

    There may be no amount of money some employers can pay workers who already know the risks of working for The Man.

    Montana held first place in 2021 but South Dakota is again the most lucrative state to practice medicine thanks to its medical industry triopoly. Nurses’ salaries still surf the bottom and the state is 22nd in “medical environment” so why isn’t there a regulatory body like the Public Utilities Commission to regulate medical care costs? Because the state is a corporatist tax haven for an exclusive set of Republicans while over $4 trillion languishes in South Dakota banks and trusts.

    Despair and desperation will always give the underground economy markets for people looking for any remedy to make the pain go away. So, the callous denial of most Republicans that capitalism is failing an ever-growing number of Americans and driving crime rates higher while blaming their own victims will crush this republic before they will ever raise wages.

  3. P. Aitch 2022-06-07 15:23

    Algebra: You made nine wild assertions with zero credible links to where we can fact check your outlandish allegations.
    So, we’ll have to assume those are just nine opinions you have about how our American government helps we who are much poorer than you.

  4. ABC 2022-06-07 23:00

    C is going down!

    68% NO

    Only Douglas County went for C, 51 to 49% NO.

    Democracy lives !!!!!

    Celebrate all of 2022 !!!

  5. Algebra 2022-06-10 07:04

    P. Aitch they are not wild assertions and you can look up the effect of corporate healthcare services yourself.
    The nursing homes are struggling because so many of their residents are on Title XIX. Reimbursement rates are low. Who benefits when they close and the residents are moved into urban facilities far from home?
    And the reason so many elderly people are on Title XIX is interesting.
    What has happened in the long term care industry is elderly people divesting their assets, giving their money away or selling their assets for less than market value, timing the divestments to avoid the Medicaid look-back period.
    Here is how it works: you can gift $16,000 per year without paying any gift tax, to as many people as you want. Let’s say you have two kids, their spouses, and four grandchildren. You have 8 people who can each receive $16,000 from you without taxation. You can easily give away $128,000/ year. And you can do this every year until you get within 5 years of needing long-term care. You can feel your physical condition declining, so you start to make those plans.
    You sell your house, retain enough money to pay for an assisted living facility for 5 years, ($500,000 should cover it) and when that money is gone, you apply for Medicaid and move into a nursing home.
    The simple fact is, a lot of people with an awful lot of money are hiring estate planners to help them figure this out. Medicaid isn’t just for poor people any more.

    The other group of people who want Medicaid expansion are the Native Americans already covered under the Indian Health Service. They don’t like it and want to go on Medicaid so they can have more choices. This would actually help more of them leave the reservations and that would be beneficial to them in the long run. But they should not be counted among the poor people who aren’t uninsured.

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