SIOUX FALLS, S.D. - Boosting health-care access and tapping into federal aid often are cited as reasons to expand Medicaid, but a new report says South Dakota also would see new jobs and more revenue.

The nonpartisan Commonwealth Fund analyzed the nearly dozen states that haven't expanded their Medicaid programs. If South Dakota acted, the report said, the state could see more than 4,000 new jobs and nearly $10 million in economic activity.

Shelly Ten Napel, executive director of the Community HealthCare Association of the Dakotas, is backing one of two Medicaid ballot initiatives in the state. She cited benefits from the care that already is provided free of charge to uninsured patients.

"Adding Medicaid to that picture would just make those services more financially viable," she said, "able to extend hours, extend services to those who need it - or just to maintain services in communities that are small and kind of losing population over time."

More than a decade ago, the Affordable Care Act incentivized states to expand Medicaid, with the federal government picking up most of the tab. The new American Rescue Plan offers added incentives. Generally, conservatives cite budget concerns, and Gov. Kristi Noem has been a staunch opponent of Medicaid expansion. These ballot campaigns are aimed at the November 2022 election.

Ten Napel suggested that policymakers sometimes get too bogged down with the financial ramifications, and may forget about what's at the core of the idea.

"Do we want to make sure that our neighbors are able to get care when they need it? I think people really respond to that," she said.

Beyond economic factors, a new American Cancer Society study said cancer patients in states with lower Medicaid income-eligibility limits had worse long-term survival rates. Supporters hope these findings convince enough South Dakotans to back the initiatives. The Legislature added a wrinkle by passing a proposed constitutional amendment for the June 2022 primary. It would raise the approval threshold for future ballot questions to 60%, meaning Medicaid expansion would need more than a simple majority to pass.

An Eau Claire resident is speaking out about how federal cuts to Medicaid and the Supplemental Nutrition Assistance Program could affect his life and his family's.

Oliver Winn and his parents all live with disabilities. He said Medicaid has allowed him to have surgeries that have improved his quality of life to such a degree, he no longer needs a wheelchair. It also helps him pay for medication which would otherwise cost $5,000 a month. Winn described the forthcoming federal cuts to Medicaid and SNAP as "terrifying."

"It's going to change a lot of things for a lot of people, and I'm concerned for myself, I'm concerned for my family, my community," Winn explained. "Everyone is going to be affected by this and it's a very scary time to be living through."

It's estimated more than 276,000 people in Wisconsin could lose their Medicaid coverage and another 90,000 risk losing their SNAP benefits over the next decade.

One in eight people in Wisconsin depends on SNAP to help pay for groceries. Winn is one of them. Although he currently works overnight shifts, he noted he still needs SNAP to afford food for him and his child. Before he had Medicaid and SNAP, Winn added his high medical debts meant he struggled to keep up with food and housing expenses, which led him to become homeless.

"Because there's no way to balance trying to feed yourself, trying to pay off this debt and still have access to health care and rent," Winn stressed. "It's impossible, and I wish that the people writing these bills and enacting these policies could get a taste of the life that they're creating for other people."

Along with federal cuts, the Trump administration is implementing stricter work requirements for these programs in an effort to curb what it calls "welfare dependency." More than 45% of SNAP recipients in Wisconsin are in working families and the majority of Medicaid recipients in the state are part of the workforce.

Winn argued the rhetoric suggesting beneficiaries are lazy and unmotivated is not based in reality.

"We do and want to work," Winn emphasized. "Almost everyone I know is on Medicaid. My friends, my family that are capable of working are the hardest workers I know, because we have to work so hard to scrape out ends meet."


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The mayor of Lancaster, Pennsylvania is voicing concerns about the state budget delay, warning it could affect the city's more than 58,000 residents.

Lawmakers missed the June 30 deadline for the fourth year in a row.

Danene Sorace, mayor of Lancaster, said she is closely monitoring both the state budget and the federal transportation, housing, and urban development budget coming before Congress today, noting both have significant implications for the city.

"There's been a significant reduction in federal funds that are coming to the state," Sorace pointed out. "How the state, in a divided House and Senate, reconcile these reductions in federal funding for Medicaid and address the other issues at hand, specifically equitable school funding, is yet to be determined."

Gov. Josh Shapiro said the state budget talks are making progress and expects a deal soon.

Sorace added since the "One Big Beautiful Bill Act" has passed and the state must deal with reduced federal funding, Lancaster will likely experience losses in health care access. She explained the city is fortunate to have strong hospitals and community health systems, which is not always the case in rural areas.

"I think that long term, the impacts are going to be potentially more damaging," Sorace observed. "For our rural brethren in other parts of Pennsylvania and across the country, we're more concerned about their access to health care."

The new law slashes Supplemental Nutrition Assistance Program funding by $186 billion over the next decade, adding stricter work and reporting rules, threatening benefits for many Pennsylvanians.

Sorace emphasized food insecurity was already rising before the cuts and she now expects even more demand at local food pantries.

"Our nonprofit community is trying to figure out what the state is going to do to help fill those gaps," Sorace stressed. "Of course, we're very concerned about food insecurity, especially during the summer months, when kids aren't in school and don't have breakfast and lunch always available to them."

Sorace added she recently joined more than 200 mayors at the annual meeting of the U.S. Conference of Mayors to discuss key issues, including housing and public safety. She underscored cities across the country are making progress on public safety, highlighting Lancaster's achievement of its lowest homicide rate since 1983.


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While cuts to food support programs and Medicaid gained attention as the debate over the budget bill went on, there is also a long-term likelihood it will result in automatic spending cuts to Medicare.

According to the Congressional Budget Office, the reconciliation bill is projected to add more than $3 trillion to the deficit over 10 years. If the estimate is accurate, the Statutory Pay-As-You-Go Act would require the executive branch to enact automatic spending cuts, including 4% annual cuts to Medicare starting in January, translating to around $500 billion in cuts over 10 years.

John Geer, professor of political science at Vanderbilt University and co-director of the Vanderbilt Poll, said a spring survey found Tennesseans were broadly opposed to cuts.

"We ask about Tennesseans' willingness to support cuts to Medicaid, Medicare, Social Security, veterans, etc.," Geer outlined. "And the truth of the matter is that Tennesseans are opposed to cuts in any of these programs. And it doesn't matter your partisan stripe, whether you're a liberal Democrat or a conservative MAGA-ite, you don't want to see these programs cut."

More than 1.5 million Tennesseans depend on Medicare. Congressional action would be needed to avoid automatic cuts, likely requiring a 60-vote majority in the Senate.

While funding to research under the National Institutes of Health would not be subjected to automatic cuts, the Department of Government Efficiency has already fired 2,500 researchers at the NIH and canceled more than 800 research grants. Geer's polling found more than 70% of Tennesseans oppose cutting funding for basic research.

"We asked a battery of questions about cutting research at universities, at hospitals, for drug discovery, etc., and again, there's partisan differences," Geer reported. "The MAGA folks, so to speak, are happy to do the cutting but the rest of the state has concerns."

The poll found 73% of Tennesseans support research at teaching hospitals and 66% supported research at universities.


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