South Dakota is poised to launch a Medicaid expansion this summer, after voters approved the idea last fall, but there is a legislative push to add a wrinkle to the eligibility process.

A Senate committee is expected to ramp up debate on a plan to ask voters in 2024 whether the expanded Medicaid program should include a work requirement. The resolution has already cleared the House, and said the requirement would apply to "able-bodied" recipients.

Sandy Frentz, retired public health manager for the City of Sioux Falls and former co-chair of the American Heart Association Medicaid Expansion Cabinet, said it is the wrong thing to do, given the promise of helping uninsured South Dakotans, and would create too many headaches for certain situations.

"What if we have somebody who's eligible that is working that ends up with a catastrophic health diagnosis and is unable to work?" Frentz asked.

She pointed out it creates burdens for administrators, especially if the state has to argue over the scope of the term "able-bodied." Sponsors of the plan contended it is about incentivizing people to work, and said they simply want to ask voters how they feel about the idea.

Tony Burke, state government relations director for the American Heart Association of South Dakota, argued voters already expressed their opinion.

"They wanted this to be implemented, they want it to be implemented swiftly, in its current way, shape and form," Burke asserted.

For any lawmaker concerned about fraud, he noted the state's program is nationally recognized in the area of prevention.

A Department of Social Services report noted South Dakota is one of a handful of states exempt from certain audits due to the low prevalence of provider fraud.

Under the Affordable Care Act, the federal government covers most Medicaid expansion costs for states.

While Black Maternal Health Week is wrapping up, health disparities for pregnant Black women continues to be an issue.

From April 11-17 this year, the high death rate of Black mothers is in the spotlight. Black women are three times more likely to die from pregnancy-related causes than their white counterparts.

Dr. Patricia Egwuatu, a family practice physician at Kaiser Permanente in Seattle, said racism is at the root of the disparities, which create barriers to health care access. She pointed out lack of access can lead to problems during pregnancy that are preventable or treatable.

"They may exist prior to pregnancy and then it gets worse during pregnancy if it's not managed as part of that maternity care," Egwuatu emphasized. "There are more pregnant women that have chronic conditions such as hypertension, diabetes and heart disease that are amplified during pregnancy."

The White House released a proclamation recognizing Black Maternal Health Week. The Biden administration began recognizing the week in 2021.

Egwuatu noted there are some warning signs any pregnant woman should be aware of and check in with their physician if they develop.

"You might get some changes in your vision that is not your normal. So, like, fuzziness, you can't see as well, or an excruciating headache," Egwuatu outlined. "You could also develop new swelling in your lower extremities that's making it difficult to get around or even new shortness of breath."

Egwuatu stressed physicians also need to recognize the role of racism in medicine. She argued continuous medical education is important for learning how to confront biases, and it is important for doctors to understand how they can provide people with resources.

"Asking the questions about personal barriers," Egwuatu suggested. "Does a patient have issues with getting to work, child care, transportation? What's their education, what's their cultural background and language? And do they even have a cell phone so we can connect with them?"

Today, Connecticut health care advocates are holding a student day of action.

They will speak to state lawmakers about raising the age limit for undocumented immigrants eligible for HUSKY, the state's Medicare program. Undocumented people up to age 15 are eligible and the General Assembly is considering raising it to 18.

Yenimar Cortes, New Haven organizer for the group Connecticut Students for a Dream, said undocumented people not having health insurance is problematic.

"When it came to some stuff, like even a simple physical, my mom would have to like work and my dad would have to work like more shifts to be able to cover the costs," Cortes recounted. "It also meant getting sick was something we didn't want to do."

She added if they got sick, they would try home remedies before going to the hospital. Some people pay for visits out of pocket and take on medical debt. Some lawmakers opposed the age limit increase due to high costs, which studies estimated to be $83 million. However, the study noted expanding HUSKY could save hospitals between $63 million and $72 million.

Though uninsured rates fell during the pandemic, health officials are trying to ensure people maintain any coverage they have.

Luis Luna, coalition manager for the nonprofit HUSKY 4 Immigrants, said the pandemic helped advocates see the problem as a whole.

"It helped us see that health care is a fundamental human right," Luna asserted. "It helped us see that when people get sick and they don't take care of themselves their family suffers, and it helped us see that there's a really big disparity with health care access."

Several states have made health care affordable or available to undocumented immigrants. Luna added the hope is to make all immigrants, regardless of their status eligible for HUSKY.

A 2022 survey found most people support expanding HUSKY to all immigrants.

Today is National Healthcare Decisions Day, a day when everyone is encouraged to review their end-of-life planning. The 2024 Alzheimer's Association annual report predicts that the number of Americans 65 and older who are living with the most common form of dementia will double from nearly 7 million to 14 million patients by 2050.

Jessica Empeño, national director of clinical engagement with the end-of-life advocacy group Compassion & Choices, said legal matters are just part of the equation.

"The most important part is to have conversations about what matters most to you, what your wishes are, and share those things, not only with your family and your loved ones but with your health-care team," she explained.

People may want to put in writing who they want to be able to make decisions on their behalf once dementia progresses. They might consider whether in the future they would be OK with things like artificial hydration or nutrition, aggressive treatments or surgeries.

Compassion & Choices' website offers a free End of Life Decisions tool and a Dementia Values & Priorities Tool that helps people communicate and document their future health-care wishes, both for those who have early-stage dementia or those who just want to be prepared for the possibility.

Angela Schultz, California state advocacy director for Compassion & Choices, said people need to make a plan sooner rather than later.

"We just did recent polling, and 93% of Americans said that having an advanced directive and a health-care proxy and sharing that with your doctor is very important. But only 37% of Americans have done that," she said.

National Healthcare Decisions Day falls on April 16th, the day after tax day. It is a reference to the famous quote from Benajmin Franklin that "In this world, nothing is certain but death and taxes."