SD County level data – uninsured eligible for health insurance under Medicaid expansion and federal exchange subsidies

QUESTION:  How many uninsured South Dakotans per county would be eligible for health insurance under Medicaid expansion and federal exchange subsidies?

 ANSWER: Analysis of Census Bureau 2010 SAHIE data[1] (the most recent available) reveals there are 678,859 South Dakotans who are non-elderly (under 65 – the eligibility age for Medicare).  Of this South Dakota age group, 94,404 do not have health insurance.  The majority of these uninsured are adults. Their household incomes in 2010 were: 

• 40,164 or 43% of uninsured South Dakotans lived in households with incomes below 139% – the income limit for Medicaid Expansion
• 45,532 or 48% of uninsured South Dakotans live in households with incomes between 139% to 400% – the income range eligible for federal subsidies to purchase private health insurance on the exchange
• 8,707 or 9% of uninsured South Dakotans live in households with incomes above 400% FPL – theses higher income households are not eligible for subsidies or Medicaid expansion.

SD Budget & Policy Project analyzed Census Bureau 2010 SAHIE data to create county specific graphs illustrating how may uninsured South Dakotans are in the county and how many fall into income eligibility categories for health insurance under provisions of Medicaid Expansion and Federal exchange subsidies. Minnehaha, Pennington, Lincoln, Brookings, Brown and Meade had the highest uninsured population.  To see data from every county, check the below table or this link to graphs for all counties in the state. 

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 SD Budget & Policy Project analyzed Census Bureau 2010 SAHIE data to create county specific graphs illustrating how may uninsured South Dakotans are in each county and how many fall into income eligibility categories for health insurance under provisions of Medicaid Expansion and Federal exchange subsidies. 

Link to data source:  http://www.census.gov/did/www/sahie/data/interactive/index.html,http://www.census.gov/did/www/sahie/data/interactive/index.html

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QUESTION:  Which counties in South Dakota have uninsured residents who would be eligible for government health insurance coverage if South Dakota expands Medicaid?

ANSWER:  All of them. 

Check out SD B&PP analysis of Census Bureau 2010 SAHEI data[i]  (the most recent available) detailing the number of uninsured non-elderly adults are in each South Dakota county..   LINK:  All SD counties have residents eligible for Medicaid Expansion

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South Dakota’s decision on Medicaid Expansion in the spotlight  with opportunity for public testimony.

At the end of the 2013 SD Legislative Session, Governor Daugaard announced he would be forming a task force to further study the pros and cons of Medicaid Expansion in South Dakota. 

On April 19th the first meeting of that task force, named the Medicaid Opportunities and Challenges Task Force, was announced in state news.   The meeting is scheduled to be held Tuesday, April 23, 2013 3:00 p.m. – 7:00 p.m. & Wednesday, April 24, 8:30 a.m. – 3:00 p.m. at Red Rossa Grille – Hills Meeting Room in Pierre, SD. 

The meeting agenda indicates the public will have a chance to testify for or against Medicaid Expansion between 5:30 and 7:00 PM on Tuesday 4-23-13. 

Committee Chair Deb Bowman, Senior Advisor to the Governor informed SD Budget & Policy Project:  ”The purpose of this Task Force is to identify the pros and cons of South Dakota expanding Medicaid so we will ask that public testimony be focused on the “pros and cons” of Medicaid expansion.  Testimony will be limited to 5 to 10 minutes per person depending upon the number of individuals who wish to testify.  There will be a sign-in sheet at the meeting for those who wish to testify in front of the task force.”  She further clarified “We do not need information about members of the public who will be attending the meetings as these are public meetings and anyone who wishes to attend may.  The room will be set up accordingly.”

SD Budget & Policy Project has been researching Medicaid Expansion:  A South Dakota decision for the past eight months and providing public education opportunities regarding the impacts in South Dakota.

See research links here. 

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SD Budget & Policy Project shares research with SD Indian Business Association Convention

On April 12, 2013, research describing Medicaid Expansion – Impact on health care for Indian Country was shared with attendees of the South Dakota Indian Business Alliance convention in Rapid City. 

Discussion centered on the unique impact Medicaid Expansion would have for South Dakotans who are American Indians:

•  IHS (Indian Health Service) is able to bill Medicaid for services, stretching IHS allocations.

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Two amendments EXPANDING MEDICAID among list for Joint Appropriations Committee

An unofficial copy of general appropriations committee amendments has been circulating among legislators and lobbyists in Pierre  today although an official copy has yet to be released to the public. 

The 72 amendments include two that expand Medicaid in SD in accordance with the affordable care act.   

amendment #8 (ug):  To expand South Dakotan’s Medicaid Program in accordance with the Affordable Care Act submitted by B. Hunhoff for $1,499,482 million in general funds and $58,294,779 in federal funds.

amendment #9 (un) :  To expand South Dakota’s Medicaid Program in accordance with the Affordable Care Act and to include a trigger mechanism submitted by Adelstein for $1,499,482 in general funds and $$58,294,779 in federal funds. 

The funding would cover Medicaid Expansion costs in South Dakota for the last half of FY14 (from 1-1-14 through 6-30-14).

See additional research compiled by SD B&PP on Medicaid Expansion - A South Dakota Decision

The Joint Appropriations Committee isn’t scheduled to meet at 9:00 am Thursday morning 3-7-13 and has not confirmed when they will take public testimony on the amendments.   If citizens wish to contact committee members, amendment sponsors or their legislator  about any of the possible amendments, click the preceding links to contact info on the SD Legislative Research Council website.

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According to the SD Constitution¹ it now takes a simple majority of South Dakota voters to change a law or amend the constitution.   South Dakotans can make changes with a ballot measure – referring a law, initiating a new law or amending the constitution.

Senate Joint Resolution 2 (SJR2) proposed a state-wide vote to change the constitution’s simple majority requirement to a supermajority (two-thirds of voters) to pass initiated measures² or constitutional amendments³ “that have the effect of increasing the rate of taxation by the state.”⁴  When a vote requires a supermajority to pass, the minority of voters (1 of 3) effectively control the outcome of the election. 

SJR2 was amended by and  passed out of Senate Tax Committee on 1-25-13 with a 6-1 vote, passed the Senate by a vote of 25 to 10, passed the House Judiciary Committee on 2-4-13 with a 8-4 vote but was ultimated defeated in the house both on initial vote 34-35 and reconsideration 32-35.

Joint Resolutions require only a simple majority to pass each house and do not require a governor’s signature.  Had it passed and been placed on 2014 SD ballot, a simple majority vote of the people would have been required to pass the constitutional amendment, restricting future measures from 2016 forward to a two-thirds majority vote. 

According to the office of the SD Secretary of State,⁵ there are no other portions of the constitution that require a two-thirds majority vote for amendment. SJR2 language also requires a super-majority to “further amend this [new] section of the Constitution.”

South Dakota was the first state to adopt initiative and referendum on a statewide level and did so in 1898.⁶ The simple majority ratification criteria has been part of the SD constitution for 115 years.   

See previously published SD B&PP descriptive research on Ballot Measures in South Dakota. 

¹SD Constitution Article XI, §13 and Article  XXIII § 3

²SD Constitution Article XI, section 13 – proposed change increases from simple majority to “consent of a two-thirds vote of the people in exercise of their right of initiative to change the rate of taxation imposed by the state of South Dakota on personal,or corporate income or on sales or services, or the allowable levies of the percentage basis for determining valuation as fixed by law for purposes of taxation on real or personal property. 

³SD Constitution Article XI NEW SECTION 16  includes statement “any amendment to this constitution that has the effect of increasing the rate of taxation by the state or that has the effect of imposing any new tax, or that has the effect of extending the imposition of a tax beyond the defined period of time for which it was imposed, or that further amends this section of the Constitution, is deemed to be approved by the people only by consent of a two-thirds vote of the people.

⁴The Title of Senate Joint Resolution 2 is:  Proposing and submitting to the electors at the next general election amendments to Article XI of the constitution of the State of South Dakota, relating to the vote required to increase taxes.

⁵Consultation with SD Secretary of State office 2-12-13.

⁶Initiative & Referendum Institute at the University of Southern California.  http://www.iandrinstitute.org/South%20Dakota.htm  See David Schmidt, Citizen Lawmakers: The Ballot Initiative Revolution (Temple University Press, 1989).

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According to the SD Constitution¹ it now takes a simple majority of South Dakota voters to change a law or amend the constitution.   South Dakotans can make changes with a ballot measure – referring a law, initiating a new law or amending the constitution.

Senate Joint Resolution 2 (SJR2) proposed a state-wide vote to change the constitution’s simple majority requirement to a supermajority (two-thirds of voters) to pass initiated measures² or constitutional amendments³ “that have the effect of increasing the rate of taxation by the state.”⁴  When a vote requires a supermajority to pass, the minority of voters (1 of 3) effectively control the outcome of the election. 

SJR2 was amended by and  passed out of Senate Tax Committee on 1-25-13 with a 6-1 vote, passed the Senate by a vote of 25 to 10, passed the House Judiciary Committee on 2-4-13 with a 8-4 vote ,was defeated in the house but a reconsideration vote will be held- probably later yet today..

Joint Resolutions require only a simple majority to pass each house and do not require a governor’s signature.  If it passes and is placed on 2014 SD ballot, a simple majority vote of the people would be required to pass the constitutional amendment, restricting future measures from 2016 forward to a two-thirds majority vote. 

According to the office of the SD Secretary of State,⁵ there are no other portions of the constitution that require a two-thirds majority vote for amendment. SJR2 language also requires a super-majority to “further amend this [new] section of the Constitution.”

South Dakota was the first state to adopt initiative and referendum on a statewide level and did so in 1898.⁶ The simple majority ratification criteria has been part of the SD constitution for 115 years.   

See previously published SD B&PP descriptive research on Ballot Measures in South Dakota. 

¹SD Constitution Article XI, §13 and Article  XXIII § 3

²SD Constitution Article XI, section 13 – proposed change increases from simple majority to “consent of a two-thirds vote of the people in exercise of their right of initiative to change the rate of taxation imposed by the state of South Dakota on personal,or corporate income or on sales or services, or the allowable levies of the percentage basis for determining valuation as fixed by law for purposes of taxation on real or personal property. 

³SD Constitution Article XI NEW SECTION 16  includes statement “any amendment to this constitution that has the effect of increasing the rate of taxation by the state or that has the effect of imposing any new tax, or that has the effect of extending the imposition of a tax beyond the defined period of time for which it was imposed, or that further amends this section of the Constitution, is deemed to be approved by the people only by consent of a two-thirds vote of the people.

⁴The Title of Senate Joint Resolution 2 is:  Proposing and submitting to the electors at the next general election amendments to Article XI of the constitution of the State of South Dakota, relating to the vote required to increase taxes.

⁵Consultation with SD Secretary of State office 2-12-13.

⁶Initiative & Referendum Institute at the University of Southern California.  http://www.iandrinstitute.org/South%20Dakota.htm  See David Schmidt, Citizen Lawmakers: The Ballot Initiative Revolution (Temple University Press, 1989).

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Estimates show increasing state continuing revenues for the next two budget years with fluctuating one-time revenue amounts

SD is expecting $1.349 billion in general fund revenues in FY13 and $1.328 billion in revenues in FY14.  This does not reflect a decrease in continuing receipts.  In fact continuing receipts (those that come into the SD state general fund on an ongoing basis) are expected to increase.  See the graph below.  

Continuing revenues are adjusted by any anticipated one-time revenues.  One-time revenues are projected higher in FY13 at $86 million than in FY14 at $8 million.

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American Indian and Alaska Native Poverty Rate About 50 Percent in Rapid City, S.D., and About 30 Percent in Five Other Cities, Census Bureau Reports

The poverty rate for American Indians and Alaska Natives in Rapid City, S.D. (50.9 percent) was around three times the rate in Anchorage, Alaska (16.6 percent) and about 30 percent or greater in five other cities most populated by this group (Gallup, N.M.; Minneapolis; Rapid City, S.D.; Shiprock, N.M.; Tucson, Ariz.; and Zuni Pueblo, N.M.), according to American Community Survey data collected from 2007 to 2011 by the U.S. Census Bureau. See figure.

Nine states had poverty rates of about 30 percent or more for American Indians and Alaska Natives (Arizona, Maine, Minnesota, Montana, Nebraska, New Mexico, North Dakota, South Dakota and Utah).  

“With the American Community Survey, we can look at the poverty rates for even the smallest race and Hispanic-origin groups,” said Suzanne Macartney, an analyst in the Census Bureau’s Poverty Statistics Branch.

These figures come from Poverty Rates for Selected Detailed Race and Hispanic Groups by State and Place: 2007-2011, an American Community Survey brief that presents poverty rates by race and Hispanic origin for the United States, each state and the District of Columbia. For the nation and each state, poverty rates are summarized for the major race groups. For the nation, each state and selected places, poverty rates are summarized for American Indians and Alaska Natives, detailed Asian groups with populations of 750,000 or more, Native Hawaiian and Other Pacific Islander groups with populations of 25,000 or more and Hispanic-origin groups with populations of 1 million or more.

Two race groups had poverty rates more than 10 percentage points higher than the national rate of 14.3 percent: American Indian and Alaska Native (27.0 percent) and black or African- American (25.8 percent). Rates were above the overall national average for Native Hawaiians and Other Pacific Islanders (17.6 percent), while poverty rates for people identified as white (11.6 percent) or Asian (11.7 percent) were lower than the overall poverty rate. Poverty rates for whites and Asians were not statistically different from each other. The Hispanic population had a poverty rate of 23.2 percent, about nine percentage points higher than the overall U.S. rate.

The American Community Survey provides a wide range of important statistics about people and housing for every community across the nation. The results are used by everyone from town and city planners to retailers and homebuilders. The survey is the only source of local estimates for most of the 40 topics it covers, such as education, occupation, language, ancestry and housing costs for even the smallest communities. Ever since Thomas Jefferson directed the first census in 1790, the census has collected detailed characteristics about our nation’s people. Questions about jobs and the economy were added 20 years later under James Madison, who said such information would allow Congress to “adapt the public measures to the particular circumstances of the community,” and over the decades allow America “an opportunity of marking the progress of the society.” 

Press Release from the US Census Bureau

CB13-29

Melanie Deal

Public Information Office

301-763-3030

e-mail: pio@census.gov

• bar chart 2.19.13.pdf

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