Cara Sanquist had an itchy spot on her shoulder and hoped it would go away.
But late at night she worried her melanoma had returned.
The 35-year-old is a nursing student at the University of Sioux Falls. She was first diagnosed with melanoma in 2019. But she put off a dermatology appointment for two months because she couldn’t pay for it.
“Is it back? I can’t afford for it to be back, but is it back?” Sandquist says. “It was really scary.”
Since her diagnosis, Sandquist has lived in Washington state and Minnesota. When the pandemic hit and she lost work, she was able to get Medicaid in both states. Sandquist had healthcare coverage until she moved to South Dakota.
“I went through two months of shoulder pain because I didn’t know how I was going to pay for it if I ended up needing surgery on it again,” Sandquist says. “Nobody should do that—put off their cancer checks because they don’t know how they’re going to afford it.”
Sandquist does not qualify for Medicaid in South Dakota because she does not meet a certain income threshold, nor is she pregnant. She supports expanding Medicaid in the state.
A new survey from SDPB, the Chiesman Center for Democracy and the University of South Dakota, shows that a majority of South Dakotans support Medicaid and Medicare expansion. Fifty-two percent say they’re definitely in favor of expansion. Another 20 percent say they’re probably in favor. There is no current plan to expand Medicare.
Two different groups want the state’s voters to expand Medicaid. They hope for a ballot measure next year.
Expansion would extend benefits to South Dakotans making about $17,000 a year or less. According to the Legislative Research Council, if that ballot initiative passes, Medicaid benefits would extend to an additional 42,500 South Dakotans.
Medicaid expansion would cost about $302 million. The federal government would cover 90 percent of that. The state covers the rest.
The latest coronavirus relief package from the federal government sweetens the Medicaid expansion deal. According to the Kaiser Family Foundation, the feds would give any hold out states money to cover the first two years of the program.
Five years ago, then-Governor Dennis Daugaard pitched lawmakers a proposal to expand Medicaid in South Dakota.
“It is a good deal. It is a very good deal,” Daugaard said.
Daugaard said it’s the state’s job to understand federal policy and take advantage of it. Here’s how he described his expansion proposal in 2016.
“This plan will fix the long-standing Indian Health Service reimbursement issue, secure better healthcare for Native Americans and cover 50,000 more South Dakotans at no cost to our state general fund,” Daugaard said then. “It will reduce the charity care expense that hospitals now pass on to patients like you.”
But Daugaard wanted the support of the legislature to expand Medicaid. He didn’t have it in the House.
Don Haggar was a House Republican that year. He proposed a bill requiring legislative approval for changes to Medicaid. He opposed Medicaid expansion then and the ballot questions out there now. He says government should not be involved in healthcare.
Haggar says his biggest concern is Medicaid expansion will crowd out those who need the service the most—children, those who are disabled and the elderly.
“Ultimately, Medicaid expansion will lead to higher taxes or cuts to essential services like first responders or education,” Haggar says. “Things that are really core functions of government.”
If expanded, the state’s share of Medicaid costs would increase by $20 million annually. Republican State Senator Jim Bolin says that money will come from somewhere.
“And I’m afraid it’s going to come out of the hide of the schools,” Bolin says. “If we expand Medicaid, I’m very confident that the state can’t support that on a long-term basis without a tax increase and that’s not going to happen.”
State Democrats say Medicaid expansion is a workforce development issue. State Senator Troy Heinert worked with the Daugaard administration on Medicaid expansion and was disappointed when the lawmakers failed to go along.
“Who do you think absorbs all the uncompensated care that hospitals absorb right now? At some point it’s the taxpayer,” Heinert says. “It’s just sad that we have to go through the referendum process because the governor and the legislature don’t realize the benefits that it would give to thousands of South Dakotans, many of whom are employed.”
After months of searching, nursing student Cara Sandquist found healthcare coverage. Because she’s a Minnesota resident she was able to claim residency and qualified for Medicaid in that state.
“Minnesota is basically saying ‘We’re going to give you a year grace period. You’re going to study. You’re going to work really hard. We’re going to take care of you. In the meantime—when you’re ready to work—we’re going to be ready for you.”
Sandquist was able to set up an appointment and got the news she was hoping for—no melanoma.
“What I was feeling in my shoulder was not what I thought it was,” Sandquist says. “I was just—I couldn’t believe it. Words can’t describe the kind of relief that you feel when somebody says we’re going to take care of you.”
Sandquist says she’s thankful for Medicaid coverage while finishing the yearlong nursing program. In the meantime, she says she’s going to work her tail off to become a great nurse for a hospital -- in Minnesota.