Despite numerous and often burdensome attempts by health plans and government programs over the past few decades to contain health care costs, our current health care system continues to suffer from unsustainable cost increases, excessive fragmentation and significant variations in quality.

Meaningful changes and increased accountability are being demanded by employers, consumers and tax payers who are paying the health care bills. For meaningful change and appropriate accountability to occur, however, changes must be clinically sound, and physicians need to lead the way.

Reforming the health system, advocating for medical homes for Medicaid patients, expanding Medicaid eligibility, and strengthening primary care are top issues for the South Dakota State Medical Association.

Read over our accomplishments during the 2017 legislative session. 

SDSMA's 2017 Advocacy Agenda

The problem of prescription drug abuse and its related health consequences is a significant public health problem. The SDSMA is at the forefront on this issue by providing physicians with helpful, evidence-based guidelines for prescribing opiate analgesics to both effectively treat pain and minimize patient risk. Through a special committee on pain management and prescription drug abuse, the SDSMA has developed a whitepaper, Opiate Analgesics for Chronic Non-Cancer Pain, to serve as a resource for physicians and prescribers when treating patients for chronic, non-cancer pain. Over the past several months, our committee has researched evidence-based guidelines based on a review of the literature by a diverse group of highly trained physicians. 

Download the SDSMA whitepaper, Opiate Analgestics for Chronic Non-Cancer Pain.

Download the checklist for prescribing opiates for chronic, non-cancer pain.

Marijuana

Download the SDSMA's whitepaper, Marijuana as Medicine.

Health System Reform

In February, Mary Carpenter, MD; Robert Van Demark, Jr., MD; Tom Hermann, MD; and Barb Smith attended the American Medical Association's (AMA) National Advocacy Conference and met with members of South Dakota's congressional delegation, with these Hill visits focusing on proposals to repeal the Affordable Care Act. The AMA is advocating that: 

Proposals should maintain key insurance market reforms, such as coverage for pre-existing conditions, guaranteed issue, parental coverage for young adults, as well as stabilize and strengthen the individual insurance market, ensure that low and moderate income patients are able to secure affordable and adequate coverage, and adequately fund Medicaid, Children’s Health Insurance Program, and other safety net programs.

Any new proposal should ensure that comprehensive coverage options remain available and affordable, regardless of income, age, or place of residence.

For those who gained coverage by reason of Medicaid expansion, new proposals must ensure that coverage remains available and affordable as well and that state governments that chose to accept enhanced federal funding are not disadvantaged in their efforts to improve and preserve the health of their citizens. Changes to the financing of Medicaid must also guarantee that the safety net remains strong and is able to respond quickly, not only to changes in enrollment but to sudden and unforeseen increases in necessary medical expenditures such as epidemics or break-through treatments for serious medical conditions.

The SDSMA recognizes that the current law can be improved and that there are problems that need to be fixed. However, SDSMA does not support changes to the health care system that would result in health care coverage being beyond the reach of those who are currently covered, that would weaken the health care safety net, or that would compromise the ability of physicians to provide care for our patients.

IPAB

The SDSMA has consistently expressed its opposition to the Independent Payment Advisory Board (IPAB) on several grounds. IPAB puts important health care payment and policy decisions in the hands of an independent body that has too little accountability and too much power to make indiscriminate cuts that adversely affect access to health care for patients.

We have already seen first-hand the ill effects of the broken SGR physician payment formula. IPAB would be another arbitrary system that relies solely on payment cuts. This would subject physicians to “double jeopardy” and would leave physicians in a position in which they would bear a disproportionate burden of any cuts under the IPAB.

Instead, we must focus on new payment and delivery models that give physicians the ability to improve patient care and reduce costs to stabilize Medicare now and in the future. We appreciate the need to reduce the federal budget deficit and control the growth of spending in Medicare; however, we believe this can best be achieved by Congress working in a bipartisan manner to reform the delivery system and improve quality, access and efficiency.

Medicaid/CHIP

Medicaid is a state and federally funded health care program that provides essential health care services to low-income patients. Without Medicaid, thousands more South Dakotans would be uninsured. Currently, Medicaid covers 116,000 South Dakotans. 

To qualify, patients must be low income, though being poor does not mean a patient will qualify. For example, low-income childless adults are not eligible even if their income meets the state’s Medicaid income requirements.

Medicare and Medicaid, which now cover 35 percent of health care in the U.S., often pay physicians less than it costs them to provide services. Commercial insurance companies’ payment rates, computed largely as a percentage of Medicare, have followed the government-run programs. This leaves many South Dakota physicians struggling to keep their practices open. As a rural state, South Dakota faces tough challenges in providing access to quality, affordable care for all of our citizens.

The medical community understands the financial challenges facing South Dakota and our country, and that there are no easy decisions for policymakers when it comes to balancing the needs of the state with the resources available. However, cutting payments for health care services is not an effective tool for controlling health care costs, and often exacerbates the cost of care. Without physicians to see patients, the health care delivery system cannot be effective. 

The SDSMA advocates not just for adequate funding for the Medicaid program, but for Medicaid eligibility expansion for those who make less than 100 percent of the federal poverty level, and for the program to promote wellness and prevention, coordinated care for those with chronic diseases, and assurance that all Medicaid patients have a medical home. 

Medicare

Every year for more than a decade, physicians faced a significant Medicare payment cut — the result of a flawed sustainable growth rate (SGR) formula. In April 2015, after years of advocacy from the SDSMA, American Medical Association, and other state medical societies, Congress passed historic SGR repeal legislation. This legislation contains core elements of a more reasonable and better-functioning Medicare program.

Strengthening Primary Care 

A primary care task force created by Gov. Dennis Daugaard in 2012 aimed to expand the state's educational capacity to train more primary health care providers for rural areas of South Dakota. The group was comprised of medical and health professionals, as well as policymakers. SDSMA Past-President Robert L. Allison, MD, represented the SDSMA on the task force. 

Task force recommendations focused on medical school class size, components of rural training for medical students, residency programs in the state, and physician assistant and nurse practitioner program capacity. Dr. Allison continues to serve on the task force's Oversight Committee to ensure accessibility to primary care for all South Dakotans -- particularly in rural areas of the state.