South Dakota

South Dakota

I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In most states I've been able to get more recent enrollment data from state websites and other sources. For South Dakota, I'm using estimates based on raw data from the South Dakota Dept. of Social Services for January 2021 and beyond.

South Dakota is one of 12 states which still hasn't expanded Medicaid eligibility under the ACA (13 if you include Missouri, whose voters expanded the program last year...but which the state legislature refuses to fund).

South Dakota

 Now that I've developed a standardized format/layout & methodology for tracking both state- and county-level COVID vaccination levels by partisan lean (which can also be easily applied to other variables like education level, median income, population density, ethnicity, etc), I've started moving beyond my home state of Michigan.

Here's South Dakota:

WARNING: The CDC lists ~67,000 South Dakota residents (a whopping 21.8% of the total fully vaccinated) whose county of residence is unknown; this could impact the trendline significantly.

South Dakotans Decide Healthcare

 

Back in January, I. noted that:

...over the past few years, the voters of some of those states have decided to take it upon themselves to force their legislators/governors to expand Medicaid anyway, via statewide ballot initiative campaigns:

The ACA was originally designed with the intention that all documented Americans living in all 50 states (+DC) earning up to at least 138% of the Federal Poverty Level (FPL) would be eligible for Medicaid. Unfortunately, the 2012 NFIB v. Sebelius ruling by the U.S. Supreme Court stated that Medicaid expansion under the ACA had to be left up to each individual state.

This meant that each state had to decide, whether by legislation, executive order (depending on the state) or ballot initiative, whether or not to expand the low-income public health program or not. Under the ACA, any state which does so will have 90% of the cost paid for by the federal government, while the state has to pony up the other 10% of the cost.

Of all the elected officials who have been aping Donald Trump's horrific COVID-19 pandemic denialism, perhaps none have been worse (at least in terms of actual policy impact) than Republican South Dakota Governor Kristi Noem.

Not only has Gov. Noem refused to take any significant action to slow the spread of COVID-19, she's openly mocked those who do and is even starring in TV ads encouraging tourism of South Dakota based on her refusal to impose any reasonable measures using federal COVID-19 relief funding...even as South Dakota has become the second worst COVID hot spot in the nation (first place? SD's neighbor to the north...North Dakota).

In response to widespread criticism, Gov. Noem today penned an Op-Ed for the Wall St. Journal in which she argues that everything is actually peachy-kean in the Mount Rushmore State:

South Dakota's 2021 individual & small group market rate filings are up, and there's not much to say about any of them: Individual premiums are going up around 2.6%, small group market policies around 2.8% overall statewide.

I'm not sure how this happened, but it looks like I missed posting about South Dakota's requested 2020 premium rate filings. No matter, though, because the approved avg. rate increases (for unsubsidized enrollees) are exactly the same as what Avera Health Plan and Sanford Health Plan asked for anyway.

Statewide, South Dakota is looking at 6.5% average hikes for 2020.

MLR rebate payments for 2018 are being sent out to enrollees even as I type this. The data for 2018 MLR rebates won't be officially posted for another month or so, but I've managed to acquire it early, and after a lot of number-crunching the data, I've recompiled it into an easy-to-read format.

But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:

This is a pretty minor update, but I'm trying to lock in all of the approved 2019 rate changes as they come in. Last month, South Dakota's two carriers, Avera and Sanford, posted requested rate increases which I thought were 2.6% and 10.0% at the time. I also estimated their relative enrollment at around 27,000 and 4,000 enrollees apiece for market share calculations, which gave a statewide average increase of around 3.5%.

I checked the South Dakota Insurance Division website again today, and it certainly looks like the filings have been approved by the state insurance regulators...however, when I double-checked the filings themselves, it looks like they were actually slightly lower than I thought: 2.5% and 9.7% respectively.

In addition, I was able to find the hard enrollment numbers for each...the total is pretty close to what I had it at (29,180 vs. 31,000), but the splut is quite different. Insetad of Avera still having an 87% market share, it looks ike the split is more like 63/37 this year. Since Sanford is requesting a significantly higher increase than Avera, that means the weighted statewide average is higher as well...around 5.2% instead of 3.5%.

South Dakota has two ACA indy market carriers, Avera and Sanford. The relative enrollment market shares are based on last year's numbers. The 14.4% #ACASabotage impact assumes 2/3 of the Urban Institute's projections to err on the side of caution.

THe average unsubsidized SD indy market enrollee pays $624/month this year; instead of that dropping by around $68/month, it's expected to increase by $22...for a total monthly difference of $90.

Assuming that's accurate, this means unsubsidized SD residents will be paying over $1,000 more apiece next year than they'd otherwise have to.

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