The American health care system is a mess. Everywhere I go I hear about outrageous medical bills South Dakotans receive, the staggering cost of prescription drugs, and the loss suffered by rural communities as local hospitals and nursing homes shut down. The U.S. spends over $4 trillion on health care annually. Numerous studies concluded that roughly 25% of such spending is unnecessary. That amounts to $1 trillion of wasteful spending every year. What do we receive for paying top dollar? Compared to similar countries, we get worse outcomes for life expectancy, infant mortality, unmanaged diabetes, and asthma to name but a few conditions.

Our health care system desperately needs reform to reduce waste while maximizing both affordability and access. Despite its flaws, the Affordable Care Act (ACA) was a step in the right direction. It led to the lowest uninsured rate in our history by enabling over 30 million Americans to access quality, affordable health care. It also ensured 150 million Americans with pre-existing conditions would not be summarily denied access. Senator Thune originally voted against the ACA and has repeatedly voted to repeal it. Despite the ACA’s progress, over 31 million Americans still do not have health care coverage.

As Senator, I will advocate for maximum access to quality, affordable health care and affordable prescription drugs for every American by acting to:

  1. Expand Medicaid. When the ACA was signed into law, it raised the income levels for Americans to qualify for Medicaid from 100% of the floor poverty level to 138%. The Supreme Court ruled that each state had the option to adopt or refuse Medicaid Expansion. Currently, 12 states including South Dakota have refused Medicaid Expansion. Expansion would give over 40,000 working-class South Dakotans access to health care coverage not provided by their employer. It would also improve the fiscal stability of struggling rural hospitals by dramatically reducing uncompensated care. South Dakotans have the power to bypass obstructionist career politicians in our state government by voting to approve Medicaid Expansion in November. If it is approved, our state politicians may still try to overturn the will of the people as they have done so frequently in the past. In such a case, I will support pending legislation in Congress allowing Americans in states that have refused Medicaid Expansion to purchase subsidized health insurance in the ACA marketplace.
  2. Permanently extend ACA premium tax credits. The ACA included tax credits correlated to taxable income as an incentive to purchase health insurance. While helpful, many people still found it difficult to afford health insurance. The American Rescue Plan of 2021 made such tax credits adjustable so no American paid more than 8% of their income on health insurance premiums. This change led to the lowest uninsured rate in our history. These tax credits are set to expire in 2025. Permanently extending the credits will allow millions of Americans to retain affordable health insurance. Sen. Thune not only voted against this legislation to reduce health insurance premiums, he voted to repeal the ACA numerous times. This would take us back to the days when over 130 million Americans with preexisting conditions could be denied health care coverage.
  3. Add a Medicare Option. In 2021, 10% of all American counties had only one health insurer offering coverage. This lack of competition deprives far too many Americans the opportunity to choose the best health care plan for their situation. Availability of another option, Medicare, is blocked by career politicians who refuse to allow Americans the opportunity to purchase Medicare coverage. According to the Kaiser Family Foundation, 94% of Americans over age 65 are satisfied or very satisfied with Medicare. Moreover, Medicare costs less than private insurance. Senior citizens already have a choice between traditional Medicare or a Medicare Advantage plan administered by private companies. All South Dakotans deserve the same opportunity to purchase Medicare coverage or a private health insurance plan. Multiple past proposals creating a Medicare Option were rejected with Senator Thune helping organize Republican resistance.
  4. Reduce Prescription Drug Prices. With a yearly cost averaging $1300 per person, Americans pay more for prescription drugs than anyone else in the world. Exorbitant drug prices impose a significant financial and health penalty on the American people. For example, 3 in 10 citizens do not take their drugs as prescribed due to high costs. If prescription drugs were more affordable, everyone would benefit from lower insurance premiums, small businesses with employer-sponsored health insurance would save money, and no American would have to choose between eating, paying rent, or filling a prescription. The recent Inflation Reduction Act capped Medicare Part D total out-of-pocket spending at $2,000, limited the monthly cost of insulin products to $35 for Medicare beneficiaries, and authorized the federal government to negotiate prices for some top-selling drugs covered by Medicare. Yet 200 million Americans not on Medicare are still suffering. Over 80,000 South Dakotans are diabetic and another 220,000 are prediabetic. I support capping the out-of pocket cost of insulin at $35 per month for all. I want to ensure employer-sponsored health care plans and ACA exchange plans can negotiate the best possible drug prices for all Americans. We need to incentivize drug manufacturers to spend less money on advertising and more on research and development. Additionally, I will advocate for a treaty with the European Union and Canada to establish common drug development, testing, and approval standards for a common drug market in all participating countries. Such a treaty would open up most of the developed world as a potential market for new drugs thereby reducing costs while maximizing access.
  5. Reproductive Health Care. Americans justifiably expect to make reproductive decisions themselves without undue government interference. For nearly 50 years, American women relied upon the freedom to make such choices as a matter of fundamental personal right. The U.S. Supreme Court’s recent decision in Dobbs v. Jackson Women’s Health Organization eliminated that constitutionally protected right instead making it subject to the discretion of state government politicians. The International Covenant on Civil and Political Rights–a human rights treaty that became legally binding upon the U.S. after ratification in 1992–is interpreted to require the elimination of barriers to safe and legal abortion. Despite the Dobbs decision, the treaty imposes an international legal obligation upon the federal government to prevent states from criminalizing abortion. The Roe v. Wade decision correctly articulated that unrestricted maternal choice and a state’s legitimate interest in protecting both maternal health and the “potentiality of human life” must be assessed differently depending upon the stage of pregnancy. Reproductive health issues, however, are not only about the right to choose. My agenda also includes working to maximize access for pre and postnatal care, reduce maternal mortality, and ensure new families do not start family life mired in debt from giving birth.
  6. Protect Long-Term Care. Our senior citizens and their families are dealing with a worsening elder care crisis. Across South Dakota, I hear about the growing shortage of nursing homes and assisted living facilities. There are significant problems in this industry including chronic worker shortages, abuse and neglect to the patients, unsatisfied resident needs, quality problems, worker training and competency, and lack of integration with medical care. Long-term care is so expensive that it can easily deplete a lifetime of savings in a few years. The average monthly rent for a South Dakota nursing home is $6,060. Medicare does not cover nursing homes so senior citizens dispose of a lifetime of financial assets to qualify for Medicaid coverage. I support more robust investments into Home and Community Based Services. Such services allow senior citizens to remain in their own homes–their overwhelming preference–while receiving necessary care to improve quality of life. This shift would also create thousands of good paying jobs. Additionally, I support expanding Medicare to include long-term care. Shifting away from Medicaid coverage will disincentivize seniors from disposing of all assets thereby enabling them to bear at least part of the cost of their care so struggling long-term care facilities do not rely solely upon Medicaid compensation rates.

In sum, American health care costs far too much and remains inaccessible for far too many. As a result, it requires significant structural changes to correct both problems. Career politician Senator Thune, who has platinum government health insurance for his family, believes the only problem with our health care system is the continuing existence of the ACA, Medicare, and Medicaid. As Senator, I will do everything I can to enable you and your family members to live a life of meaning and purpose free from worry about having no or inadequate health care coverage.