The federal governments newly proposed budget includes a staggering $1 trillion in cuts to Medicaid over the next decade. This move will create one of the most significant rollbacks of health care access in modern U.S. history, stripping 12 million Americans, including 13,000 South Dakotans, of their health coverage.
According to Makenzie Huber of South Dakota Searchlight, our state alone stands to lose $931 million in federal Medicaid funding by 2034. This isnt just a budget line item; its a direct threat to the health and economic stability of our communities.
Medicaid is a lifeline
Medicaid is more than a safety net. Its a lifeline for children, seniors, people with disabilities, and low-income adults. It ensures that children get a healthy start to life, that seniors receive long-term care and that working families can access the medical services they need to stay healthy and productive.
When people have access to Medicaid and health care in general, they are more likely to seek preventive care, report better health outcomes, experience lower rates of depression, and avoid crushing medical debt. These benefits ripple outward, strengthening families, communities, and the broader economy.
Who qualifies and who will lose?
In South Dakota, Medicaid eligibility is based on income and family size. It covers:
- Pregnant women earning up to 138% of the federal poverty level
- Children aged 018 in families earning up to 187% of the FPL
- Adults under 65 earning up to 138% of the FPL
These are not abstract statistics; they are our neighbors, coworkers, and family members. Cutting Medicaid means cutting off their access to care.
The budget bill includes a work requirement for non-disabled Medicaid recipients. Enrollees will have to regularly file paperwork proving they are meeting the work requirements. Other states that have implemented the work requirements have found it to be a significant financial cost, reducing the health benefits for enrollees.
Out-of-pocket costs will increase for Medicaid enrollees, specifically for appointments. The legislation requires states to charge a fee for some services that previously did not have a fee. Participants on a limited budget or fixed income may forgo medical services because of this cost.
The real cost of losing coverage
When health care becomes unaffordable, people delay or skip necessary treatment. This leads to worse health outcomes and, ironically, higher long-term costs. Many end up in emergency rooms for conditions that could have been managed with routine care. Others fall into medical debt, which can destabilize entire households.
According to the KFF Health Care Debt Survey, nearly half of U.S. adults say its difficult to afford health care. One in four report that they or a family member had trouble paying medical bills in the past year. Unsurprisingly, those most affected are people with lower incomes, those in poor health, and the uninsured.
A threat to rural health care
The impact of these cuts wont stop with individual patients. Rural hospitals and nursing homes, many of which rely heavily on Medicaid reimbursements, may be forced to reduce services and employees or shut down entirely. This would create health care deserts in parts of South Dakota, leaving residents without access to essential services.
Additionally, patients may need to take on more of the costs and receive less services that were previously supplemented by funds received from Medicaid.
The closure of even one rural hospital can be catastrophic, forcing patients to travel hours for care, delaying emergency treatment, and weakening the local economy.
We can and must do better
Health care is not a luxury. It is a basic human need and a cornerstone of a strong, resilient society. Slashing Medicaid funding may appear to save money on paper, but the real cost will be paid in human suffering, economic instability, and lost lives.
South Dakotans deserve better. We must speak out against these proposed cuts and demand a budget that protects not endangers our health and our future.
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