RAPID CITY, S.D. — South Dakota is one of 14 states that has not expanded Medicaid under the Affordable Care Act, a move that would improve healthcare services for the state’s large American Indian population, according to one expert.
Nurse Margaret Moss has spent 30 years researching and educating the public about the health of indigenous people. South Dakota has the fourth-largest percentage of Native Americans in the U.S., with rates of death from heart disease, diabetes, pneumonia and other causes that are significantly higher than non-Hispanic whites. And Moss said the numbers have been static for three decades.
“People think American Indians are the past, they’re not around anymore,” Moss said. “And if you don’t have a very good understanding or view of the history or politics, or culture of American Indians in a state, then you’re not going to vote for things.”
Gov. Dennis Daugaard appointed a coalition four years ago with the goal of improving healthcare for American Indians. But opposition from fellow GOP lawmakers led him to decide against applying for Medicaid expansion, and the coalition was disbanded last month.
In South Dakota, 36 percent of the 50,000 state residents who would qualify for expanded Medicaid are Native Americans. The state’s Argus Leader newspaper recently reported the median life expectancy for Native Americans in South Dakota is 21 years shorter than the state average.
Moss said a huge obstacle for improving healthcare is a patient misidentification, which is higher for American Indians than any other group.
“So, if the numbers are all wrong, we don’t even really know what are the true death rates, what are the true cancer rates, or admission rates, access rates,” she said. “We don’t know a whole lot because nobody asks, or they guess.”
In the 1800s, the U.S. government promised to provide health services for tribes in exchange for their land. But Moss said the federal Indian Health Service is chronically underfunded. She noted there are now 573 federally recognized U.S. tribes. But when addressing policymakers, she’s found few are familiar with their own state’s demographics.
“‘Do you know the tribes that are there, and what are they, and whatever?’ And no one ever knows!” Moss said. “I said if you don’t know that, how can I even get to the intricacies of their specific problems.”
The Indian Health Service is one of several agencies affected by the last government shutdown.