As President of the Rosebud Sioux Tribe, I am a firsthand witness to the profound healthcare challenges that our people face, a crisis that confronts Indian Country nationwide.

Nationally, compared to white adults, American Indian adults are almost three times more likely to lack insurance. In South Dakota the disparity is even greater. At the same time, people in our communities are also much more likely to experience serious health challenges like obesity, a physical disability, or a substance use disorder, making access to healthcare that much more critical.

While the Indian Health Service (IHS) plays a central role in the healthcare system for American Indians, millions of us are enrolled in Medicaid, which is celebrating its 56th anniversary this month. Medicaid provides health insurance for more than 80 million Americans nationwide, including more than a quarter of non-elderly American Indian adults and half of our children. From 2013 to 2018, the uninsured rate among American Indians fell from 28% to 20%, thanks to the increased access to health insurance created by the Affordable Care Act (ACA), including a major expansion of Medicaid.

Unfortunately, thousands of Native people in South Dakota and 11 other states are being denied this access to lifesaving healthcare because of political games that have nothing to do with what is best for our health. In these 12 states, which have failed to expand Medicaid because of partisan opposition to the ACA, millions of Americans — 16,000 South Dakotans among them — are trapped in a “coverage gap,” where they can’t afford private coverage but they also don’t qualify for Medicaid.

In South Dakota, American Indian groups like the Great Plains Tribal Chairmen’s Association are helping lead the fight to pass a ballot measure to expand Medicaid in our state, which would provide coverage to an additional 42,500 South Dakotans, including thousands of American Indians. Unfortunately, the state legislature keeps trying to put additional obstacles in our way, including seeking to raise the vote percentage needed for a successful ballot measure from 50% to 60%. But we are determined to succeed in this fight, starting with gathering enough signatures to get Medicaid expansion on the ballot, because the health of our families and communities are at stake.

Medicaid is a lifeline for Indian Country, plain and simple.

Although we are entitled to care from IHS or tribal facilities whether we are insured or not, proposals to expand access to Medicaid would benefit our communities in several ways. First, having health insurance from another source makes it easier for our people to access care from other providers when IHS facilities are geographically distant or over capacity. Second, having more patients insured by Medicaid would help increase reimbursements to IHS clinics, which are chronically underfunded and rely on this funding to provide care to those they serve.

We saw the benefits of expanding access to Medicaid for American Indian communities when Montana approved its own expansion in 2016. Over the course of two years, more than 15,000 newly eligible tribal members enrolled in Medicaid. The tribal and IHS-run facilities on the Blackfeet Reservation in northern Montana received an additional $13.6 million in federal reimbursements during that time, helping them provide care to thousands more people.

As we fight to finally win Medicaid expansion in South Dakota, Congress also has an important role to play in states that continue to refuse to expand coverage for families, seniors and veterans in their states. The Medicaid Save Lives Act, which was recently introduced in both the House and Senate, would help people in states that have failed to implement Medicaid expansion over the last decade access healthcare.

The Medicaid Saves Lives Act [S.2315 | H.R.4595] would help South Dakotans by creating a federal program for individuals currently in the “coverage gap” that would offer health care coverage for ACA’s essential health benefits, help with prescription drug costs, maternal and newborn care and other critical healthcare services. The bill also provides incentives to any holdout states that do decide to expand Medicaid, building on the incentives included in the American Rescue Plan passed earlier this year.

We will continue our efforts to ensure that our neighbors have access to the care they need, no matter who they are, what they look like, or how much money they have. And we expect Congress to do everything in its power to expand Medicaid in holdout states, including South Dakota. That starts with passing The Medicaid Saves Lives Act. Indian Country can’t afford to wait.

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President Rodney M. Bordeaux is currently serving in his fourth term leading the Rosebud Sioux Tribe. He holds concurrent leadership positions with the Great Plains Tribal Chairmen’s Association, the Great Plains Tribal Leaders Health Board, the National Congress of American Indians, and Dakotans for Health. Mr. Bordeaux received a Bachelor of Arts degree from Augustana College and a Master of Arts from Oglala Lakota College.

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