Julie Rovner follows up on a report she did for NPR in 2012 noting that Hobby Lobby and other corporations who want to deny women coverage for birth control are still discriminating on the basis of sex and pregnancy under the Pregnancy Discrimination Act, as determined by the Equal Employment Opportunity Commission in 2000. Furthermore, 28 states require insurers to cover FDA-approved contraceptive drugs and devices; 20 of those states offer religious exemptions, just as the Affordable Care Act did before yesterday's Hobby Lobby ruling, but few if any go as far as saying private corporations can hold religious beliefs and get out of covering contraception.

South Dakota has no such independent contraceptive requirement for insurance policies. Rep. Joni Cutler tried to create one with House Bill 1156 in 2010, but the bill did not pass the House. Senator Ed Olson offered a more general defense of contraception in 2008 with Senate Bill 164:

...It is the public policy of this state that the interest in freedom from unreasonable government intrusions into the private lives of citizens, and specifically the right of consenting individuals to obtain and use safe and effective methods of contraception without interference by governmental entities, shall be safeguarded and that the laws of this state shall be interpreted and construed to recognize and protect these rights [2008 SB 164, Section 2(3)].

Senator Olson's bill also would have clarified that contraception is not governed by South Dakota's abortion statutes, including the statute that allows pharmacists to refuse to fill prescriptions if they think those prescriptions will be used for abortions... the same false pretext under which Hobby Lobby won its battle in the war on women before the Supreme Court yesterday.

Worth noting: both Olson and Cutler are Republicans. They are no longer in the Legislature, but they demonstrate that when South Dakota Democrats blast the Hobby Lobby ruling and demand that health care decisions be made by women and their doctors, not their bosses, they can find a few allies and win a few votes across the aisle.


The Supreme Court ruled this morning that corporations can believe in God. I'm looking for the Scripture that says, "Blessed are the corporations...."

The Supreme Court thus ruled that Hobby Lobby and other pious corporations don't have to follow the law that requires employer health insurance policies to include contraception.

Sarah Stoesz of Planned Parenthood wrote in March that contraception isn't a religious issue; it's basic health care:

Since birth control became legal and widely available, women’s health has improved dramatically; the infant death rate has plummeted; and women have been able to invest in their education and careers. Not to mention that increasing access to birth control significantly reduces unintended pregnancy, which in turn reduces the abortion rate [Sarah Stoesz, "Birth Control Is Not a Religious Issue; It Is a Basic Health-Care Issue," MinnPost, 2014.03.25].

Stoesz saw coming this dire precedent: allow corporations to refuse to pay for emergency contraceptives and birth control pills because of their religious objections, and you open the door for corporations who practice Christian Science to refuse to pay for insurance for chemotherapy or antibiotics, for Jehovite corporations to refuse to cover blood transfusions (and maybe even provide legal cover for Jehovites to reassert their opposition to vaccines), and for some fundamentalist corporations to decline to cover any medical treatment other than prayer.

All of this assumes, of course, that a corporation, a legal fiction, a paper construct, can hold religious beliefs, an absurd position, insulting to every religion, that our Supreme Court has now posited as true.


John Hult exposes a glaring hole in HIPAA, the federal law that protects your medical privacy. The law requires your doctor to keep your medical history under wraps—not talk about your case outside of the office, not plunk your files down in front of reporters at a press conference, etc.

But Hult finds that if you're late on paying your medical bill and the hospital or clinic takes you to court for payment, all privacy bets are off:

Health care providers, health plans and health care clearing houses are barred from releasing confidential medical information, said Paul Stephens of the Privacy Rights Clearing House.

Collection agencies don’t fall under the privacy provisions of the Health Insurance Portability and Accountability Act, or HIPPA.

“Once you get into the judicial system, it would be up to the law and judge in that jurisdiction to determine what can be done with the information and how it’s handled,” Stephens said [John Hult, "Privacy Risk Rises with Push for Online Medical Records," that Sioux Falls paper, 2014.06.21].

Hult says the new electronic filing system adopted by South Dakoa's courts makes it easier for curious parties to access the medical information available in court documents. But First Circuit administrator Kim Allison says we shouldn't worry:

Online records will be easier to access, but a search by name alone won’t give the public access. Those searching records online need a specific case number, which generally would require a $20 background search on either the plaintiff or defendant.

That’s one reason why Allison doubts that individual debtors should worry about their personal information being widely available.

“Realistically, no one is going to look at small claims except the parties,” Allison said [Hult, 2014.06.21].

Ms. Allison misreads public concerns about privacy. We don't protect privacy with assumptions that nobody is going to look. We protect privacy by putting up curtains. Realistically, if the information is out there, someone (private investigators, bloggers, folks with axes to grind) can get it and publish it. HIPAA says our medical information should not be subject to such risk.

Hult notes that South Dakota law already protects some confidential information in court filings, like Social Security numbers and bank account information. It would be an easy and responsible step to add medical information, like the treatments and procedures your doctor has performed for you, to that list of protected information. Legislature, add courtroom medical information protections to your 2015 to-do list.


Subversion and hooch afoot! Unapologetic liberals are gathering for libations at Wiley's Tavern at 330 North Main in Sioux Falls after work today, 5 p.m., as they reconstitute the Sioux Falls chapter of Drinking Liberally. Among topics that may stir conversation:

The National Partnership for Women and Families finds South Dakota is one of the crappiest places to be a working mom:

NPWF grades for working mom conditions June 2014

Grades by state for legal protections for working mothers, based on state laws on family leave, sick leave, and other family issues. Data from National Partnership for Women and Families; map from Bloomberg Businessweek.

Hmm... probably won't see Governor Daugaard plastering that map on a banner ad for South Dakota in the Minneapolis airport... where NPWF finds much better conditions for working moms.

The Affordable Care Act still hasn't caught the United States up with other countries in terms of quality health care. For the fifth year in a row, the U.S. ranks last in the Commonwealth Fund's scoring of eleven industrialized nations' health care systems.

health-ranking 2013

(Click to embiggen!)

Continuing a long-standing trend (compare the numbers from 2010), the United States continues to spend far more (50% more than extravagant Switzerland, 88% more than colder Canada, 150% more than clammier Great Britain) per capita on health care than any of our industrialized counterparts. Interestingly, many of those countries also drink more alcohol per capita than we do. Hmm... Drinking Liberally Sioux Falls, what can you do about that?

Of course we know poor working-parent policy, inefficient health care, and all of our other problems are caused by irrational, ignorant, unempathetic conservatives... or are they? Discuss, tonight, Willy's Tavern, 5 p.m.!


The Affordable Care Act's Medicaid expansion is doing what Tim Johnson, Stan Adelstein, and Joe Lowe have said it would do in states smart enough to adopt it. More people are getting affordable health care, and hospitals are seeing lower rates of uncompensated care, the costs that hospitals forgive uninsured patients and spread out to the rest of us.

  1. In a survey of 465 hospitals in 30 states, the Colorado Hospital Association finds average charity care in Medicaid expansion states has dropped 30% in one year. Average charity care in ACA-embracing Colorado has decreased 36% in urban hospitals and 38% in rural hospitals. In anti-ACA states, charity care has increased 11%.
  2. Arkansas Governor Mike Beebe says hospitals in his Medicaid-expanding state saw a 24% drop in uninsured emergency room visits and a 30% drop in uninsured hospital admissions in the first quarter of this year.
  3. Tenet Healthcare finds a 33% decrease in uninsured and charity inpatient admissions and a 24% decrease in uninsured and charity outpatient visits in four Medicaid expansion states. The non-expansion states in its fold saw a 2% increase in uninsured and charity inpatient admissions and a 10% decrease in those cost-risky outpatient visits.

Numbers, numbers, numbers: expand Medicaid, and hospitals are more likely to get payment for treating the sick and injured.

Oh yeah: and it's nice to help more people get well.


GOP Senate candidate Mike Rounds can't tell the truth about Medicare. He can't even tell a consistent story about his own position on government-run health care.

Consider Rounds's statements about the Veterans Health Administration and the Affordable Care Act in this in-depth report from Northern Plains News. He says both programs are engaged in rationing, because rationing is a big scary word Republicans use to make us think we're in some leaky European lifeboat with Marxists hoarding provisions while Lady Astor swoons at the stern.

But notice that a guy who cries rationing is saying not enough health care is being dished out, at least to people he likes, if not to people in general. Rounds, unlike the conservative he claims to be, appears to believe that there's plenty of health care to go around, and he wants us to pay for it. Consider his statement on veterans' health care:

A lack of doctors and hiding behind bureaucracy to meet arbitrary goals, according to Rounds, are just ways the VA system meters out health care to veterans.

“Health care shouldn’t be rationed,” Rounds said in an interview Monday (June 2, 2014). “They should be allowed to go to another health organization” [Todd Epp, "Rounds Says the Federal Government Is in the Health Care Rationing Business," Northern Plains News, 2014.06.10].

Sending veterans to other health care providers sounds like a good idea to the U.S. House: they unanimously passed a bill to that effect yesterday. HR 4810 would let the VA outsource care for two years to clear the queue. But even reimbursing non-VA facilities at VA, Medicare, or Tricare rates, the VA will spend more money than it does currently. So conservative Mike Rounds is saying he wants more government-funded health care, not less.

Interestingly, Rounds doesn't trust the government to set reimbursement rates high enough to make providing some health services worth private hospitals' while. To pound this fear home, Rounds trots out his wealthy old dad again to scare old folks about the Affordable Care Act:

...Rounds is afraid the Independent Payment Advisory Board would set doctor reimbursements so low for lifesaving procedures for elders like his 86-year-old father Don, who has had a history of heart problems and operations, as to make them unprofitable. Thus, physicians and hospitals won’t offer the services or severely limit the number they perform.

“It’s a way of rationing health care. It’s wrong. It’s not what we want for our dads, our grandmas, for our moms, for our kids,” Rounds said [Epp, 2014.06.10].

Again, Rounds has two logical policy responses. He can advocate higher reimbursement rates, which means spending more tax dollars on health care. If Rounds doesn't want to spend more tax dollars on health care, then deep down he must be o.k. with rationing, just not rationing done by government. In his calls to repeal the Affordable Care Act, Rounds has yet to enunciate any policy other than free market voodoo, which also rations health care, but ensures that the biggest rations go to rich folks like his dad and his campaign donors.

Rationing is a scare word used to distract us from what Mike Rounds is really thinking. He's a conservative advocating either more government spending on health care or less affordable care for most Americans. Rounds is not offering consistent policy; he's just saying stuff to get votes and hoping we won't notice until he's in power.


Hey, ever notice how capitalism and cannibalism sound an awful lot alike?

On the rare, unfortunate occasions when I must deal with doctors, I am relieved to have access to their expertise and insurance to pay for it. But that doesn't change the fact that the health care industry is filled with capitalist dogs. Two examples:

Jonathan Ellis follows up on his coverage of surgeon Allen Sossan's alleged malpractice with a report on a new lawsuit by Michelle Weidner-Jordan, the former head of physician-owned Lewis and Clark Specialty Hospital, where Sossan was a doctor and owner. According to her lawsuit, Sossan harassed and threatened fellow employees but was immune to discipline because he was bringing big profits by performing unnecessary medical procedures. When he was finally booted in March 2012, profits dropped. Weidner-Jordan says the hospital board blamed her for the losses and told her resign or be fired last summer.

It sounds as if Lewis and Clark was more worried about turning a profit than practicing good medicine and good management, But in the topsy-turvy ethics of the Hypocritic Oath, Sioux Falls doctor and conservative R. Blake Curd says profit motive couldn't motivate doctors to do such things:

But Sioux Falls surgeon Blake Curd, president-elect of the Physician Hospitals of America, an advocacy group for doctor-owned hospitals, disputes that it’s a conflict. Curd said the facility fees are spread out among a pool of doctors that typically own small shares in the hospital, so there’s not an incentive to admit patients for procedures that aren’t needed.

“The reimbursement on the surgical fee is several times what the reimbursement would be on the facility fee,” he said [Jonathan Ellis, "A Lawsuit Is Shining Fresh Light on Specialty Hospitals," that Sioux Falls paper, 2014.06.08].

Since the surgical fee is the real meat, there's no motivation for doctors to reach for the gravy of the facility fee. Right, R. Blake.

The profit motive in medicine also appears to be driving exploitation of Medicare Advantage, costing taxpayers billions of dollars. Under Medicare Advantage, Medicare contracts with private insurers to provide coverage that can offer more services and lower out-of-pocket costs than original Medicare.

However, Medicare Advantage uses a "risk score" to reimburse its health plans: the sicker the patient, the higher the reimbursement for a a given procedure.

The Center for Public Integrity finds that insurers appear to be inflating those risk scores to inflate their reimbursements, with such inflation notably prominent in South Dakota:

Risk score errors triggered nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013 — mostly overbillings, according to government estimates. Federal officials refused to identify health plans suspected of overcharging Medicare, citing agency policy that keeps many business records confidential. The Center is suing to make these records public.

Risk scores of Medicare Advantage patients rose sharply in plans in at least 1,000 counties nationwide between 2007 and 2011, boosting taxpayer costs by more than $36 billion over estimated costs for caring for patients in standard Medicare.

In more than 200 of these counties, the cost of some Medicare Advantage plans was at least 25 percent higher than the cost of providing standard Medicare coverage. The wide swing in costs was most evident in five states: South Dakota, New Mexico, Colorado, Texas and Arkansas [Fred Schulte, "Why Medicare Advantage Costs Taxpayers Billions More Than It Should," Center for Public Integrity, 2014.06.04].

The Center for Public Integrity says the Medicare Advantage error rate has averaged 12% over the past six years. Last year it dropped to 9%, or $11.8 billion. $9.3 billion of that was overcharges. Meanwhile the SNAP/Food Stamps error rate in 2012 was 3.42%, or about $2.5 billion. But since hungry people can't afford lobbyists and media campaigns, Senator John Thune squawks about waste and abuse plaguing Food Stamps while opposing cuts to root out waste in Medicare Advantage (cuts on which the Obama Administration bailed in April).

Doctors and insurers have to eat. But we can all recognize the difference between healthy eating and cannibalism.


One of the talking points Democratic nominee Susan Wismer needs to adopt from her vanquished primary opponent Joe Lowe is his talk of the "culture of corruption" fostered by the Rounds-Daugaard administration. Why?

  1. It's true!
  2. Fighting a "Culture of Corruption" will synergize with the "Take It Back!" populist message of Sue's new best buddy on the prairie, Rick Weiland.
  3. South Dakota's higher-than-normal corruption has policy impacts, like an over-emphasis on economic development based on bribe-prone corporate handouts and less funding for education and health care:

...Economic development projects are ripe for corruption, the study published this spring in the Public Administration Review, found.

Using data from the Department of Justice that encompassed more than 25,000 public corruption-related convictions nationwide between 1976 and 2008 of elected officials, judges and local employees, the study concluded that higher instances of corruption correlate with more spending in certain areas. Among the most corrupt states were Mississippi, Louisiana, Alabama, Florida, Tennessee, Kentucky, Pennsylvania, Illinois, South Dakota and Alaska.

The study found that high levels of corruption in a state can shape its budget allocation. More corrupt states tended to spend money on construction, highways, and police protection programs, which provide more opportunity for corrupt officials to use public money for their own gain. These states spend less on health, education, and welfare, which provide less opportunity for officials to collect bribes... [Liz Farmer and Kevin Tidmarsh, "What Corrupt States Spend Their Money On," Governing, 2014.06.06].

Wismer can also point out that the culture of corruption ends up hamstringing the economic development that Daugaard and pals say they are promoting:

The shakedown culture can also be a deterrent to economic development, with developers who are attempting to play fair getting disenchanted by pay-to-play politics, he added. After all, there's little incentive to spend time and money on a bid when the winning bidder has already bought political favor [Farmer and Tidmarsh, 2014.06.06].

Corruption could even have something to do with lower voter turnout:

Public confidence in government is also a hidden – and immeasurable – cost of corruption, added Sergio Acosta, a corporate attorney who was the former federal prosecutor for the Northern District of Illinois [Farmer and Tidmarsh, 2014.06.06].

The culture of corruption that Joe Lowe identifies hinders public welfare, economic development, and civic life in South Dakota. Sue, that's your message, in one sentence. Get on it!


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