Senator Tim Johnson | Working for South Dakota

Tim talks with a doctor

Guaranteeing quality, affordable and accessible health care for South Dakotans has always been a priority of mine. I understand that, as a rural state, South Dakota faces special hurdles to providing health services in our communities. As a member of the Senate Rural Health Caucus, I have worked with my Senate colleagues from both political parties to push for greater equity for rural patients and providers. I will continue to do all I can to build a strong health care system that all South Dakotans can depend on.

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HEALTH CARE ACCESS / UNINSURED
I believe that access to affordable health insurance is one of the leading domestic issues facing our country. The cost of insurance continues to rise with health care inflation, increased administrative burdens and the skyrocketing costs of prescription drugs. Health care spending continues to outpace the growth of the economy and, as a result, is increasing the financial burden on working families.

A 2005 report by the Henry J. Kaiser Family Foundation found that 92,180 South Dakotans lack health insurance coverage. This is about 12% of the state population. Of this number, 65,810 uninsured South Dakotans are in working families.

I have cosponsored legislation that would make health insurance coverage more affordable for small businesses and provide individuals with the same type of insurance offered to members of Congress. I have also worked on legislation to reduce the cost of prescription drugs and to make health insurance premiums fully tax deductible. I will continue to work with my colleagues to find ways to decrease the number of uninsured families in South Dakota, as well as the nation at large.

KIDS' HEALTH
Seventeen percent of the uninsured in our state are children. This statistic is staggering and completely unacceptable. Basic health coverage for our young people is essential in order to ensure that all Americans have the chance to live long, healthy, and productive lives.

I have long supported the State Children's Health Insurance Program (SCHIP) and have fought to increase SCHIP funding so that the program can cover as many uninsured children as possible. I have also cosponsored legislation that would improve federal health insurance to cover more children than are now eligible under SCHIP and Medicaid.

RURAL HEALTH
Rural states, such as South Dakota, face numerous challenges when it comes to meeting the health needs of our communities. We can and should continue to push for improved access to quality health care, and we need to attract more health professionals to our state's underserved areas. Key to this endeavor is ensuring that providers are adequately reimbursed by Medicare and Medicaid. I have supported many legislative efforts to improve payment for providers, including: eliminating caps on physical therapy services, allowing mental health professionals to be billable providers under Medicare, and improving the payment methodology for physicians. I have also long supported increased payments for community health centers and increased funding for the Nurse Reinvestment Act.

All of these efforts can improve the stability of our health care system in South Dakota and should be enacted. As a member of the bipartisan Senate Rural Health Caucus, I will continue to push for improvements to these critical health care programs, which can provide stability for the rural areas of our state. Members of the Senate may disagree about many things, but the Rural Health Caucus has a strong history of working across the aisle for the benefit of rural health care providers and their patients. I look forward to continuing that important work in the current Congress.

MEDICARE
Medicare was implemented in 1965 to assist the nearly 28.5% of elderly Americans who lived in poverty and could not afford medical insurance coverage. As a result of Medicare' s successes over more than 40 years, elderly Americans now maintain healthy, active lives well past the average life expectancy of Americans during the first half of the 20th Century.

I strongly support Medicare and realize how critically important it is to one in six South Dakotans and their families who rely on this health program. Unfortunately, the President has once again proposed substantial and potentially devastating cuts to Medicare, including increased Part B premiums (which cover outpatient services, such as doctor' s visits) for higher income seniors and reduced payments to hospitals and other providers, including nursing homes and home health providers. While I agree that the cost of this program is increasing at an alarming rate, any reforms should not compromise patient access or quality of care. As a member of the Budget and Appropriations Committees and the Rural Health Caucus, I will continue to fight these cuts and ensure that seniors have access to critical programs that help them continue to lead active and productive lives.

The Medicare Modernization Act of 2003 (MMA) made many changes to Medicare, including the establishment of the Medicare Advantage program under Part C of Medicare. Medicare Advantage replaced the Medicare+Choice program and it now offers Medicare beneficiaries a variety of managed care options outside of traditional Medicare. In addition, Medicare Advantage organizations are required to offer at least one plan in every area that includes Part D prescription drug coverage (for more on Part D, please see below). Medicare Advantage plans have been available in South Dakota since January 1, 2006, and have received mixed reviews from both seniors and providers. I will continue to study the impact that these plans have on seniors' access to health care and on rural health care providers' ability to provide quality care in partnership with Medicare Advantage.

I believe Medicare beneficiaries deserve adequate access to various mental health professionals, as well as parity in payment for treatment, and I strongly support legislation to improve Medicare beneficiary access to various mental health care services. It is time to stop the discrimination against patients with mental illness, substance abuse problems, and other ailments.

MEDICARE PART D
Congress passed the Prescription Drug and Medicare Improvement Act of 2003 (H.R.1), which added a prescription drug benefit to the program and fundamentally changed Medicare as we know it. While I supported the more comprehensive Senate version of the legislation, I voted against final passage of the conference report. This program has been a frustrating and confusing experience for seniors as well as their family members, physicians, and local pharmacists.

Part D, which went into effect January 1, 2006, leaves many seniors worse off and falls short in addressing the rising cost of prescription drugs. The program has resulted in gaps in coverage and varied premium rates and benefits across the country. Rural communities in particular are struggling to make Part D work for their citizens. A portion of retirees who previously had comprehensive employer-sponsored retiree coverage lost that coverage when Part D went into effect. Many seniors are losing money under the plan because they are spending more on premiums, co-payments and deductibles than the value of the benefits they will receive in a given year.

Medicare beneficiaries should have access to a real, reliable drug benefit, and that is why I support several changes that will improve this program. These changes would require the federal government to negotiate lower prices for prescription drugs; close the coverage gap known as the "donut hole"; extend the annual open enrollment period; and allow seniors to change plans during the year if they are not happy with the initial plan they selected. I will continue working with my colleagues to protect and strengthen Medicare and the retirement security of our seniors.

MEDICAID
With states facing the most serious fiscal shortfalls to date, it is imperative that the federal government ensure that Medicaid programs receive the support needed to remain viable. I have been a strong supporter of Medicaid because I know how instrumental the program is in providing health care coverage for many Americans who would otherwise fall into the growing ranks of the almost 47 million uninsured. I have worked with colleagues to defeat legislative attempts to cut funding from Medicaid, as well as supported legislative initiatives to increase the Federal Medicaid Assistance Percentage (FMAP) rate.

As a member of the Senate Budget and Appropriations Committees, I will do all I can to fend off misguided cuts to Medicaid and other crucial health safety net programs. We need to support legislative initiatives that will increase, rather than decrease, access to care in rural communities.

PUBLIC HEALTH
In South Dakota, we face numerous public health challenges, many exacerbated by the rural nature of our communities. Public health involves many activities at the local, state and national levels. Such work involves surveillance of diseases, diagnoses of health hazards in communities, health education and health promotion regarding both chronic and infectious disease, and ensuring access to essential health care services.

Some of the public health challenges we are facing in South Dakota include: 1) Cancer and stroke death rates which parallel the U.S. averages, 2) A motor vehicle death rate which ranks in the top 10 in the nation, 3) Occupational fatality death rate which ranks 5th highest in the nation, and 4) Teen deaths from accident, homicide or suicide ranking 10th highest in the nation. South Dakota also suffers from one of the highest incidences of Fetal Alcohol Spectrum Disorders (FASD) in the nation, high rates of diabetes among the elderly and Native Americans, significant smoking rates, limited numbers achieving recommended levels of physical activity and high rates of obesity.

Addressing these public health issues is a challenge within itself, but finding workable solutions within a rural context presents additional challenges that we must consider. Rural states and communities face a continuing problem of attracting and retaining the proper mix of public health professionals.

Whether the threat is from a newly emerging infectious disease, bioterrorism, or a chronic health care condition, improving our public health capacity will yield countless benefits to individuals, communities and our state as a whole.

FAMILY PLANNING/UNINTENDED PREGNANCY PREVEVTION
Our nation' s goal should be to make abortion a much more rare occurrence, and the best way to accomplish that goal is through education, voluntary contraceptive resources, improved access to family planning, and help for low-income new mothers and their children. I also believe that improved adoption procedures are needed and, as a founding member of the bipartisan Congressional Coalition on Adoption, will continue to work with my colleagues to encourage adoptions in our country.

I will continue to support legislation that would expand access to preventive health care services and education programs that help reduce abortion, unintended pregnancy, and infection with sexually transmitted disease.