Senator Tim Johnson | Working for South Dakota

The status quo is no longer acceptable. We need to preserve choice, reduce cost and assure quality, affordable health care for all Americans.

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 for all

Click on a health topic you are interested in:

ACCESS TO QUALITY, AFFORDABLE HEALTH CARE
I believe that access to affordable health insurance is one of the leading domestic issues facing our country. Health insurance premiums have doubled in the last eight years, rising 3.7 times faster than wages. Many people are unable to keep up, falling in with the ranks of the 47 million uninsured, 8 million of them children. Far too many South Dakota families cannot afford the skyrocketing cost of health insurance, yet they are not eligible for federal health programs.

It is clear that throwing more money at a broken system will not generate new results. We already spend more on health care than any other country, 50% more per capita than the next highest spender, but America remains nearly the only western democracy in the world to not have a national strategy to assure all citizens affordable access to health care. Since virtually all issues require 60 votes for passage in the U.S. Senate, we must work in a bipartisan way to truly reform our health care system.

I believe we have a moral obligation to fix the problems that plague health care in America, and recent events have demonstrated that we also have an economic incentive to do so. When families go without health insurance, they receive less preventive care, which can lead to more costly care as illness advances undetected. Furthermore, too many uninsured families are forced to declare bankruptcy when they are unable to pay bills resulting from a health crisis.

Some say we can’t afford meaningful health insurance coverage for all, but it is really just a matter of priorities.

With a new President and a new Congress, our nation has an incredible opportunity to dramatically improve the health and health care of all Americans. Ensuring that every American has meaningful health insurance is a critical first step. We must also provide all citizens with access to preventive care, and citizens must take responsibility for their health, utilize prevention resources available to them, and make smart lifestyle choices to stay healthy. We must ensure that health care providers use best practices in the delivery of quality care and increase the use of information technology to eliminate duplicative diagnostic tests and other procedures. According to the Agency for Healthcare Research and Quality, in 2002, 5% of the population accounted for 49% of overall U.S. health care spending. Reform efforts must focus on how to provide efficient and effective care for this population, many of whom are chronically ill and require long-term care services.

KIDS' HEALTH
More than 20% 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.

The State Children’s Health Insurance Program has helped provide health insurance coverage to targeted low-income children whose parents earn too much money to qualify for Medicaid but not enough to purchase private health insurance. I voted for the creation of SCHIP in 1997 to provide health insurance to targeted low-income children whose parents earn too much money to qualify for Medicaid but not enough to purchase private health insurance. I have also fought to increase SCHIP funding so that the program can cover as many uninsured children as possible. After 10 years, this program has successfully reduced the number of uninsured children and currently covers more than six million children in the United States, including roughly 11,000 South Dakota children each month.

I was pleased one of the Senate’s first accomplishments in the 111th Congress was to pass the Children’s Health Insurance Program (CHIP) Reauthorization Act on January 29, 2009. President Obama signed this bill into law on February 4, 2009. This new law will provide coverage to an additional 4.1 million uninsured children across the United States, including as many as 6,000 South Dakota children. In addition, the legislation provides states resources to conduct outreach activities to find and enroll eligible children, provides mental health parity in the program, and allows children whose private insurance does not include dental coverage to enroll in the CHIP dental plan. Finally, I was especially pleased that child advocacy organizations and faith-based groups, including my own church, the Evangelical Lutheran Church in America, supported this legislation.

RURAL HEALTH
Rural states like 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. A key to this endeavor is ensuring adequate reimbursement by Medicare and Medicaid. I have supported many legislative efforts to guarantee rural interests are accounted for in federal payment policies, including: ensuring fair reimbursement to critical access hospitals and rural health clinics, expanding access to mental health services, and improving the payment methodology for physicians and other health care providers. I have also long supported increased funding for community health centers, workforce development, and the expansion of telehealth services.

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. 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 thousands of South Dakotans and their families who rely on this health program. I have supported numerous pieces of legislation to ensure the program is expansive to the needs and interests of both beneficiaries and providers.

During the 110th Congress, I was pleased to support broad, bipartisan legislation, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. This law included numerous important provisions to improve the Medicare program for providers and beneficiaries alike.

This law also included improvements to Medicare for beneficiaries, such as improved coverage of preventative services, equity in mental health copayment rates, and expanded access to therapy services. Congress also included substantial improvements to programs that assist low-income Medicare beneficiaries, such as the Medicare Savings Program and the Low Income Subsidy Program. As a member of the Appropriations Committee and the Rural Health Caucus, I will continue to working to ensure that seniors have access to critical programs that help them continue to lead active and productive lives.

MEDICARE PART D
The Medicare Prescription Drug Improvement and Modernization Act of 2003 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 bill. I believe that Congress should have enacted a simple plan so people could have shown their Medicare card to their pharmacist and then received a discounted price. 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, falls short in addressing the rising cost of prescription drugs. The program has resulted in gaps in coverage, premium rates that vary wildly from one year to the next, and formularies, the lists of prescription drugs a plan covers, that change even more frequently. Rural communities in particular are struggling to make Part D work for their citizens. 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 am proud Congress passed legislation that eliminated late enrollment penalties for Medicare beneficiaries who are eligible for the Low Income Subsidy Program. 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.

In early 2009, I was pleased to support the American Recovery and Reinvestment Act. This economic rescue plan was the product of extensive negotiations between both political parties, who worked to craft a proposal that would bring stability to our troubled economy. The U.S. Government Accountability Office estimates South Dakota will receive approximately $120 million in additional Medicaid funding as a result of this new law, though the estimate is based in part on predictions of future employment rates. This funding will ease the economic pressure on states to effectively operate their programs.

As a member of the Appropriations Committee, 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 10th 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, and 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.

As part of my efforts to improve public health in South Dakota, I have introduced legislation to improve the federal government’s response to the problem of Fetal Alcohol Spectrum Disorders (FASD). FASD is an umbrella term that describes a range of physical and mental birth defects that can occur in a fetus when a pregnant woman drinks alcohol. Alcohol exposure during pregnancy is a leading cause of non-hereditary cognitive disability in the U.S. Many children affected by maternal drinking during pregnancy have irreversible conditions, including severe brain damage, which causes permanent, lifelong disability.

While there is no known cure, FASD is 100% preventable. That is why, during the 110th Congress, I introduced the Advancing FASD Research, Prevention, and Services Act. My bill will help states and communities develop and implement targeted outreach programs; improve coordination among Federal agencies involved in establishing strategies to improve outcomes for individuals with FASD by establishing stronger communication lines; improve support services for individuals living with FASD and their families; strengthen educational outreach efforts to doctors, teachers, judges, and other whose work puts them in contact with people with FASD, or with women who might be at risk for drinking during pregnancy. I look forward to reintroducing this legislation during the 111th Congress.