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• Gov. Daugaard said he feared that the federal government might not be able to fulfill its promise to fund its share of the Medicaid expansion after 2020. North Dakota skirted that issue, as it only approved the expansion of Medicaid for three years, while it is fully funded by the federal government.
• The task force's report will be presented to the S.D. Legislature for their consideration in the 2014 session. Deadlines were set earlier for states to decide on Medicaid expansion, but they have been set aside. "States can take up that expansion at any time," Sebelius said.
• The two Dakotas are similar in many respects, but at least for now have fallen on two different sides of this issue. With North Dakota enacting the Medicaid expansion, how will the two states fare differently if South Dakota does not expand Medicaid?
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• The gap
• The Supreme Court decision making the Medicaid expansion optional for states created a problem that the PPACA did not have in it when it was made law: If states don't expand Medicaid, people who are not eligible for Medicaid currently and who make less than 100 percent of the federal poverty level (in 2013, that's $11,490 for an individual or $23,550 for a family of four) get no help at all from either the state or federal government.
• That's where the biggest difference will be for residents of the Dakotas: In North Dakota, about 24,000 who are currently uninsured and below 100 percent of FPL will be eligible for health care coverage through Medicaid. In South Dakota, about 46,000 in that same category will not. (These numbers are from the Kaiser Family Foundation.)
• Since children, pregnant women and very poor parents are already covered, those who be left out are adults without children and parents who aren't extremely poor.
• An additional 12,000 in North Dakota and 13,000 in South Dakota are currently uninsured and fall between 100 percent and 138 percent of the federal poverty level. They are eligible for federal subsidies if they chose to buy their own insurance through a health exchange. In North Dakota, most of those (those up to 133 percent of the FPL) would also be eligible for Medicaid.
• So what happens in South Dakota if these 46,000 or so remain uninsured?
• "We know people without health insurance coverage live sicker and die younger," said Dan Heinemann, president of the South Dakota Medical Association, when he spoke before the S.D. Medicaid task force in June. He encouraged passage of

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