- Associated Press - Wednesday, November 25, 2015

Editors: Please note that The Associated Press welcomes editorial contributions from members for the weekly Editorial Roundup. Three editorials are selected every week. Contributions can be made by email at [email protected]

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Rapid City Journal, Rapid City, Nov. 22, 2015

Governor right to seek Medicaid expansion

The upcoming legislative session is shaping up to be an interesting one.

In addition to likely introducing legislation that would change how the state funds public education, Gov. Dennis Daugaard is working on a bill that if approved by lawmakers would make South Dakota the 31st state to expand Medicaid coverage as part of the Affordable Care Act, commonly referred to as Obamacare.

Since the legislation was signed into law by President Obama, Daugaard has expressed concerns about how much the program would cost the state in 2020 when the federal government will cover 90 percent of the costs. Since 2013, the federal government has picked up 100 percent of the expansion costs and will continue to do so through 2016 when the states will be expected to gradually contribute to the program until they pay for 10 percent of the costs in 2020 and beyond.

In order to make the program affordable for the state, the governor’s office is working with the U.S. Department of Health and Human Services to expand the number of services offered by Indian Health Service, which offers care to Native Americans. A spokesman for the federal government told the Associated Press that the administration is working at “warp speed” to review the proposed changes.

If the federal government approves the plan, it would make as many 55,000 additional low-income South Dakotans under the age of 65 eligible for the public health program.

The reason they become eligible is that any individual or family that earns up to 138 percent of the federal poverty level is covered by Medicaid if their state legislature opts in to the plan.

According to the Department of Human Services in North Dakota, which expanded Medicaid in 2013, the income guidelines are $16,243 for a single person, $21,983 for a couple, $27,724 for a family of three and $33,465 for a family of four.

Gov. Daugaard has said in the past that his concern with Medicaid expansion is the cost to the state beginning in 2020, which is what we expect from a fiscally conservative governor.

Others, however, oppose it on ideological grounds. They see it has an expansion of the welfare state that provides handouts to healthy men and women who would rather feed at the public trough than work for a living.

But that point of view glazes over some important facts, including that South Dakota is one of the lowest-wage states in the nation and it would be even more dire if voters had not approved a ballot measure in 2014 to raise the minimum wage to $8.50 an hour. A quick glance at any help-wanted section in this area shows that many jobs pay $12 an hour or less and many of those are part-time positions that do not offer health-care coverage.

The reality is that many in this state are among the working poor. Many are mothers and fathers and their children. By getting these families enrolled in Medicaid, they can get the kind of preventive care that can lead to cost savings in the future. As we should know by now, we all pay through higher insurance rates or other charges when an uninsured person goes to the emergency room or is admitted to the hospital.

It also is important to remember that Medicaid funds go directly to hospitals, clinics and other health-care providers. It is not a blank check for the recipients.

Gov. Daugaard deserves credit for working with the federal government to pick up more of the costs of Medicaid expansion. In the end, taking advantage of this program to make health care available to more residents is the right thing to do.

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Argus Leader, Sioux Falls, Nov. 21, 2015

End lag in mental illness evaluations for defendants

This is a problem we can fix.

We don’t hear that too often these days. Among the tectonic struggles that plague our public debate - demise of the middle class, terrorism, teacher pay - there seems but precious room for measurable progress.

Here is a chance for government, for the people, to do some good.

A recent Argus Leader Media investigation revealed that people with mental illnesses can spend months sitting in a jail cell waiting for a psychiatric evaluation.

Just to be clear about the situation.

These are people who have not been convicted of a crime.

People living on the margins of society, unable to pay even a small bail bond.

People plagued with one of a variety of complex illnesses such as schizophrenia, bipolar disorder or depression.

They sit in jail because a judge ordered an evaluation to determine whether mental illness played a role in whatever behavior brought them into contact with police in the first place. The number of defendants who require the examination inexplicably rose to 147 last year.

Yet the state of South Dakota will only conduct three evaluations per month through the Human Services Center in Yankton, about a quarter of what was needed. That leaves the counties - which run the court system - to pick up the bill.

Counties are chronically strapped for cash.

Plus, there is an ongoing shortage of psychiatrists in South Dakota, only a portion of whom will actually take cases from the court system.

All of which leads us to our present situation: the State of South Dakota is holding unconvicted, mentally ill citizens in jails ill-equipped to handle them for periods of time well-beyond what is reasonable.

This must change.

It’s not humane to treat people this way.

It’s not practical in terms of cost or jail management.

It’s not consistent with our constitutional right to due process, which has led to a successful lawsuit with similar circumstances in Washington state.

The good news is that we can fix it.

Chief Justice David Gilbertson announced Friday that he will appoint a task force to look at the role mental illness is playing in the criminal justice system. Gov. Dennis Daugaard said in an interview published by Argus Leader Media that the series of stories led to discussions about potential solutions. There are several topics that need to be addressed, Daugaard said, the lag in evaluations among them.

The quick action from Daugaard and Gilbertson is encouraging.

In the grand scope of our challenges, it’s not that much money. Even at $5,000 per evaluation, well above what the state says it costs at the Human Services Center, the total bill would be less than $750,000, and that’s a high estimate to be safe.

That’s not spare change but it could easily be saved from what we’re currently spending to house defendants before trial. Consider that the average wait time for a competency evaluation is four months. That translates to about $10,000 per case just for food, supervision and other associated costs.

Beyond the dollars and cents, there has to be room in government for compassion and humanity.

We need to better understand mental illness. Too often we’d rather move people out of sight. When a person’s actions bring them in touch with police, we are able to marginalize their humanity with stunning efficiency. If that crazy old man punched a cop maybe a jail cell is the best place for him, we tell ourselves.

Maybe it’s not.

It’s possible that the best course of action is a more enlightened approach.

Among the possible solutions:

- Regional mental health centers have been suggested by professionals in the field. How many and how it would work and where we’d find the staff are legitimate points of discussion. But the need is there beyond just these defendants. Resources for South Dakotans with mental illnesses are woefully inadequate.

- Eliminate or severely reduce cash bail at the discretion of the judge ordering the examination. If we can get them done in time, we still must respect the due process requirements in the U.S. Constitution. They are there specifically to guard against tyranny and should not be cast aside because they are inconvenient.

- Put out a request for proposals for a private contractor to provide the exams at a set cost. Even at $1 million, it could end up saving the state money if it means timely processing of cases.

These are merely starting points for a conversation. But make no mistake, it must happen, and soon.

Leaving citizens in jail for months at a time waiting to find out whether a mental illness played a role in their actions will only end badly for the state.

It will end up in court, as happened in Washington state, with South Dakota as the defendant.

Let’s fix it now.

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Yankton Daily Press and Dakotan, Yankton, Nov. 23, 2015

Transgender policies: Awkward issues

Officials in South Dakota and Nebraska are working to deal with a modern issue that baffles many of us.

This issue is how the activities associations of the two states will deal with potential transgender athletes in their schools.

Both state groups are currently weighing proposals to make these accommodations.

Last month, the South Dakota High School Activities Association’s (SDHSAA) Interim Committee rejected a pair of proposals that would define athletes’ genders based on what their birth certificates say. The association has been grappling with the transgender issue for more than a year after the committee drafted a policy that was based on similar measures in other states. So far, 14 other states, as well as the District of Columbia, have laws on the matter similar to what South Dakota has adopted. This law currently states that athletes who want to participate in a gender-specific activity must submit a request to the SDHSAA along with documentation to prove they aren’t applying for the move in order to gain what is termed “an unfair competitive advantage.”

Meanwhile, the Nebraska School Activities Association’s board of directors has been meeting privately to discuss the direction of its changes. Several parochial schools and at least one conservative group have called on the state to pass guidelines mandating - similar to the failed South Dakota measures as well as efforts in other states - that athletes compete in sports based on the gender listed on their birth certificates. Other issues include locker room and restroom access, and whether mandates on how to treat transgender athletes violate the constitutional rights of church schools.

This has been a tricky issue in both states and across the nation, and it’s one that may well be addressed in legislative proceedings this winter.

This is also an issue that, frankly, many people find awkward and confounding. Most of us cannot profess to know or understand the issues involved with changing one’s gender identity. This is, obviously, a genuinely profound personal conflict that defies easy understanding by those who haven’t experienced it. We cannot truly appreciate the inner struggle that leads to this kind of decision, which can never be made lightly. We know what seems logical, but what does that mean for those people for whom such “logical” guidelines do not apply? Thus, finding a clear, workable solution can be difficult.

Ultimately, the activities associations in the two states are taking the more prudent approach on this issue, which, they do admit, doesn’t arise too often. Addressing this sensitive issue rather than adopting rules aimed at locking in the status quo is a more productive method than ignoring it or passing rules that effectively make it go away.

The associations are confronting reality. It’s a reality that has been shaped in part by the people who are bringing these issues forward. The reality has also been shaped by court decisions that support the rights of transgender students in public institutions. Also, the Office of Civil Rights has declared that such issues fall under Title IX oversight, which means these cases are being monitored for discriminatory practices.

So, South Dakota and Nebraska officials know the lay of the land in this matter, and they’ve responded accordingly.

How the lawmakers in those states will react could be another matter. Or maybe it won’t. That remains to be seen.

But as is, the two associations are sailing the right course, and probably the most practical one possible in this difficult issue.

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