The recently enacted American Rescue Plan Act of 2021 (ARP) includes new large financial incentives for states to extend health insurance coverage to low-wage workers and other adults earning less than $17,775 a year.¹ These incentives apply to regular spending in a state’s Medicaid program and offer a five-percentage point across the board increase in the federal share for a 24-month period after the state extends coverage. The Kaiser Family Foundation estimates that South Dakota’s budget would see a net gain of $60 million over a two-year period if the state expanded Medicaid.² Approximately 27,800 uninsured nonelderly adults, or 42 percent of the state’s uninsured adult population, would gain health insurance.³
This fact sheet examines which workers and industries would benefit from expansion of Medicaid coverage.4 The hospitality sector accounts for 28 percent of those working without insurance (see Table 1). Restaurants and other food service businesses employ one in five low-wage uninsured workers in the state.5
Which parts of the state have higher proportions of uninsured workers?
The map below shows counties in the state and their proportions of uninsured adult workers of all incomes and citizenship status. Workers in Buffalo County have an extraordinarily high uninsured rate of 56 percent.
1 For more information on the provisions of the law, see E. Park and S. Corlette, “American Rescue Plan Act: Health Coverage Provisions Explained” (Washington DC: Georgetown University Center for Children and Families and Center on Health Insurance Reform, March 2021), available at https://ccf.georgetown.edu/2021/03/11/american-rescue-plan-act-health-coverage-provisions-explained/. Low-income individuals defined as those earning less than 138 percent of the Federal Poverty Line—approximately $17,775 for an individual or $30,305 for a family of three. Workers defined as those who report industry and occupation information on the American Community Survey. Contact authors for more information on sources of data and methods.
2 R. Rudowitz, B. Corallo, and R. Garfield, “New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending” (Washington DC: Kaiser Family Foundation, March 2021), available at https://www.kff.org/medicaid/issue-brief/new-incentive-for-states-to-adopt-the-aca-medicaid-expansion-implications-for-state-spending/.
3 Kaiser Family Foundation, “Who Could Medicaid Reach with Expansion in South Dakota?” (Washington DC: Kaiser Family Foundation, February 2021), available at https://files.kff.org/attachment/fact-sheet-medicaid-expansion-SD.
4 All data are derived from the American Community Survey (2019). Most data come from the Public Use Microdata Sample; county data calculated from American Community Survey five-year (2015-2019) prepared tables. Contact authors for more information on sources of data and methods.