A Profile of South Dakota’s Low-Wage Uninsured Workers by Joan Alker and Alexandra Corcoran June 2021 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 The Georgetown University Center two-year period if the state expanded Medicaid.2 Approximately 27,800 uninsured for Children and Families (CCF) is an nonelderly adults, or 42 percent of the state’s uninsured adult population, would independent, nonpartisan policy and gain health insurance.3 research center founded in 2005 with a mission to expand and improve high- This fact sheet examines which workers and industries would benefit from quality, affordable health coverage for expansion of Medicaid coverage.4 The hospitality sector accounts for 28 percent America’s children and families. CCF is of those working without insurance (see Table 1). Restaurants and other food based in the McCourt School of Public service businesses employ one in five low-wage uninsured workers in the state.5 Policy’s Health Policy Institute. Table 1. Top Industry Sectors in South Dakota For Low-Wage Workers For Low-Wage, Uninsured Workers* Accommodation and food services 18.6% Accommodation and food services 27.7% Retail 13.0% Health care and social assistance 12.6% * Due to small sample size, only the top sector in employing low-wage uninsured workers can be identified. Educational services 8.3% Note: Workers with no occupation are not listed. Manufacturing 6.6% Source: Georgetown University Center for Children and Families analysis of U.S. Census Bureau American Community Survey (ACS) 2019 Public Use Agriculture, forestry, fishing, and hunting 6.1% Microdata Sample (PUMS). Demographics of uninsured Figure 1. Low-Income, Uninsured Nonelderly Citizens by Gender low-income adults Overall, White people comprise 57 percent of low- Source: Georgetown University income uninsured nonelderly adults. American Women Center for Children and Indians are disproportionately represented and 41.1% Families analysis of US Census Bureau American comprise 39.4 percent of low-income uninsured Men Community Survey (ACS) 2019 adults. Low-income uninsured citizens are more 58.9% Public Use Microdata Sample (PUMS). Contact authors likely to be men than women as Figure 1 shows. for more information on the methodology. June 2021 CCF.GEORGETOWN.EDU south dakota’S low-wage, uninsured workers 1 Which parts of the state have higher proportions of uninsured workers? The map 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. As Table 2 shows, the counties with the highest proportion of uninsured workers are all rural,6 and 5 out of 8 are entirely tribal land. In fact, all of the counties in South Dakota that consist entirely of tribal land have among Uninsured Rate for the highest uninsured rates for workers Nonelderly Workers in the state. According to the Census Above 20% Note: Includes all workers ages 19-64 regardless of Bureau, people whose only health coverage is Between 10-20% income or citizenship status. Source: Georgetown University Center for Indian Health Service are uninsured as IHS is Lower than 10% Children and Families analysis of U.S. Census not considered comprehensive coverage. Estimate suppressed Bureau American Community Survey (ACS) 2015- due to unreliable data 2019 Table DP03. Table 2. Top Eight Counties with County Uninsured Rate Highest Uninsured Rates for United States 11.0% Nonelderly Workers in South Dakota South Dakota 10.8% Buffalo 56.4% Note: Includes all workers ages 19-64 regardless of income or Oglala Lakota 46.0% citizenship status. Source: Georgetown University Center for Children and Todd 44.8% Families analysis of US Census Bureau American Community Mellette 32.6% Survey (ACS) 2015-2019 Table DP03. Out of South Dakota’s 66 counties, 15 county estimates were suppressed due to high Dewey 30.2% margins of error and low-reliability. Suppression rules did not Bennett 27.3% affect the top eight presented in this table. Access to Indian Health Service alone is not considered a comprehensive form Ziebach 26.9% of health coverage. Contact authors for more information on Corson 23.9% the methodology. Endnotes 1 For more information on the provisions of the law, see E. Park and S. 4 All data are derived from the American Community Survey (2019). Most data Corlette, “American Rescue Plan Act: Health Coverage Provisions Explained” come from the Public Use Microdata Sample; county data calculated from (Washington DC: Georgetown University Center for Children and Families American Community Survey five-year (2015-2019) prepared tables. Contact and Center on Health Insurance Reform, March 2021), available at https:// authors for more information on sources of data and methods. ccf.georgetown.edu/2021/03/11/american-rescue-plan-act-health-coverage- 5 Ibid. provisions-explained/. Low-income individuals defined as those earning less than 138 percent of the Federal Poverty Line—approximately $17,775 for an 6 Rurality drawn from J. Hoadley et al., “Rural Health Report: Medicaid is a individual or $30,305 for a family of three. Workers defined as those who report Lifeline for Small Towns and Rural Communities” (Washington DC: Georgetown industry and occupation information on the American Community Survey. Center for Children and Families and the University of North Carolina NC Rural Contact authors for more information on sources of data and methods. Health Research Program), available at https://ccf.georgetown.edu/wp-content/ uploads/2017/06/Rural-health-final.pdf. Contact authors for more information on 2 R. Rudowitz, B. Corallo, and R. Garfield, “New Incentive for States to Adopt the methodology. 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. June 2021 CCF.GEORGETOWN.EDU south dakota’S low-wage, uninsured workers 2