South Dakota Insurance Provider, Initiated Measure 17 (2014)

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Initiated Measure 17
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Type:initiated state statute
Referred by:Citizens
Topic:Insurance
Status:Approved Approveda
2014 measures
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November 4
Initiated Measure 17 Approveda
Initiated Measure 18 Approveda
Amendment Q Approveda
Polls
The South Dakota Insurance Provider Measure, Initiated Measure 17 was on the November 4, 2014 ballot in South Dakota as an initiated state statute, where it was approved.[1]

The measure, which was sponsored by three South Dakota doctors, was designed to end the restrictions put in place by insurance companies regarding which healthcare providers their clients can and cannot see. The measure allowed any healthcare provider to join an insurance company's network, assuming the provider agrees to the company's terms and conditions and works within the company's coverage area, a concept known as "any willing provider."[2]

Election results

Below are the official, certified election results:

South Dakota Measure 17
ResultVotesPercentage
Approveda Yes 166,401 61.81%
No102,79238.19%

Election results via: South Dakota Secretary of State Office

Text of measure

Ballot title

The ballot title was as follows:[3]

An initiated measure to require health insurers to include all willing and qualified health care providers on their provider lists.

[4]

Ballot summary

The ballot summary was as follows:[3]

Some health insurers offer health benefit plans in which the insurer maintains a list of health care providers. Plan members must use listed providers in order to obtain the maximum plan coverage, or to have coverage at all. "Health care providers" include doctors and other licensed health care professionals, clinics and hospitals.

The initiated measure establishes who is entitled to be on the insurer's list of providers. The measure requires that these insurers list all health care providers who are willing, qualified and meet the conditions for participation established by the insurer.

The measure does not apply to all health insurers, nor to certain kinds of insurance and plans including those involving specific disease, indemnity, accident only, dental, vision, Medicare supplement, long-term care or disability income, and workers' compensation. [4]

Full text

The full text of the measure was as follows:[3]

FOR AN ACT ENTITLED, An Act to ensure patient choice in the selection of health care providers.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF SOUTH DAKOTA:

Section 1. No health insurer, including the South Dakota Medicaid program, may obstruct patient choice by excluding a health care provider licensed under the laws of this state from participating on the health insurer's panel of providers if the provider is located within the geographic coverage area of the health benefit plan and is willing and fully qualified to meet the terms and conditions of participation as established by the health insurer.

Section 2. Terms used in this Initiated Measure mean:

(1) "Health benefit plan," any hospital or medical expense policy or certificate, hospital or medical service plan, nonprofit hospital, medical-surgical health service corporation contract or certificate, provider sponsored integrated health delivery network, self-insured plan or plan provided by multiple employer welfare arrangements, health maintenance organization subscriber contract of more than six-month duration, or any health benefit plan that affects the rights of a South Dakota insured and bears a reasonable relation to South Dakota, whether delivered or issued for delivery in South Dakota. The term does not include specified disease, hospital indemnity, fixed indemnity, accident only, credit, dental, vision, Medicare supplement, long-term care or disability income insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, automobile medical payment insurance, or any plan or coverage exempted from state regulation by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 18;
(2) "Health insurer," any entity within the definitions set forth in subdivisions 58-17F-1(11), (12), and (15), any entity offering a health benefit plan as defined by § 58-17F-2, all self-insurers or multiple employer welfare arrangements, and self-insured employer-organized associations. The term does not include any entity exempted from state regulation by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 18;
(3) "Health care provider," any individual or entity within the scope of the definition of health care provider as defined by subdivision 58-17F-1(9).

[4]

Background

A similar measure, House Bill 1142, was defeated in the legislature in March 2013. This bill was opposed by business groups, insurance companies and South Dakota's three large hospital systems.[2]

Support

The group Patient Choice for South Dakota led the campaign in favor of Measure 17.


Yes On 17 - Patient Choice

Arguments

Supporters argued that Measure 17 would give patients more options. Dr. Stephen Eckrich, one of the sponsors of the initiative, said, "Who would be against patients allowing themselves to choose their own doctor?" He believed that if patients couldn't choose their own doctors, it would lead to "the end of good health care as we know it."[2]

The Patient Choice for South Dakota campaign website listed the following as arguments in favor of Measure 17:[5]

Patient Choice:

  • Makes it more likely that you can see the doctor of your choice.
  • Enables any South Dakotan/patient to visit the provider of their choice without paying more.
  • Requires insurance companies to admit doctors who meet their terms.
  • Allows patients of major health care system-sponsored insurance plans to see competing doctors without penalty.

[4]

The following arguments were submitted in favor of Measure 17:[6]

Initiated Measure 17—Patient Choice—will help control out-of-pocket costs and co-pays while improving medical outcomes. Patients deserve the freedom to choose their own doctor. Without IM-17, many patients are forced to use providers in insurance company networks or pay extra, and some are required to undergo unnecessary travel at their own expense. IM-17… Allows families to see doctors and other medical providers they know and trust. Cuts unnecessary re-testing by providers not familiar with their case histories. Reduces probability of diagnostic or prescription errors. Eases unneeded travel.Virtually eliminates out-of-network personal medical fees. Increases competition, helping control spiraling medical costs. Insurance companies must admit to their networks providers who meet their standards and agree to the insurance companies' terms. This will virtually eliminate out-of-network fees as a personal expense for most South Dakotans. The only study that deals with states' transition to similar laws shows that competition will put downward pressure on costs. There is no credible research or empirical support for opponent claims that costs will go up. And with out-of-pocket fees reduced or eliminated, patients will themselves spend less. Nearly 70% of South Dakotans surveyed support the measure. Hundreds of medical providers across South Dakota have joined together to bring patients this freedom. It is endorsed by nearly every provider organization in the state, including, among others:

SD State Medical Association, SD Orthopedic Society, SD Optometric Society, SD American Physical Therapy Association Independent Healthcare Associates, SD Academy of Physician Assistants

They support IM-17 because having a consistent, ongoing relationship with a provider is in the best interest of quality care.

Vote Yes on IM-17 Patient Choice! You shouldn’t have to change doctors if your job or insurance changes. [4]

Campaign contributions

As of December 1, 2014, the campaign contribution totals for Patient Choice for South Dakota were:[7]

PAC info:

PAC Amount raised Amount spent
Patient Choice for South Dakota $894,692.45 $953,590.77
Total $894,692.45 $953,590.77

Disclaimer: According to campaign finance reports published by the state of South Dakota, the group, Patient Choice for South Dakota, spent more than it raised. This was possible because the group was able to accrue debt.

Top contributors:

Donor Amount
Medical Facilities (USA) Holdings, Inc $300,000
Sioux Falls Specialty Hospital $175,000
Black Hills Surgical Hospital $100,000
American Association of Orthopaedic Surgeons $30,000
Surgical Management Professionals $20,000

Opposition

The group No on 17 led the official campaign in opposition to Measure 17.


Vote No On 17

Opponents

  • Sioux Falls Area Chamber of Commerce[8]
  • South Dakota Chamber of Commerce & Industry
  • South Dakota Association of Healthcare Organizations
  • Avera
  • Regional Health
  • Sanford Health
  • Independent Insurance Agent
  • America's Health Insurance Plans (AHIP)
  • Wellmark BlueCross BlueShield

Arguments

Those opposing the measure argued that these types of insurance plans are more expensive. Dave Hewett, president of the South Dakota Association of Healthcare Organizations, explained that insurance programs that offer patients expanded networks and their choice of providers already existed, though these plans were more expensive. Hewett said, "Those who want more choice and are willing to pay for it have that option."[2]

The following arguments were submitted in opposition to Measure 17:[6]

History tells us that government intervention into health care drives up costs for consumers and employers. Initiated Measure 17 would force all health plans to include any hospital or doctor to be in their network, regardless of existing contracts. This notion is known as “Any Willing Provider”. IM-17 will increase the cost of what you pay for health insurance premiums.

Proof that IM-17 will drive up the cost for everyone. In March, the Federal Trade Commission concluded “Any willing provider . . . provisions can therefore undermine the ability of plans to reduce costs. This is likely to result in higher negotiated prices, ultimately harming consumers.”

IM-17 is more government interference in health care. The Government doesn’t tell any other business who they have to hire. Schools are not required to hire any-willing teachers, and medical practices are not required to hire any-willing doctor. The Attorney General’s explanation reinforces the need to vote NO – you will see the language in quotes on the ballot.

1. Defined networks offer lowest possible price. “Some health insurers offer health benefit plans in which the insurer maintains a list of health care providers. Plan members must use listed providers in order to obtain the maximum plan coverage.”

2. IM-17 gives government the power to force insurers to list doctors and hospitals regardless of existing contracts that save consumers money. “The initiated measure establishes who is entitled to be on the insurer’s list of providers.”

3. IM-17 only applies to certain insurance plans, but everyone will end up paying more. “The measure does not apply to all health insurers, nor to certain kinds of insurance and plans including those involving specified disease, indemnity, accident only, dental, vision, Medicare supplement, long-term care or disability income, and workers’ compensation.”

Vote NO on 17

Why pay more? [4]

Campaign contributions

As of December 1, 2014, the campaign contribution totals for No on 17 were:[7]

PAC info:

PAC Amount raised Amount spent
No on 17 $681,100.00 $675,506.26
Total $681,100.00 $675,506.26

Top contributors:

Donor Amount
Rapid City Regional Hospital $170,000
Avera Health $150,000
Sanford Health $150,000
SD Associations of Healthcare Organizations $115,500
Wellmark South Dakota $50,000

Media editorial positions

See also: Endorsements of South Dakota ballot measures, 2014

Opposition

  • The Argus Leader said,
Both sides in this debate agree that IM17’s requirements would not apply to Medicare recipients or to their supplemental policies, to Tri-Care recipients or self-insured groups. That leaves a relatively small pool of affected individuals.

So, if most people wouldn’t be affected by the change and it doesn’t substantially affect a person’s ability to see a doctor of his or her choice, then why move forward with this law?

We think Initiated Measure 17 should be defeated.[4]

Argus Leader, [9]

  • The Rapid City Journal said,
Backers of 17 say that private medical groups also provide indigent care, and accept Medicare or Medcaid [sic] patients. But it's at a miniscule level compared to what community hospitals are providing. Opponents also point out that despite the measure's apparent focus on patients, it is really about money: more for private doctors, and ultimately higher costs for patients.

Finally, though the language is simple, the ramifications are not as well understood, and often the best legislation or policy measures are developed over a period of years, not in one fell swoop at the ballot box. For now, though there may be some pain felt by patients who must travel for care, there is no crisis present that would warrant such a major shift in the complex health-care system. We strongly suggest a "no" vote on IM 17.[4]

Rapid City Journal, [10]

Polls

See also: Polls, 2014 ballot measures
South Dakota Initiated Measure 17 (2014)
Poll Support OpposeUndecidedMargin of ErrorSample Size
Mason-Dixon Polling & Research Inc.
10/20/2014-10/23/2014
55%28%17%+/-3.5800
SurveyUSA
10/21/2014-10/26/2014
41%20%39%+/-4611
AVERAGES 48% 24% 28% +/-3.75 705.5
Note: The polls above may not reflect all polls that have been conducted in this race. Those displayed are a random sampling chosen by Ballotpedia staff. If you would like to nominate another poll for inclusion in the table, send an email to editor@ballotpedia.org.

Path to the ballot

See also: Laws governing the initiative process in South Dakota

Supporters were required to collect a minimum of 15,854 valid signatures by November 4, 2013, for the measure to appear on the November 2014 ballot, as planned.[2]

External links

See also

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References