Health care coverage remains a priority for Senator Tim Johnson as he prepares to leave office. Even with the passage of the Affordable Care Act, South Dakota is one of a hand full of states that isn't expanding Medicaid coverage.
"Our state government has opted not to expand, leaving up to 45,000 South Dakotans without access to coverage," Sen. Tim Johnson said.
That decision is already having an impact in Sioux Falls. With over half of its patients not insured, Falls Community Health Center is limited in what care it can offer.
"We have an open-door and open-access policy here and are happy to see those patients, but if they require more specialized care, it is very difficult to accommodate to those patients," Dr. Jen Tinguely said.
For states like North Dakota, which has expanded Medicaid, nearly 20 percent more people now receive vital medical coverage.
"They've been some of the most heart-warming stories of people who have had very chronic conditions and didn't have insurance and didn't have the means to see out the care. It's making a great impact," Mark Johnston with Sanford Health said.
Medicaid is not the only concern for Senator Johnson. The Children's Health Insurance Plan, or CHIP, is set to expire in 2015, potentially leaving 4,300 South Dakota kids uninsured.
"If the CHIP funding expires and those kids that are only eligible for CHIP don't have coverage, then bottom line, our costs go up. Period. It's very simple for us," Rebekah Cradduck said.
Johnson hopes to see CHIP renewed at the national level, and is looking to local legislators to keep fighting for Medicaid expansion.
"There's conjecture about what will happen in the future. Some of us worked very hard across the aisle with no success," Rep. Karen Soli said.
Governor Dennis Daugaard has said that he wanted to wait and see the impacts of the Affordable Care Act nationwide before making a final decision on whether to expand Medicaid in the state.