Health Care


While I opposed the partisan health care reform bills passed by Congress and signed into law in March of 2010, I share a common belief that reform is necessary. Like a growing number of individuals, I believe the Patient Protection and Affordable Care Act is not the solution to our health care problems.

On June 28, 2012, the Supreme Court of the United States ruled 5-4 on the constitutionality of the Patient Protection and Affordable Care Act. While the Court declared that the individual mandate was in violation of both the Constitution’s commerce clause and necessary and proper clause, it held that the mandate was Constitutional under Congress’ taxation powers. Additionally, the Court held that the law’s expansion of Medicaid is constitutional. However, the provision that would have stripped states of all Medicaid funding if they did not participate in the expansion was ruled unconstitutional. Thus, allowing states to decide if they would like to participate in the Medicaid expansion and the corresponding costs that states will be required to pay.

Reboot ReportWhile I still support full repeal of ObamaCare, Congress must continue to repeal the most onerous provisions of the bill. Even before enactment of ObamaCare, I opposed the creation of a new long-term care entitlement program called the Community Living Assistance Services and Supports (CLASS) Act. I offered amendments during the debate of ObamaCare to strip the CLASS Act from the final bill, but it was ultimately included despite bipartisan opposition to this unsustainable entitlement program. 

On April 4, 2011, I introduced the Repeal the CLASS Entitlement Act in the U.S. Senate. If enacted, this legislation would fully repeal the newly-created CLASS Act. Under this program, sick people who needed the long-term care benefits would quickly outnumber healthy people paying into the system. With premiums unable to keep up with payouts, the new entitlement program would have gone bankrupt, requiring untold billions of dollars in taxpayer bailouts. Or worse, it would have been shut down after people had paid their premiums and were beginning to rely on the program for help.

On October 14, 2011, the Department of Health and Human Services (HHS) announced that the department would no longer move forward with the implementation of the CLASS Program because they were unable to develop a program that was fiscally sustainable. This news came just weeks after I led a bicameral working group in the release of a report that detailed how the Obama Administration ignored repeated warnings about the financial solvency of the CLASS program. Clearly the administration determined what my colleagues and I had long been saying: The CLASS program is financially unsustainable. 

I was pleased that the Repeal the CLASS Entitlement Act was included in the American Taxpayer Relief Act of 2012 that was enacted on January 2, 2013. Repealing the CLASS Act was a critical first step in approaching sustainable solutions to long term care in America. 

Pre-existing Conditions

I support finding affordable options for the uninsured or those who have been priced out of the insurance market. I support expanding and reforming high-risk pools and reinsurance programs to help all Americans, regardless of pre-existing conditions or past illnesses, have access to affordable care. 

Small Business Health Plans

I hear from many small business owners in South Dakota who want to provide quality health care coverage for their employees, but often cannot afford the high cost of premiums. South Dakota has nearly 73,000 small businesses and a large portion of our state's uninsured population work for small businesses. I support creating Small Business Health Plans (SBHPs), which allow individuals and small businesses to band together to purchase more affordable health insurance for their employees. According to the non-partisan Congressional Budget Office, SBHPs would expand health care coverage to approximately 750,000 employees of small businesses nationwide who are currently uninsured.

Reform Medical Liability Laws

I support reforming medical liability laws that protect doctors from frivolous lawsuits so they can stop practicing defensive medicine in order to avoid lawsuits and focus on what is best for patients. I support comprehensive medical liability reform that will lower the cost of health care for all South Dakota families.

Reform Health Insurance Regulations

I am in favor of reforming health insurance regulations and allowing individuals and companies to purchase insurance across state lines. This would provide consumers in South Dakota with a greater number of options in insurance plans and would increase competition in the insurance industry. Additionally, I support providing state incentives to pursue state-based reforms to their insurance markets.

Waste, Fraud, and Abuse in Current Health Care Programs

I believe it is imperative that we address the waste, fraud, and abuse that currently plague the Medicare and Medicaid systems. I support combating fraud in our health programs and ensuring their sustainability before expanding them, or creating a new government-run program that will simply add to the problem. Medicare alone has over $60 billion in losses sustained by taxpayers each year due to fraud.

Enhance Health Savings Accounts (HSAs)

I support creating incentives that will support people saving for current and future health care needs by allowing participants to use HSA funds to pay premiums for high deductible health insurance. HSAs are proven to encourage more cost-conscious spending.


As a member of the Senate Rural Health Caucus, I support initiatives that will strengthen our rural health care infrastructure. Tele-health is innovative technology that can provide real-time information to a health provider from a patient hundreds of miles away by using video-conferencing and other technologies. This technology could help home health agencies provide home-monitoring equipment to patients in order to improve care and allow seniors more flexibility to remain at home rather than other more expensive options.

Focus on Wellness and Prevention

I believe we must change our focus to wellness and prevention. Helping people lead healthier lives is a critical part of controlling the cost of health care for everyone, not just the unhealthy. I support reforms that will make it easier for employers, insurers, and patients to take action to control the chronic disease and obesity epidemic in our country through incentives that encourage healthier behavior and participation in wellness programs.