Initiated Measure 17 Repeal effort in the works? I don’t know if I would. The will of the people could prove painful.

When you talk to people hanging out in the Capitol during session as much as I do, sometimes you hear “things.”   And one of the issues/rumors that you find bubbling out there is connected to the 2014 election, and a ballot measure which passed with strong support.

As part of the 2014 election, there was a measure introduced called the patient’s choice act, or IM17. As noted by the measure’s proponents:

logoPatient Choice allows insured patients improved and less costly access to highly qualified, quality physicians that may be better suited or more familiar and convenient than those offered by the insurance company chosen by their employer.

In some instances, a change of insurance may make it cost prohibitive for a patient to see their long-term provider.  For example, if an employer selects a new group health insurance plan from a company that uses a closed network, an employee’s longtime primary care provider may be excluded from the network if he is not an employee of the hospital system that owns the insurance company that issued the new group policy. This results in the employee paying expensive out-of-pocket costs or finding a new, unfamiliar provider.

Read that here.

Initiated Measure 17 passed on a decisive vote of 166,401 in favor of, versus 102,792 against – the highest margin of victory for the three measures on the ballot.

Fast forward to the 2016 legislative session.  I’m hearing rumors afoot that there may be a bill brought in the legislature that could potentially alter that language and void IM17 at least in part.  Upon hearing that, a phrase that comes to mind is “the will of the people.”  And for whoever decides to sponsor such a measure, bucking that electoral will could be painful.

I think back to what happened last year; in the session immediately following the elections, a measure was brought to slightly modify a minor provision of another ballot measure, the minimum wage act.  The least popular of the three ballot measures, the minimum wage act was passed 150,819 to 123,167, and was not just controversial, but strongly opposed.

The bill, which was passed, brought outrage in the state’s media, and a petition drive was initiated, where the repeal of a minor portion of the ballot measure was immediately referred for election this year. The fervor of that measure has somewhat died down over the past year, where it might not affect the election fortunes of the measure’s proponents.  At least until their opponents remind the voters of it.

That happened when a minor provision was passed to slightly alter the least popular ballot measure from 2014.  Anger and near-automatic referral. What do you think the reaction will be for the legislator who might attempt a major alteration of the most popular ballot measure from the preceding election, which had virtually no opposition at the ballot box?  Especially coming smack dab in the middle of the election year?

Based on last years’ experience, I suspect it’s going to generate a wave of negative publicity that the legislator probably didn’t contemplate when they put their name on the line to support such a measure.  And that could be a wave that might dash them on the rocks in the next election.

In that instance, taking direct aim at the will of the people in such a manner might not just be an unwise thing. It could prove to be downright painful.

31 Replies to “Initiated Measure 17 Repeal effort in the works? I don’t know if I would. The will of the people could prove painful.”

  1. Springer

    Is this something we can look up on the LRC website yet? And just who is rumored to be bringing this bill and the cosponsors?

  2. Observer

    I think Sanford is litigating this currently. It’s probably their idea. No one tells Sanford what to do.

  3. Anonymous

    IM17 put an outdated model of care in South Dakota and patients will feel it. Further, this measure has nothing to do with patients but is designed to further line the pockets of speciality hospitals in the state. But hey if this rumor is true than Blake Curd might actually show up to work at the capital.

    1. Troy Jones

      While I agree with you that IM17 was not consistent with cost containment of lowering health insurance costs and is likely be good for Specialty Hospitals who don’t offer comprehensive captive plans, I disagree with the characterization it was to line anyone’s pockets and the characterization distracts from the questions the voters/legislature needs to consider openly.

      The questions are quite simple:

      1) Do we want the law to be one that gives employee-patients broad discretion on where they get their care (clinics and hospitals) at higher health insurance costs or do we want the law to be one that allows employers to negotiate plans with provider restrictions at lower health insurance costs.

      There are legitimate merits on both sides.

      2) Is the best solution some middle ground? If so, I think we should see that and have a choice between the three.

      P.S. If the “best solution” is in the middle, this is a good example where Initiated Measures can be inferior to measures drafted by the Legislature because we only get one choice (Proposal or status quo) and not something in the middle.

      1. Harold Koiman

        “Do we want the law to be one that gives employee-patients broad discretion on where they get their care (clinics and hospitals) at higher health insurance costs or do we want the law to be one that allows employers to negotiate plans with provider restrictions at lower health insurance costs.”

        You’ve got this backwards. Independent healthcare providers have the lowest cost. The more integrated the health system, the more primary care doctors they have purchased, the higher the cost (I will try to post supporting links…not sure if this message board will allow it). Sanford wants to lock us in to a higher cost system to support their unsustainable cost structure.

        (Just a note from the Great and Terrible Oz…. Or at least the blog editor. More than 2 links, and the spam filter is set to kick you into moderation.)

    2. Anon2

      This is the greed of the big health systems at its finest. They don’t care about their patients, only about steering volume to doctors they own. Sanford is the symbol for all that is wrong with big healthcare. They’d rather have their name on the pentagon than pass on savings and help their patients. It is shameful to think any legislator would stifle the voice of their constituents like this.

  4. Troy Jones


    Maybe and maybe not. Many company’s had plans negotiated with either Sanford or Avera. Because of the negotiated plans are no longer as negotiated, rates charged to these employers have gone up (in some cases significantly) and the cost is passed on to employees (especially on the portion of coverage afforded to non-employees under a family plan). When the reason for the increase is explained to employees, some employees express a desire to go back to a captive plan vs. have carte blanche ability to go where they want because they don’t want to pay for the higher cost (especially if those employees are willing to go where the plan was negotiated).

    I don’t know if I’m for what is being suggested. But, what many thought was a “cost-free” change in the law is now seen as having a cost they don’t want to pay.

    1. Voter

      The people voter for patient choice by a huge margin (62%) just over a year ago. Costs are going up because of Obamacare, not IM 17

  5. Troy Jones


    You are correct IM17 passed by a strong majority. You are correct health insurance costs are going up because of Obamacare.

    But, you are incorrect IM17 doesn’t have an impact on cost. Just as all regulation and intervention into the free market has a cost someone has to pay for (ala Obamacare), IM17 isn’t exempt from having a cost borne by someone. And, because it negates contracts negotiated lower prices in exchange for exclusive provider services, it shows up quickly in premiums.

    That said, I haven’t decided where I stand and may be leaning to IM17 because of the freedom to choose care providers. But, to claim IM17 is a free lunch is inaccurate. There is no free lunch ever.

    1. Harold Koiman

      Interesting that Avera wanted nothing to do with this. For Sanford, it’s always my way or the highway. Their arrogance is wearing thin.

  6. JimV

    I have it from a credible source that Sanford is behind this amendment effort. I will also assure you that “Any Willing Provider” laws have little impact on health care costs. They’re about access and patient/physician relationships which is an legitimate issue in a rural state. If a payer sets up a closed panel to save costs then a willing provider must meet ALL the requirement including reimbursement to be allowed in.

    Health systems that operate insurance companies use narrow networks to monopolies the market and drive out competition. Sanford has no intention of respecting “the will of the people” or gaining market share the old fashion way by earning it. I hope our representative have more respect for the voters than the hospitals do.

  7. Troy Jones


    It is no secret the specialty hospitals and independent clinics were behind IM17. It is no secret that Avera and Sanford (RC Regional if they have an insurance plan) want its repeal.

    Your assurance ““Any Willing Provider” laws have little impact on health care costs” is a promise of a free lunch. Pre-IM17, Avera and Sanford were willing to provide health insurance at a discount if their hospitals/clinics were going to provide the bulk of the health care services. Now they don’t get that and whatever that discount was is gone.

    Maybe your words “little impact” was an acknowledgement of that discount and you don’t think it material. But even so, “little impact” is relative and some employees are finding it material, especially those who pay all or a bulk of the family coverage.

    1. JimV

      Troy…You are incorrect. Nothing prohibits Sanford or Avera from providing a plan that discounts costs if they provide the bulk of care. I suggest you do some non-biases research on the rising cost of health care & what cost-saving strategies have proven effective. Check the CMS website on quality and costs in SD.

  8. PorterLansing

    Health insurance costs went up because the section of Obamacare that stopped them from going up was removed by a Republican Senator. When the Senate goes blue next session the risk corridors will be put back, extended another five years and costs will stabilize.

  9. Troy Jones


    Please give me the name of this Republican Senator and specifically when and how he took out a section of a bill without the approval of both Houses of Congress and signature of President Obama.

    1. PorterLansing

      That’s a rhetorical question, isn’t it. We’ve discussed the provision Rubio slid into the spending bill before and you tried to change the direction then, also.

        1. PorterLansing

          Thanks for reminding me that most Republicans are low educated readers. I said it last post but I’ll be happy to say it again. Marco Rubio is responsible for the health insurance rate hikes. He slid a provision into the spending bill which eliminated the risk corridors that caused many insurers to raise rates. Stopping it would have ended funding for our brave troops, which our President wouldn’t do. Here’s the proof.

          1. Michael Wyland

            Technically, risk corridors were not eliminated. Funds for the risk corridors were limited to funds raised from taxes/”contributions” from profitable insurance plans. The initial legislation allowed unlimited funds to be allocated to risk corridors based on claims made by unprofitable health insurance plans. The change meant that the risk corridor fund could only pay out about 12% of claims.

  10. Anonymous

    The only thing worse than liberals are Republican who think they know better than the people they serve. Curd should be gone for violating the state constitution with his obvious conflict of interest. Corruption at its best.

    1. Harold Koiman

      Beg your pardon??? Speaker Pro Temp Mark Mickelson is on the Sanford Board of Governors!!! Talk about potential conflict of interest!!!

      1. Captain Conflict

        Pretty laughable comparison. Curd is the president of and shareholder in the Sioux Falls Specialty Hospital. He’s made a fortune off of conflicted medicine. IM17 is only an extension of that. Exactly what right did patients get when the law passed? Nada. Curd and his buddies used a government mandate to access whatever health plans could further pad the bottom line. The will of the people doesn’t mean a whole lot when it’s premised on a lie.

  11. SD Physician

    Sanford is behind this bill. As a physician in the state, one of my first patients who benefitted from this bill was able to get care locally rather than drive 6 hours across the state. I took care of the patient at the same reimbursement as her plan, AND she did not have to take multiple days off work, pay for gas, lodging etc. She benefitted, her employer benefitted, the local economy benefitted. Sanford, however, didn’t get the money and that is why they are angry and behind this effort.

    1. Springer

      Thank you for giving us an answer based on actual experience. I know the state employees plan covered certain procedures only at certain hospitals at one end or the other of the state, and certain others at the other end of the state. If you wanted to stay local, you had to pay out of your own pocket. This might have been good for the hospitals, but it certainly was not good for the patients. Patient choice needs to stay.

  12. Bernie Sanders

    I agree that selective contracts, which create more affordable options for consumers, should be invalidated. Tear those contracts up! Let every provider into every insurance plan once and for all! Hell, just get rid of insurance! Single payer, baby!

    1. Springer

      Yep, single payer is the answer. We all see just how wonderfully well that is working at the VA system with Uncle Sam in charge, and of course IHS is working great too. No problems, no, none..

  13. Anonymous

    Either your a doc who is lying about the patient or you’re the planned parenthood lackey who took credit for a semi-decent commercial.

    Either way, I’d remind folks that it was a pro-choice and a planned parenthood activist who works for liberal ad firm media one in Sioux Falls who sold us a bill of goods. Just looking at that makes me want to see the whole thing repealed.

  14. Troy


    Rubio is effectively just making Obamacare live with its program cost projections Obama promised when he presented the bill. Getting the projections wrong by 600% is not a small matter.