South Dakota Patients Deserve Better: Reform The 340B Program By Dr Bill Cohen
The 340B Drug Program was intended to help vulnerable or uninsured patients access life-saving medications while allowing hospitals serving low-income communities to purchase drugs at discounted rates. Unfortunately, many South Dakota hospitals are allegedly keeping the difference for their own financial benefit. I believe it’s time for lawmakers to reassess 340B and implement the necessary reformsto clean up this program.
Since 2010, the 340B program has expanded by 500%, with over 25,000 contract pharmacies now involved. You would think that growth would mean this program would be reaching more of its target populations. However, only 35% of 340B hospitals are in medically underserved areas.
Disproportionate Share Hospitals (DSH), which make up the majority of 340B participants, provide a clear example of the program’s failure. Just in South Dakota, DSHsearn more from 340B profits than they spend on charity care. In 2022, Avera McKennan, a major hospital, allocated just 0.3% of its operating costs to charity care. Meanwhile, nationally, DSH hospitals earned $44 billion in 340B profits in 2022, but only 42%was used for charity care. This begs the question: where are they directing the other 58%? Investigations show they are largely being directed toward other operational costs instead of being passed down to patients.
The lack of transparency in the 340B program has allowed hospitals and large corporations to take advantage of the system. Hospitals in South Dakota are profiting from discounted medications intended for low-income patients. Companies like Walgreens, CVS, and Walmart have increased their participation in 340B and profited significantly while patients see little benefit. In 2021 alone, CVS, Walgreens, Walmart, Cigna’s Express Scripts, and UnitedHealth’s OptumRx profited a combined $3.2 billion from 340B sales.
This unchecked profiteering harms patients, taxpayers, and state budgets. The solution is simple: we need transparency and accountability in South Dakota. A potential solution is shifting to a rebate-based model, where hospitals would only receive drug discounts through rebates once it is confirmed patients received the lower costs drugs. With nearly 75% of 340B auditsbetween 2012 and 2019 revealing noncompliance, it’s clear too much trust has been placed in this program’s discount distributors.
In the interest of cleaning up our federal government, it’s important that some sunlight is put on its programs. 340B reform would be a strong priority for this new Congress. With Senator John Thune taking the helm of the US Senate and with Elon Musk and Vivek Ramaswamy leading the Department of Government Efficiency, there’s hope to bring much needed attention and yes –shed light on ways to better care for our patients. I encourage the soon-to-be Majority Leader to add this to the docket. South Dakota patients, particularly ones in underserved communities that already face significant health challenges, are counting on our policymakers to fix the program so it helps them access the lifechanging medicines they need.
Dr. Bill Cohen is a board-certified pain relief specialist and founder of American Pain Relief Institute.
Ring in the New Year By: Lt. Gov. Larry Rhoden December 27, 2024
New Year’s means looking ahead. Growing up on my family ranch, we always looked forward to a long year of hard work. After all, calving season wasn’t too far in the future. We celebrated the holidays; we wished each other “Merry Christmas!” and “Happy New Year!” with smiles, good food, and the enjoyment of each other’s company. And then we got back to work taking care of the land and the animals so that they can feed us and everyone else.
We have important work to get back to in the upcoming year, as well. A new year means that a new legislative session is right around the corner, and we will get back to work on behalf of the people of South Dakota.
It is in my nature to always look for ways to do even better. New Year’s is a great time to do this. As Benjamin Franklin once said, “Let every new year find you a better man.”
South Dakota is full of truly excellent men and women. Over the last several years, I have been so impressed by how South Dakotans tackle adversity. And through that adversity, we found an opportunity to demonstrate to the nation what adhering to Christian conservative principles can achieve. We demonstrated to the state, the nation, and the planet what Freedom looks like.
We’ve built the strongest economy in America, and I hope that we find opportunities to take our state to even greater heights. We’ve become the freest state in a nation built on the principle of Freedom. But defending the Freedom of our people is not work that ever ends. We need to work hard to protect our rights and look for leaders who understand where those rights come from – from God. And we should honor those who fought and died to defend the Freedoms which we are blessed with.
It is an awesome charge to carry Freedom on to the next generation, and South Dakotans are well equipped to do it.
I hope that every South Dakotan took time to celebrate with friends and family this holiday season. I hope that your time together was special and full of memories, and I hope that the new year brings plenty more for you to celebrate. As we kick off 2025, I hope that you find ways to make your families, your communities, and our state stronger than ever before.
Our people have built a state that I am proud to call home. I have been honored to serve them in a position of leadership alongside Governor Noem. I am blessed with the opportunity to continue serving South Dakotans in this new year. If you ever have any ideas for how we can make South Dakota even stronger in the days and years to come, please do not hesitate to reach out.
Senator Michael Rohl has pre-filed a legislative measure that would close a legislative loophole which was abused in a most egregious manner earlier this year:
Senate Bill 12 Introduced by: Senator Rohl
An Act to limit the amount of money that may be loaned to a candidate or political committee.
Be it enacted by the Legislature of the State of South Dakota:
Section 1. That a NEW SECTION be added to chapter 12-27:
A candidate or political committee may not accept a loan from a person if the principal of which, or any combination of the principal and contributions made by the person, exceeds the limit to the amount of money that the candidate or political committee may accept as a contribution pursuant to §§ 12-27-7 to 12-27-10, inclusive. Any loan made by a person to a candidate or political committee must be counted toward the amount that the person may contribute, as an individual or entity, to a candidate or political committee pursuant to §§ 12-27-7 to 12-27-10, inclusive.
The “campaign loan loophole” has been used to varying degrees in the past in political campaigns, when someone has wanted to go far beyond South Dakota’s already loose campaign limits. Because there are NO limits for campaign loans.
Anyone can loan any amount to a campaign. And set any repayment terms that they feel like. Or they can write it off as a bad loan, never to be repaid. Consider this the ultimate campaign finance dodge.
But there’s always someone who has to show why you probably can’t have things like that.
This past year, one of the worst examples ever seen in modern state history occurred after Toby “dumpster fire” Doeden donated $100,000 to his political PAC. Which was a blatant violation of state campaign finance law which would have normally limited such a donation to $10,000.
Whoops! What do you do about something like that?
Given that in South Dakota campaign violations are allowed to be ‘fixed,’ the violation which was against the law instantly became termed “a loan” by a new filing.
Aberdeen businessman Toby Doeden, who established Dakota First Action after vowing to help conservative candidates in South Dakota, says a $100,000 contribution to his PAC was inadvertently reported as a donation, a violation of state campaign finance law. Instead, the six-figure check he cut was intended to be a loan, he said.
“I spoke with the folks from the finance team and they were already aware of this and working on filing the amended report,” Doeden said in a statement.
I’m suuuurrreee it was just a filing mistake. If you believe that, I’m sure there are several bridges along the Missouri river I can sell you. Nevertheless, it highlights the loophole in state campaign finance law where campaign finance limits can simply be ignored. By just calling it a loan.
What Senator Rohl’s legislation proposes is to count “loans” towards the total amounts that are already set in South Dakota state law for campaign donations, eliminating the unlimited donation loophole, where a $10,000 loan would be treated no differently than a $10,000 donation to a political action committee. And you would no longer be permitted to give a $100,000 loan to a candidate where your limit might normally be $1000.
Leaving it for legislators to consider in January whether everyone should be treated equally under the law. Or if people with the cash can just buy their way around it?
it appears that the Grinch has arrived in Pierre just in time for Christmas! Because the Legislative Research Council has added new categories for legislation on their website:
Both the House and the Senate are adding “Resolutions of Disapproval” to the categories of legislation that website viewers can peruse.
i’m not exactly sure why we have a “resolution” category AND a “resolution of disapproval” category, but that might be a hint as to what we will see coming from the new legislature in January. Obviously, someone feels there will be enough disapproval to warrant categorization.
From my family to yours, Merry Christmas and Happy Holidays!
In an ever-changing, fast-paced world, it’s easy to get swept up in current events during the holiday season. But on Christmas Eve, I hope everyone takes time to remember the true reason for the season: the birth of our Lord and Savior Jesus Christ, a reminder of the promise made by our loving God. And while we should keep these in mind year-round, it’s a particularly good time of year to keep in mind the teachings of Jesus: love one another, be grateful for all of the good things in our lives and give back to others.
This Christmas, I’m feeling thankful for several things: first and foremost, my family. As most of you know, I’m the proud father to four grown children and grandpa to 11 grandchildren. This year, I’m looking forward to showing our Christmas traditions to my newest grandson Maddox, who was born to my son John and his wife Ashlee in July. One of these traditions is hosting over 100 family members for homemade chicken noodle soup on Christmas Eve (after attending Christmas Eve Mass, of course!).
I’m also grateful for our men and women in uniform, particularly those serving overseas and away from their families during the holiday season. They have sacrificed time with their families so that we are able to enjoy a peaceful holiday at home with our families. I encourage you to take a moment and say a prayer for these servicemembers, or simply to say thank you.
Finally, I am grateful for the opportunity to work for you in the United States Senate. It is an honor to show up to work every day to represent the interests of South Dakota and our people. Thank you for all you do to make our state the greatest place in the world to call home.
Merry Christmas and Happy New Year to you and yours.
US SENATOR MIKE ROUNDS WEEKLY ROUND[S] UP: December 9-20, 2024
Welcome back to another edition of the Weekly Round[s] Up after a busy couple of weeks in Washington. As I’m sure you’ve seen, we spent most of this past week discussing government funding. Last Friday evening, the Senate and House voted to pass a continuing resolution to avert a government shutdown. This bill was far from perfect, but it delivered several key wins for America: keeping government open (meaning our troops and other essential personnel get paid through the holiday season), delivering relief for our farmers and bringing disaster relief to communities devastated by hurricanes this fall.
While the government spending discussions stole the show, this past week we also sent the Fiscal Year 2025 (FY25) National Defense Authorization Act (NDAA) to the President’s desk to be signed into law. This bill contains several provisions to support our national security, which you can read more about below. In between all of our important votes this past week, I took time to meet with South Dakota groups, as well as several of President-elect Trump’s nominees. I also received my committee assignments for next Congress, which you can read about below. It’s been a busy month out here in DC and it’s about to get a whole lot busier as we prepare to hit the ground running in January. With a Republican trifecta in the Senate, House and Presidency, we’re ready to get America back on track. Here’s my Weekly Round[s] Up:
South Dakotans I met with:Jim Dover, CEO of Avera and his son Patrick; members of the Great Plains Tribal Chairmen’s Association, including Sisseton Wahpeton Oyate (SWO) Chairman J. Garret Renville, Standing Rock Sioux Tribe Chairwoman Janet Alkire, Crow Creek Sioux Tribe Chairman Peter Lengkeek and Oglala Sioux Tribe President Frank Star Comes Out; members of the South Dakota Science and Technology Authority; and Nikki Gronli, State Director of the U.S. Department of Agriculture’s South Dakota Rural Development team.
Met with South Dakotans from: Dell Rapids, Ft. Thompson, Pine Ridge, Rapid City, Sioux Falls and Sisseton.
Cabinet nominee meetings: I met with Tulsi Gabbard, President-elect Trump’s nominee for Director of National Intelligence (DNI). We had an excellent first meeting. As a member of the Select Committee on Intelligence, the committee her nomination will go through before heading to the full Senate, I am looking forward to working with her as she continues to move through the confirmation process.
I also met with John Ratcliffe, nominee for Director of the Central Intelligence Agency (CIA). John formerly served as DNI under President-elect Trump which has prepared him well for this role. His nomination will also pass through the Intelligence committee. I’m happy to work with him through the nomination process.
I met with Scott Turner, nominee to lead the Department of Housing and Urban Development. His nomination will go through the Senate Committee on Banking, Housing and Urban Affairs. I look forward to working with him to reduce the regulatory burden for individuals trying to achieve the American dream of homeownership.
Kash Patel, nominee to lead the Federal Bureau of Investigation, was also in my office for a meeting this week. We had a very good conversation about his vision for the Federal Bureau of Investigation. I believe Mr. Patel will restore the confidence of the rank-and-file team members within the FBI who work day-to-day to solve crimes in this country. I am confident in President-elect Trump’s choice of Mr. Patel to help the FBI move forward in keeping Americans safe.
I also met with Russell Vought, nominee to lead the Office of Management and Budget, and Paul Atkins, nominee to chair the U.S. Securities and Exchange Commission.
Other meetings: Michael Tackett, a journalist who covers national politics; Senator-elect Lisa Blunt Rochester from Delaware; Bruce Byrd, Executive Vice President and General Counsel at Palo Alto Networks; Harold Hamm, Executive Chairman of Continental Resources; Tim Teter, General Counsel at Nvidia; Roselyn Tso, Director of the Indian Health Service; Lt. Gen. Burt Field, CEO of the Air and Space Forces Association; a group of veterans and active duty military who were on Capitol Hill to talk about the issues they’re facing; General B. Chance Saltzman, Chief of Space Operations within the U.S. Space Force; and Anne Neuberger, Deputy National Security Advisor for Cyber and Emerging Technology. I was also a keynote speaker at the Wharton Future of Finance Forum.
I hosted Senate Bible Study in my office for the past two weeks. Our verses of the week were Philippians 2:16 and Luke 2:10-11. I also attended Senate Prayer Breakfast both weeks.
National Defense Authorization Act: This past week, the Senate and House passed the final version of the FY25 NDAA and sent it to President Biden’s desk. This piece of legislation, which I helped craft as a member of the Senate Armed Services Committee, contains several wins for our national defense. These provisions are designed to support our men and women in uniform by doing everything we can to make certain they never enter a fair fight and always have the upper hand over our adversaries.
The list of these provisions is long, so I won’t put them all here, but two of our major wins for South Dakota are $282 million authorized for construction projects at Ellsworth Air Force Base and $2.6 billion authorized for procurement of B-21s. You can read more about the bill and view a full list of my provisions here.
Continuing Resolution: As I mentioned, the Senate passed a Continuing Resolution late on Friday night to avert a government shutdown. The final bill set the next funding deadline at March 14, 2025 and included disaster relief funding, particularly for states affected by the devastating hurricanes this fall, and relief for farmers. Our budget and appropriations process in Congress has been dysfunctional for far too long. It’s my hope that come next year, we can return to doing appropriations the way we should: working through the committee process and bringing these bills to the floor before the end of the fiscal year, instead of continually kicking the can down the road with a series of CRs and shutdown threats.
Committee assignments: Speaking of appropriations, last week we received our committee assignments for the new Congress beginning in January. I will remain on the Armed Services, Banking, Intelligence and Indian Affairs Committees. I’ve also added one new committee: the Senate Committee on Appropriations. It’s been almost 30 years since Congress passed all of its required appropriations measures on time. I look forward to working with my colleagues on Appropriations to promote returning to regular order for our budgeting process and return to commonsense fiscal conservatism under a Republican trifecta in the 119th Congress. With this new assignment, I will no longer be serving on the Senate Veterans’ Affairs Committee, but I will continue to work on Veterans issues. You can read more about my committee assignments here.
Votes taken: 23 – we once again had several controversial Biden administration nominees. These nominees were for judge positions in Georgia, Pennsylvania and California, as well as positions on the National Labor Relations Board and the Nuclear Regulatory Commission.
We also voted on the CR and NDAA, which I’ve mentioned above. In addition, we voted on the Social Security Fairness Act. I voted no along with 22 of my colleagues. This bill costs $196 billion and impacts only 4% of Social Security beneficiaries. It directly increases our mandatory spending and accelerates Social Security’s looming shortfall by about six months. We must act to make Social Security solvent long term without harming the current beneficiaries.
Hearings: I attended five hearings over the past couple of weeks. Four of them were closed hearings with the Select Committee on Intelligence. The other was a Banking, Housing, and Urban Affairs Committee hearing where we heard from Rohit Chopra, Director of the Consumer Financial Protection Bureau. You can watch a clip of my questioning here.
Classified briefings: I attended three briefings, two of which were classified: one classified briefing on Anomalous Health Incidents and one classified briefing on the Next-Generation Air Dominance (NGAD) program. A third briefing on Dataminr was a briefing only – not classified.
My staff in South Dakota visited: Aberdeen, Custer, Deadwood, Dupree, Hot Springs, Huron, McIntosh, Philip, Pierre, Timber Lake, Wall and Watertown.
Steps taken this past week: Week 1: 47,799 steps or 23.92 miles, Week 2: 49,041 steps or 24.37 miles
Video of the week: I joined NewsCenter1 after the NDAA passed to discuss the bill:
As 2024 is closing, US Senator Mike Rounds is changing the guard slightly in his campaign structure.
Current member of the Board of Regents and Former State GOP Chair Pam Roberts has been designated as the campaign treasurer for the Rounds for Senate campaign in filings made with the Federal Elections Commission this weekend, changing out from former State Senator Barb Everist.
As Pam is more local to Senator Rounds’ home base in Pierre than Barb is in Sioux Falls, it could mean that Senator Rounds is getting ready to fight a more aggressive primary election effort in 2026, and Pam is a veteran of many election battles.
Which is smart, given the upheaval that the Republican Party in South Dakota has been and will continue to experience through the next election.
Stay tuned, as I’m sure we’ll see more moves on the board in coming months.
