340B Reform is Needed to Prevent Future Waste
By Troy Redler

For the last few weeks, the headlines have been filled with reports of outlandish government spending thanks to the efforts of Elon Musk’s Department of Government Efficiency (DOGE). As DOGE continues to find the worst cases of waste, fraud, and abuse across the government, it is only a matter of time before they turn their attention to the 340B program.

The 340B program was created to achieve a noble goal: to help vulnerable patients access prescription medications. This was supposed to work by allowing hospitals operating in underserved communities to purchase prescription drugs at a discounted rate. Those hospitals could then provide medicine to needy patients at a lower cost.

Unfortunately, the system was designed with a fatal flaw—there is no accountability to ensure patients actually see the savings. This has resulted in many hospitals using the 340B savings to boost their profits rather than charge patients lower prices.

This is a particularly big issue for rural states like South Dakota. Many South Dakotans live in medically underserved areas or struggle to afford their medications. Reform is desperately needed to ensure the program is serving our most vulnerable residents and prevent more resources from being wasted.

The 340B program has exploded in popularity in recent years. The number of covered entities, which is a technical term for hospitals or other healthcare providers who utilize the 340B program, has grown to over 12,700 by 2020, according to the Government Accountability Office (GAO).

The growth in the number of contract pharmacies that provide the medication paints an even starker picture. In 2010, approximately 1,800 contract pharmacy locations nationwide participated in 340B. By 2022, that number had grown to nearly 32,000.

Much of this growth has been fraudulent. Despite being a program explicitly designed to benefit vulnerable patients, only 35% of participating hospitals and clinics provide service to underserved areas. Moreover, an academic analysis found that the dramatic growth of contract pharmacies was not correlated with poverty rates or areas of medical underservice.

The GAO has found numerous instances of noncompliance across the 340B program, including ineligible facilities qualifying for discounted medications and distributing 340B drugs to ineligible patients. However, the most wasteful abuse that has been uncovered is the discovery of “duplicate discounts.” This occurs when medications that are already covered by another government benefit, such as a Medicaid rebate, are also sold under a 340b price.

While it is bad enough that taxpayer money is being wasted, what makes the situation even more concerning is that the program is failing to help the very patients it was designed to serve. Instead of lowering costs for patients, hospitals are often charging them the full sticker price for prescription medications and using the savings to invest in unrelated projects.

Defenders of the status quo sometimes argue that hospitals use their 340B savings to invest in charity care, so the program is actually achieving its stated goal. But the evidence does not support this claim. In 2022, for example, participating hospitals made over $44 billion of the 340B program but spent just under $19 billion on charity care.

Ultimately, serious changes to the program will need to be passed by Congress. Given South Dakota’s large population of underserved patients, Senate Majority Leader John Thune should make passing 340B reform a top priority.

In the short term, a good first step would be for DOGE to draw attention to the problem, as they have done for other instances of governmental abuse. After all, sunlight is the best disinfectant.

Another way DOGE can help is to advocate for a “follow the money” approach to the program. Some drugmakers have proposed moving the 340B program to a rebate model, where the manufacturers would provide the savings once a hospital verifies that the 340B drugs receiving a discount were actually purchased and dispensed by a properly eligible 340B provider.  While this system would not fix all of 340B’s woes overnight, it would be a first step towards providing the transparency necessary to ensure that at-risk patients have access to affordable medications—and that’s what matters most.

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Troy Redler is the operator of the family-owned, Redler’s LTC Pharmacy specializing in pharmaceutical care for patients in long term care and senior living communities.

Thune Statement on Air Strikes in Yemen

 SIOUX FALLS, S.D.  — U.S. Senate Majority Leader John Thune (R-S.D.) today issued the following statement:

“Today’s air strikes in Yemen sent a clear and unambiguous message to our adversaries around the world: attacking the United States and our allies will not be tolerated,” said Thune. “I applaud President Trump for taking this long overdue decisive action the American people deserve and expect to keep American servicemembers, maritime shipping, and our allies safe from Houthi terrorists. Bad actors around the globe must understand there are consequences for their actions, and we now have a president who’s willing to hold them accountable.” 

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The most unlikeable man in South Dakota, Toby Doeden, is shooting off his mouth again.

This time, on his revamped website, he’s making a completely unsubstantiated claim that the Republican legislators ousted in the 2024 Primary election were somehow corrupt:

“In 2024, he launched Dakota First Action, a political action committee that helped conservative outsiders win many elections across the state, ousting a dozen corrupt career politicians along the way.”

The guy who funded his PAC with an illegal donation (which he later claimed was a loan), is trying to say that people like Senator Jean Hunhoff, former Mayor of Yankton & one of South Dakota’s longest serving legislators or Rep. Bryon Callies, a National Vice Commander of the American Legion were somehow corrupt?

What a complete d-bag.

Rounds Leads Legislation to Extend Reporting Deadline for Emergency Tribal Care 

WASHINGTON – U.S. Senators Mike Rounds (R-S.D.) and Catherine Cortez Masto (D-Nev.), members of the Senate Committee on Indian Affairs, today reintroduced legislation to extend the reporting deadline for Indian Health Service (IHS) patients who seek emergency care outside of IHS facilities. The IHS Emergency Claims Parity Act would extend the emergency notification requirements of IHS’s Purchased and Referred Care (PRC) program from within 72 hours to 15 days.

“Nobody in an emergency situation should have to have the bureaucratic paperwork process of the IHS at the top of their mind,” said Rounds. “In an emergency, patients need to be able to seek care at the closest facility that can adequately address their needs without worrying that the IHS won’t reimburse costs. Asking them to report this care within 72 hours after a medical emergency is unrealistic and has contributed to significant medical debt in tribal communities. Currently, IHS offers one of the shortest windows to submit emergency claims out of any government-run health care system. This legislation would fix that.”

“Medical emergencies are emergencies – people can’t choose when and where they occur,” said Cortez Masto. “In a crisis, IHS patients should be able to seek care at the closest hospital without worrying about having to fill out burdensome paperwork after an emergency.”

“We thank Senator Rounds for his leadership to help improve Indian health care,” said Gay Kingman, Executive Director of the Great Plains Tribal Chairmen’s Association. “As he knows, many of our IHS patients have limited means and a clear avenue to secure assistance is critical to the provision of good health care and to improve health outcomes. These are life and death matters.”

“The last thing a medical patient should have to worry about is paperwork during a healthcare emergency,” said Frank Star Comes Out, President of Oglala Sioux Tribe. “The Indian Health Service’s current 72-hour emergency PRC reporting window places an undue burden on tribal members. We thank Senator Rounds for consulting with tribal leaders on this issue and working to find potential solutions. The restrictive rules of the PRC program need to be addressed. We look forward to working with the Senator to ensure existing flexibilities are included in the bill and get it across the finish line.”

“Tribal members are already subject to a number of strict rules when accessing Purchased and Referred Care resources,” said Wayne Boyd, Treasurer of the Rosebud Sioux Tribe. “It is unrealistic for IHS to expect patients to report PRC claims when dealing with life threatening injuries or illness. I thank Senator Rounds for working with tribal leaders and taking a common-sense approach to address this issue.”

 IHS beneficiaries are subject to a number of restrictive rules when seeking outside care; however, few of these rules are as problematic as the emergency reporting deadline. Currently, in emergency cases, the patient must notify the PRC office within 72 hours of receiving outside care. Native American patients determined to be elderly or disabled are given 30 days to notify the IHS of emergency medical care received from non-IHS medical providers or at non-IHS medical facilities.

The IHS Emergency Claims Parity Act would increase the window for timely consideration of emergency care payments to 15 days for all IHS beneficiaries. This excludes reporting requirements for patients considered to be elderly or disabled, which will stay at 30 days.

Click HERE for full bill text.

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The March 2025 FEC Report for the South Dakota Republican Party has been filed.  While the new leadership group has not STILL filed anything indicating that they’re in charge, despite FEC Requirements, the old group is closing out their books.

And as members of past SDGOP Leadership have been warning for months, the SDGOP’s toxicity, and county parties not helping has not been good to their bottom line.

March 2025 SDGOP FEC Report by Pat Powers on Scribd

The SDGOP raised a whole $32.00 in the period between 2/1 – 2/28/2025.  That’s $32 as in dollars, not $32,000. They did also get back $53.68 in bank fees/interest, which helped to double their fundraising for the month. This comes against $8358.88 in expenditures, leaving the SDGOP $49,250.01 for the new group to play with.

The new crew did manage to get the SDGOP website under their control.  But, as noted, they can’t seem to get their filings done, as neither the FEC nor the SDSOS have updated contact information.

 

I saw an item from the kooky canvassers (a.k.a., the election goofballs) on facebook where for the last day they have been going absolutely apoplectic because it appears that McPherson County State’s Attorney, and son of former Republican State Rep. Charlie Hoffman, has been appointed to the State Board of Elections. While not on the SOS website yet, according to the State’s Board and Commissions website:

This was an excellent appointment, as Hoffman has experience with some of the battles that have taken place over the last year where the election hand-counting kooks have pressed to dump election machines, such as in this story from the Dakota Scout:

Hand-counting all of the June 4 primary ballots in McPherson County proved the process is a waste of time and money.

That was the take of McPherson County State’s Attorney Austin Hoffman after a secondary audit of ballots on Tuesday.

and..

The hand-counting resulted in four missed ballots (eight missed tallies) in the District 23 House Republican primary, Hoffman said.

“In my view, that’s not acceptable for an actual election,” he said.

Hoffman said concerns about vote tabulators have “no merit whatsoever.”

Read that here.

To say the election kooks hate him, might be an understatement, as evidenced from Rick Weible using “Pillow-guy Internet TV” to specifically call out Hoffman in the middle of a rant where he attacks then Governor Kristi Noem back in March of 2024:

“So I want to warn the rest of the country, you’d better be careful who your VP pick is going to be. I’m calling it out right now. And then also Representative Darreld(?), shame on you, Representative Rehfeldt, shame on you. Representative Reimer, the prime sponsor of this? You are disgusting. I want to make sure and call out every one of those, that they need to be primaried, immediately.”

and..

“And these two attorney’s – Sara Frankenstein, how dare you represent the laws..in South Dakota.. and not be there for the people? And then a special.. special one.. Austin Hoffman, how dare you go to your county commissioners and sit there and quote statutes that are actually repealed and try to use that as an excuse to dee-reel.. derail the petition process in your county and the decisions making of your county. I would implore those county commissioners to start an investigation to find out what other lies that he’s told them.”

Read that here.

And don’t think Austin sits there and just takes it – because he’s not afraid to point out facts, and call them out for their BS:

Over the last several years, Mr. Klipfel and other members of the Executive Board have used those positions to push personal agendas. They have used the McPherson County Republican Executive Board as a vehicle to move forward an anti-CO2 pipeline agenda, an unfounded election integrity agenda, and most recently to push a blatantly false and incorrect narrative that myself, as State’s Attorney, am attempting to push a resolution that would violate First Amendment freedom of speech rights. The first two items I mention are inappropriate. The latter is absurd.

and..

“I have no issues with someone disagreeing with me politically or unhappy with the decisions I make as McPherson County State’s Attorney. Everyone has the right to their opinion. But using one’s role as Chairman of the McPherson County Republicans to make incorrect and false accusations, to push personal agendas, or to complain about legal bills they created, is an entirely different story.”

(You can read that here.)

In other words, he’s not afraid to face off with these election nonsense goofs, using logic and the law. So they don’t care for that.

Of course, they had some choice comments about his new position:

Not thinking that’s how that works..  Oh, here’s a great one:

Uh oh!  “File a complaint with Marty Jackley.”  I hate to tell this gal that Marty is well aware of Austin. And knows just what to do with him:

Attorney general announces first Open Meetings Commission hearing in nearly four years
(From SD Searchlight)

The current five-member panel consists of State’s Attorneys Austin Hoffman of McPherson County, Katelynn Hoffman of Turner County, Lance Russell of Fall River/Oglala Lakota County, Michael Smith of Clay County, and Emily Sovell of Sully County.

He appoints him to boards and commissions as well!   We’ll see how far they get with that one.

So, Congratulations appear to be in order to Austin for his apparent appointment!

(And apologies to him on behalf of not-crazy South Dakotans in advance for what he’s going to have to listen to on the Board of Elections.)

Thune: We Are Just Getting Started

 “Republicans are working to deliver for the American people.”

Click here to watch the video.

 

WASHINGTON — U.S. Senate Majority Leader John Thune (R-S.D.) today delivered the following remarks on the Senate floor

Thune Calls Out Democrats’ Willingness to Shut Down the Government

 “Democrats need to decide if they’re going to support funding legislation that came over from the House, or if they’re going to shut down the government.”

Click here to watch the video.

Gov. Rhoden Signs Bill to Address Property Taxes

PIERRE, S.D. –  Today, Governor Larry Rhoden signed his bill to address the rising burden of property taxes on South Dakota homeowners, SB 216. He signed this bill at a signing ceremony in the Capitol Rotunda, and you can find a photo of the signing here.

“SB 216 is a win for South Dakota homeowners,” said Governor Larry Rhoden. “This bill is impactful and workable, and it will certainly slow down any future tax increases.”

SB 216 addresses the property tax burden on homeowners in the following ways:

• Limits the increase in owner-occupied assessments to 3% countywide for the next 5 tax years;
• Sets a 3% cap on the amount taxing districts and school capital outlay budgets can increase as a result of new construction – local government budgets don’t need to grow just because a homeowner makes a small improvement to their property; and
• Increases the maximum income limits for the assessment freeze program to $55,000 for single member homes and $65,000 for multi-member homes – the bill also increases the maximum eligible home value to $500,000.

“I am grateful for all the legislators who worked with me to get this bill passed. The discussions and negotiations that occurred along the way are a sign of good process,” continued Governor Larry Rhoden. “This bill was an important step forward, but we are not done bringing property tax relief to South Dakotans. I am working on a proposal for a real property tax cut and will share more details on that proposal in the near future.”

Governor Rhoden has signed 126 bills and VETOED one this legislative session.

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Gov. Rhoden VETOES HB 1132

PIERRE, S.D. –  Today, Governor Larry Rhoden VETOED HB 1132, which would have expanded the child care assistance program beyond the low-income families that it is meant to prioritize. Governor Rhoden outlined the reasons for his VETO in a letter to the House of Representatives. You can find a copy of the letter here. You can find a picture of Governor Rhoden VETOING HB 1132 here.

“House Bill 1132 shifts South Dakota’s child care assistance program away from its core mission,” wrote Governor Larry Rhoden in the letter. “Currently, the program is designed as a safety net to help low-income families cover child care costs while they work toward self-sufficiency. This bill would give child care workers preferential treatment, by allowing them to receive this aid at a higher income level.”

The Department of Social Services has been actively implementing solutions to address the child care shortage in South Dakota, including:

• Shifted to weekly payments for child care assistance, which aligns with industry standards;
• Raised reimbursement rates by 18% to better compensate providers;
• Launched the ChildCare605 Campaign highlighting the value of child care professionals;
• Invested $115 million in stabilization grants, tuition relief, and expansion;
• Gave scholarships for free training to 130 providers, funding 47 associates degrees;
• Provided the Pathways to Professional Development career ladder to recognize child care professionals’ growth;
• Launched the Early Childhood Enrichment Resource Hub to provide tools, policies, and curriculum resources for educators;
• Gave free training and CPR certification for thousands of Early Childhood Enrichment System providers;
• Trained child care administrators on business and leadership skills; and
• Provided coaching, grants, and resources to improve program quality through Quality Recognition System.

“The Department of Social Services has been actively implementing solutions to support the child care industry and workforce. These solutions focus on sustainable approaches and do not involve expanding our state’s safety net program beyond its intended purpose,” continued Governor Rhoden. “The state’s role in promoting our child care workforce should be supporting economic development and encouraging private sector solutions – not broadening government safety nets into permanent workforce subsidies.”

Governor Rhoden has signed 125 bills and VETOED one this legislative session.

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