Report details wide disparity between Native American and white health in South Dakota

The report analyzes 2023–2024 data on health care access, quality, use of services and outcomes across racial and ethnic groups in all 50 states and Washington D.C. South Dakota ranked last for Native American health among 21 states with sufficient Native American population data.

Even when income, insurance and access are similar, disparities persist, said Commonwealth Fund President Joseph Betancourt.

“As a primary care physician, I know what happens when care is out of reach: Conditions that are manageable become crises, and people have poor health outcomes and ultimately live shorter lives. This is unacceptable and completely addressable,” Betancourt said.

Native American health system performance in South Dakota ranked in the lowest percentile nationally. White South Dakotans experienced the best care in the state, scoring in the 79th percentile among all population groups nationally.

The report found states with stronger health systems also have smaller disparities and said targeted policy changes could help, including:

• Funding housing, early childhood education and food access programs.
• Ensuring affordable, accessible coverage.
• Strengthening primary care in underserved communities.
• Protecting preventative services.
• Ensuring equitable use of digital health tools and artificial intelligence.

About 38% of Native Americans in South Dakota are uninsured — a key driver of disparities.

“Coverage is not the only thing that matters, but it is really the first thing that matters,” said Commonwealth Fund Senior Scholar Sara Collins, adding that states that expanded Medicaid have improved access. South Dakota voters approved expansion in 2022. Tribal members are exempt from federal Medicaid work requirements.

South Dakota officials, lawmakers and tribal leaders will launch an Indian Medicaid Managed Care Task Force later this year, which tribal officials hope will improve outcomes and efficiencies for tribal members.

In a managed care model, tribes could contract with the state of South Dakota to direct federal Medicaid dollars into a pool of funds for healthcare. An entity of the tribes’ choosing could negotiate costs with off-reservation providers and coordinate care for tribal members who seek care on or off tribal land.

“Focused actions like that can really improve disparities we see across the country,” Collins said.

David Radley, senior scientist on the report, said efforts to address health outcomes and access among Native Americans in Oklahoma have “made a difference.” Tribal governments there have invested heavily in clinics, hospitals and medical education.

Betancourt said progress in South Dakota will require high quality care and coverage to be “woven together.”

Radley added that health systems in rural states must be “built around rural places” to address coverage gaps and workforce shortages, including expanding telemedicine, improving licensing, and training more community health workers.