First, a warning to current or past copy editors: If you’re squeamish at the sight of a lede being buried, you might want to leave the room.
Or just skip the first few graphs of this story -- which eventually will be about a town-hall meeting held last week by Congresswoman Kristi Noem and the ongoing health-care dispute -- and look for a lede-like sentence somewhere down below.
I’m almost certain I’ll come up with one eventually, right after I discuss politeness.
Being polite is a cultural expectation here in South Dakota. We believe in it and define ourselves as a people in part by our commitment to being courteous.
But hold on. Another warning, this time to Donald Trump fans: I intend to say something unflattering about our president, before working my way down to where the lede will be buried.
But I’ll also say something nice about South Dakotans. So I hope it evens out.
Because it is in our nature and our upbringing, most South Dakotans are doing their best to remain polite, even during the first term of the most impolite president of my lifetime, and perhaps in the history of our republic.
Whether or not you like Donald Trump and his policies, it’s hard to argue with any credibility that he isn’t a rude, crude man. He promotes impoliteness in ways that few U.S. leaders at the national level ever have, and seems to encourage division to the same degree.
Some people who share his style and political philosophies don’t need encouragement to be rude. Neither do some people on the other side of the political aisle.
Take that reality, even here in South Dakota, and throw in the expected questions about health care, and there was plenty of reason to assume things could get rowdy last Wednesday morning during Noem’s town-hall gathering in the Pennington County Commission meeting room here in Rapid City.
These town halls have blown up in other states over the health-care issue, after all, as constituents opposed to the GOP plan to repeal and replace the Affordable Care Act lost their minds — and in some instances their sense of decent behavior. They shouted and interrupted and demonstrated and resisted. In some instances, they threatened.
And it was logical for Noem’s staff to assume such emotions could erupt at her town hall here, despite our tradition of politeness.
Beyond that, of course, there is the always-just-below-the-surface possibility — however slight — that some nut will show up with a weapon of some kind, as well as the intention of hurting Noem or others.
History, recent and not, has proven that awful reality, however small the odds.
So I understand the need to be careful. And I assume that was why the town hall was held in the commission room, which is plenty spacious for most commission business but certain to be too small for a town-hall meeting likely to inspire a large turnout, and some heated emotions.
The cynic might say it also gave Noem’s organizers the opportunity to limit the size of the crowd, which was likely to be full of constituents who are angry about GOP health care plans. But you know I’m not cynical.
And to be fair, the commission room in the county building is easier than many other environs for sheriff’s deputies to keep secure. And security concerns were apparently why those attending the meeting — including reporters — were prohibited from moving around at any angle that would put them behind the commission table, and behind Noem, who stood just in front of it.
That left about a third of the crowded room unused.
Reporters for TV, newspaper and public radio were squeezed into a spot along the wall 20 or 30 feet from Noem. I complained about that to Noem staffers, who said it was a Pennington County Sheriff’s Office mandate. I then complained to Pennington County Sheriff’s Office deputies, who said Noem staffers wanted the restriction.
Whoever decided what, nobody was allowed behind the congresswoman, mostly. Staffers and deputies were allowed that angle. And I did notice that a local tea party and 2nd amendment advocate was on the edge and sometimes in the restricted zone, something I mentioned to a Noem staffer.
And, eventually, I’m happy to say, very polite people, not all of whom were South Dakotans, for both the Noem staff and the sheriff’s office worked with me so I could get the picture I wanted for this blog story. It shows Noem and the standing-room-only crowd, which spilled out into the hallways and probably totaled about 150.
If you'll notice, it also shows Bryon Noem, the congresswoman's husband, with an appreciative expression for his wife's presentation sitting in the blue shirt to the far left of the picture. I didn't show their son, Booker, who deserves some privacy, at his age. But I noticed he was attentive, as you'd expect, to how his mother was being treated by the crowd.
Most of whom were polite, most of the time, although it wasn’t always entirely because of that South Dakota tradition. State Rep. Larry Rhoden of Union Center, a substantial man of persuasive size and demeanor, opened the town hall with an explanation of the rules of propriety, or politeness.
And during the hour, Rhoden had to cut a few people off mid-rant and occasionally remind audience members of the rules. Generally they complied, in the way that even angry, powerfully opinionated South Dakotans can be expected to comply, most of the time, when asked.
I like that about us, whatever we might think about Trump, or the Republican plan for health-care reform.
None of which means the meeting changed minds or influenced people. This is a tough one, this issue. It’s life-and-death stuff in some cases. Quality of life stuff in most. And worries about physical and psychological health and addiction services are all mixed up with concerns about financial health, skyrocketing insurance premiums and that swollen national debt.
So people are dug in, and in some cases afraid — for themselves, their family members and their health-care coverage, their financial futures and those of their children and grandchildren.
Eighteen-year-old Brook Weber of Rapid City got the first question of the open-session Q&A. And after noting that he had just registered to vote, the 18-year-old told Noem that he suffered from diabetes and an anxiety disorder, while his mother has MS and his uncle has diabetes.
Weber got emotional when he said they’ve all received affordable coverage under the ACA approved by Democrats in Congress and signed by then-President Obama, over unified Republican opposition. Weber said he didn’t understand how Noem could vote for legislation that could cause them to lose or face unaffordable coverage because of their pre-existing conditions and suffer profound impacts that, in his uncle’s case, might even be fatal.
“I’m still in shock today that you could show so much disrespect toward South Dakota,” he said.
Like she did with most other emotionally charged questions, Noem answered calmly. In this case she said the bill approved by Republicans in the U.S. House in May would not allow insurers to deny coverage because of pre-existing conditions, which prompted some to exclaim “not true!”
Rhoden intervened. Things settled down. Then they flared up again, And settled down. And so it went. At some point Rhoden asked those with “agree” or “disagree” signs to hold them “down below your chins” so those behind them could see.
But some argued that the need for order shouldn’t stifle people when they came to express themselves.
“Please don’t tell people not to show their emotions,” Emily Dupont of Rapid City said when it was her turn to ask a question. “You’re talking about their health care and their lives.”
DuPont asked Noem how she could justify her support of defunding Planned Parenthood as part of health-care reform. The controversial abortion part of Planned Parenthood services always seems to dominate debates about the organization, but DuPont pointed out the many other essential health-care services Planned Parenthood providers offer to women.
Which brought about the debate over whether providing federal funds for Planned Parenthood amounts to providing federal funds for abortion services. The law doesn’t allow Planned Parenthood to use federal dollars directly for abortion services.
But “they do receive federal dollars and they do do abortions,” Noem said.
She also argued that if the Planned Parenthood clinic in Sioux Falls closed, there would still be 103 health-care clinics in South Dakota offering essential services to women.
“I’ve always been pro-life and I’ve always told you honestly that I don’t think Planned Parenthood should receive federal funds,” she said.
Back on the overall plan, Noem emphasized again that pre-existing conditions would be covered by the GOP plan, which I believe is true. The key question seems to be whether that coverage would be affordable, which seems like a really legitimate worry.
Noem touted the fact that the Republican plan would get rid of mandates that require insurance coverage, eliminate a variety of the taxes imposed under the Affordable Care Act, also called Obamacare, and allow people to use tax credits to “shop for coverage.”
She said only a small percentage those who have coverage under the ACA would lose it under the Republican plan being developed. And those people would most often choose not to have it, Noem said.
That’s not exactly what analysts for the Congressional Budget Office say with their estimate that 23 million Americans could lose their insurance coverage during the next decade under the House plan passed in May, while about 22 million could lose it under the latest version of the Senate plan.
To that, Noem said “the CBO has been inaccurate in the past.” And it has. And it’ll probably be wrong to one degree or another on this. But it’s likely to be right on at least some things, maybe many.
And you can be certain that the Republicans will be wrong on some things, too, when they go home and make predictions to their constituents on how much money will be saved and how many people will be covered by their coverage and how affordable that coverage will be. Barack Obama and the Democrats were right on some things and wrong on others about the ACA.
Don’t expect Republicans to be much more accurate. Which won’t necessarily mean they lied, anymore than it necessarily meant President Obama and Democrats lied about things that didn’t turn out the way they predicted with Obamacare. But it will mean they were wrong.
But back to Noem, who said nothing will change at all for the next several years. The calculated delay will make sure, she said, that those who want to continue coverage may do so and lawmakers will have time to work on problems and improvements.
Repeal and replace doesn’t work, she said, without the replace part.
“I wouldn’t vote just for repeal, because I think that would be devastating for families in this country,” she said.
Noem said families are already being hurt by Obamacare, in premiums that she says have risen in South Dakota by 124 percent since the ACA was signed. She said insurance companies offering health-care coverage have backed out in South Dakota, dropping from 17 to two. And she repeated the often-heard Republican prediction that Obamacare is falling apart and will soon fail entirely.
“We are a year or two away from government-run health care,” she said, prompting a significant number in the audience to cheer.
You need the right audience for that one, apparently.
Noem challenged the notion that Americans of low or modest incomes got coverage under Obamacare without being taxed for it. The ACA imposed a variety of taxes to pay for increased coverage, primarily on the insurance industry and medical devices, individuals who make more than $200,000 a year and those who fail to get insurance.
But Noem contends that most people paid for those taxes, directly or indirectly, noting that insurance and medical companies hit with the taxes simply pass them on to consumers.
“You can’t raise taxes on something and not expect it to cost more,” she said.
It’s hard to argue with the notion of businesses passing through taxes to consumers. But you can argue that in passing them through and raising rates, the impact is spread across more people — including those who can afford it.
And, of course, the expansion of Medicaid that didn’t occur in South Dakota added millions to the coverage roles across the states where coverage was expanded, or enhanced. That all helps the destitute, the working poor and the lower middle class, as well as gray hairs who are just a few years younger than I am and likely to face substantial premium hikes under the Republican plan.
Would those hikes cause dropped policies? Many think so, on the Democratic side of the argument, at least.
“I think people are concerned that this would leave them without coverage,” Noem told reporters after the one-hour town hall. “I tried to reassure them. I think we had a great discussion.”
I thought it was pretty good myself. But then, I’m 65 and I have Medicare coverage. And my wife is a few years younger, and has a good health-insurance plan at work.
Not everyone has either. So what’s going on in D.C., with the Republican dismantling of the Affordable Care Act and a still-not-finished replacement plan, has a lot of people worried.
They expressed that worry at the town hall, sometimes with their questions and at other times with catcalls and jeers, the flashing of the “agree” or “disagree” signs and the occasional call “lies!”
Mostly, though, there was order in the place, which generally controlled the palpable undercurrent of unrest. Noem handled that well, and responded to most questions in respectful tones, even if her answers, to some, were disrespectful to people considered to be most vulnerable under the Republican plan.
“Man, I thought she misrepresented so much,” said Dr. Marvin Buehner, an obstetrician-gynecologist in Rapid City. “There’s nothing in the plan to reduce premiums unless the deductibles are so high you can’t reach them, or you include all the exceptions.”
The Republican plan as written and discussed so far would be hardest on the working poor and financially stressed older Americans who haven’t yet reached Medicare eligibility.
“Tax credits just don’t work for those people,” Buehner said.
He called the Republican plan “such a lie,” and said he was appalled that South Dakota’s only U.S. House member is “willing to throw all these South Dakotans under the bus to score political points for her party leaders.”
Noem contends that she is working for South Dakota and a better health-care system. And she said she gets significant support for the repeal-and-replace-Obamacare effort from South Dakota residents.
While the most vocal people in the crowd at the town-hall meeting were against the Republican plan, about half those there didn’t seem to show great emotion at all. I know a number of them and know them to be against Obamacare and for its repeal and replacement.
Why wouldn’t they be more vocal? Well, they had other things to bring up, including education issues involving perceived interference by federal and state officials in local education decisions.
But on health care, things are going their way right now. They’ve got Republican majorities in the Senate and the House and Donald Trump firing away on Twitter from the White House.
Obamacare seems to be on the way out, and something else on the way in.
So they’ve got political reasons to be satisfied. They’ve also got a cultural tradition of being polite, even if our president isn’t.
