South Dakota and Montana are both primarily rural states whose borders touch in one small area. They both lag behind other states in the adoption of electronic health records, health insurance exchanges and other aspects of health reform.

The states are not battlegrounds that will decide the upcoming elections and their recent primaries barely penetrated the national news cycles. And like other states, they have their own ways of approaching the coming changes in health care.

South Dakota has had no significant activity on health insurance exchanges, according to Kaiser Family Foundation health reform tracker. The state, however, received a $5.9 million grant in May to continue research into the possibility of a state-run health insurance exchange in addition to the $1 million that states started out with to study how to begin to plan one.

[Political Malpractice: 3 ACA aspects states should keep no matter how SCOTUS rules.]

The state is a participant in the lawsuit being decided by the Supreme Court. But Republican Gov. Dennis Daugaard has taken advantage of some of the funding in the Patient Protection and Affordable Care Act for community transformation grants, to help develop its nursing workforce and school-based health centers, in addition to the latest planning grant.

“Receiving this grant does not change our plans. South Dakota will continue to wait for the outcome of the lawsuit before we decide whether to pursue a state-run exchange,” he said in a recent announcement. The grant award provides funding for the state to continue researching all options.

“The best case for South Dakota would be if the Supreme Court overturns PPACA in its entirety. If that doesn’t happen, South Dakota will be prepared to do everything within its power to protect our citizens from this harmful law,” Daugaard said.

Montana did not sign on to the health reform lawsuit, and its insurance commission is studying its options for health insurance exchanges, but it has not received any funds beyond the original $1 million start-up grant.

Democratic Gov. Brian Schweitzer has butted heads with a Republican majority legislature. When the GOP legislators passed legislation last year blocking health insurance exchanges, Schweitzer vetoed it, according to Kaiser. The next legislative session is in 2013. However, states must develop their exchanges as operational by 2013 or the federal government will step in to create one.

South Dakota and Montana were among the three states with the lowest percentage of hospitals that have adopted at least a basic electronic health record system, according to a data brief  from ONC earlier this year. According to the data from 2008 to 2011, 17 percent of hospitals in South Dakota and 15 percent in Montana had established EHRs.

However, South Dakota’s regional health IT extension center, based out of Dakota State University, and Health Technology Services, Montana’s extension center, are providing technical assistance to 1,000 healthcare professionals each to promote EHR adoption. 

South Dakota’s Health Link, the statewide health information exchange, has piloted the use of Direct secure messaging for simple exchange and has made it broadly available as of May and free of charge through 2013.

Both states have more uninsured individuals falling through the cracks than the national average.

While South Dakota’s jobless rate is just 4.3 percent, almost one half the national rate of 8.1 percent, still 13 percent of the population is uninsured compared with the 16 percent nationwide average. Montana’s unemployment rate is 6.1 percent, still better than the national average, and counts 17 percent uninsured.

Besides being mostly rural, both states have an aging population with more Medicare beneficiaries than the national average, according to the Kaiser data.

[See also: CMS chief optimistic Supreme Court will uphold heathcare reform.]

Physician associations in both states worry about cuts to Medicaid reimbursements.

“Physicians have already begun to reduce their Medicaid patient load, and failure to find a solution to adequately fund the program will worsen access to care for those on Medicaid,” the South Dakota State Medical Association said in an information sheet.The Montana Medical Association is concerned that reimbursement for some Medicaid services will be cut for a second consecutive year.

South Dakota’s Daugaard has created a task force to train more primary healthcare providers for rural areas of the state. Fifty-nine of the state’s 66 counties have a federal designation as health-professional shortage areas. In addition, a significant numbers of providers are nearing retirement age at a time when the state’s school-age population is declining, meaning a smaller pool of students from which to attract to health careers.

For more of our politics coverage, visit Political Malpractice: Healthcare in the 2012 Election.