For the upcoming year, the song remains the same for the South Dakota State Medical Association.

Led by this year's association president, Dr. Tim Ridgway, Medicaid expansion and the rural doctor shortage still chart as top priorities for the SDSMA.

Ridgway is in the midst of a statewide tour to meet with each of the organization's 12 districts. He reached his fourth stop on Thursday in Mitchell to meet with local medical professionals to interact with organization members and gauge their thoughts on advocacy priorities for the upcoming year.

Ridgway, who took the role as SDSMA president in May, serves as the dean of faculty affairs and associate professor of medicine at the University of South Dakota Sanford School of Medicine.

Before the annual district meeting in Mitchell, Ridgway emphasized the need to expand Medicaid in the state.

"The South Dakota State Medical Association is supportive of Medicaid expansion simply because it's going to offer coverage to more South Dakotans, and that should mean better health for all South Dakotans," Ridgway said.

The SDMSA's efforts to expand Medicaid in the state returns to the top of the groups advocacy agenda in a year that lacks "hot-button" topics.

Since the Affordable Care Act was signed by President Barack Obama in 2010, 28 states decided to expand Medicaid under the law that would have helped about 20,000 to 40,000 South Dakota residents from acquiring affordable health insurance.

In an effort to keep all South Dakotans in peak medical condition, the SDSMA advocates Medicaid eligibility expansion for people who make less than 100 percent of the federal poverty level of $11,670 for a single person. Without Medicaid expansion, thousands of South Dakotans haven't been able to qualify for lower insurance rates under the Affordable Care Act. The SDSMA hopes to change that in 2016.

"This is going to be a matter of just being at the table and really discussion the importance of it and then hoping that creative ways of funding this can come up," Ridgway said about Medicaid expansion.

Earlier this year, Republican Gov. Dennis Daugaard said expanding Medicaid would be too costly for the state. Because Medicaid is co-funded by state and federal governments, with the federal side taking the lion's share of the cost, Daugaard was concerned adding up to 50,000 people to the Medicaid program to provide free or low-cost health coverage would cost the state $100 million by 2020.

Even as Daugaard and the state's conservative legislature have yet to change their tune on potential expansion of Medicaid, Ridgway hopes to persuade some legislators in the upcoming session.

"Our goal is to simply educate our legislators as best we can as to the ramifications of if we do it versus if we do not," Ridgway said.

Doctor shortage

One concern Ridgway had about Medicaid expansion was whether South Dakota's doctors could handle tens of thousands of newly insured patients.

"It's going to be a stressor to some degree for the physicians to meet that need, but nonetheless, is it the best thing for the public health of South Dakota?" Ridgway said. "And I think the unequivocal answer is yes."

Along with Medicaid expansion, Ridgway said the physician shortage is an issue that must be addressed.

Because South Dakota's high school graduation rates are expected to drop by 11 percent by 2019, Ridgway said, the worry is that the state's aging group of doctors will have as substantial a feeder system for state medical schools.

"So less graduates out of the state means less people potentially for medical school, and who's going to take care of the people of South Dakota?" Ridgway said.

But the doctor shortage in the state, particularly in the far rural reaches of South Dakota, is something Ridgway thinks has improved over the past year.

Under the direction of the Governor's Primary Care Task Force, the USD Sanford School of Medicine added 11 first-year medical students to the state's only medical school in the fall of 2015. Now at 67 accepted students, the hope is that there will be more medical students who remain in the state after completing their studies.

USD has also used the Frontier and Rural Medicine (FARM) program to increase the understanding and comfort of medical care in a rural environment. The program sends medical school students to Milbank, Mobridge, Parkston, Platte and Winner to increase hands-on-experience and appreciation of working in rural communities. In 2015, the FARM program added Pierre, Spearfish and Vermillion as rural training sites.

"To date it's been very successful," said Ridgway. "Students are loving it, communities are loving it even more."

Ridgway said the hope of the FARM program is to set students up to return to rural communities in South Dakota and set up a primary care practice to boost the state's rural medical care.