South Dakota
An obscure drug discount program stifles use of federal lifeline by rural hospitals • South Dakota Searchlight
Facing ongoing concerns about rural hospital closures, Capitol Hill lawmakers have introduced a spate of proposals to fix a federal program created to keep lifesaving services in small towns nationwide.
In Anamosa, Iowa — a town of fewer than 6,000 residents located more than 900 miles from the nation’s capital — rural hospital leader Eric Briesemeister is watching for Congress’ next move. The 22-bed hospital Briesemeister runs averages about seven inpatients each night, and its most recent federal filings show it earned just $95,445 in annual net income from serving patients.
Yet Briesemeister isn’t interested in converting the facility into a rural emergency hospital, which would mean getting millions of extra dollars each year from federal payments. In exchange for that financial support, hospitals that join the program keep their emergency departments open and give up inpatient beds.
“It wasn’t for us,” said Briesemeister, chief executive of UnityPoint Health-Jones Regional Medical Center. “I think that program is a little bit more designed for hospitals that might not be around without it.”
Nationwide, only about two dozen of the more than 1,500 eligible hospitals have become rural emergency hospitals since the program launched last year. At the same time, rural hospitals continue to close — 10 since the fix became available.
Federal lawmakers have introduced a handful of legislative solutions since March. In one bill, senators from Kansas and Minnesota list a myriad of tactics, including allowing older closed facilities to reopen.
Another proposal introduced in the House by two Michigan lawmakers is the Rural 340B Access Act. It would allow rural emergency hospitals to use the 340B federal drug discount program, which Congress created in 1992.
The 340B program, named after its federal statute, lets eligible hospitals and clinics buy drugs at a discount and then bill insurance companies, Medicare, or Medicaid at market rates. Hospitals get to keep the money they make from the difference.
Congress approved 340B as an indirect aid package to help struggling hospitals stay afloat. Many larger hospitals say the cash is used for community benefits and charity care, while many small hospitals depend on the drug discounts to help cover staffing and operational shortfalls.
Currently, emergency hospitals are not eligible for 340B discounts. According to a release from U.S. Rep. Jack Bergman (R-Mich.), the House proposal would “correct this oversight.” Backers of the House bill include the American Hospital Association and the National Rural Health Association.
In Iowa, Briesemeister said the 340B federal drug discount program “can be used for tremendous good.” The small-town hospital uses money it makes from 340B to subsidize emergency services and uninsured and underinsured patients who frequent the emergency department, he said.
Chuck Grassley, Iowa’s longtime Republican senator, shepherded the Rural Emergency Hospital program into law. His spokesperson, Gillie Maddox, did not respond directly to questions about why the federal law creating rural emergency hospitals omitted the 340B program. Instead, Maddox said the designation was a “product of bipartisan negotiations.”
A survey conducted by the health analytics and consulting firm Chartis, along with the National Rural Health Association, found that nearly 80% of rural hospitals had participated in 340B and nearly 40% said they reaped $750,000 or more annually from the program.
Sanford Health, a largely rural health system headquartered in Sioux Falls, South Dakota, considered converting a handful of smaller critical access hospitals into rural emergency hospitals.
Martha Leclerc, vice president of corporate contracting for Sanford, said the system analyzed how much revenue would be lost by closing inpatient beds, which is also a requirement of the emergency hospital program, and by being unable to file for drug discounts.
In the end, she said, switching did not “make a lot of sense.”
Creative thinking needed to save rural hospitals
While many rural hospitals are clamoring for the 340B provision to be added to the rural emergency hospital program, opponents have said 340B can be a cash cow for hospitals that don’t serve enough vulnerable patients.
Nicole Longo is deputy vice president of public affairs for the Pharmaceutical Research and Manufacturers of America, the nation’s largest, most influential pharmaceutical lobbying group. She wrote in a recent blog post that hospital systems and chain pharmacies are “exploiting the program” and said patients have not benefited from the growth in the program.
In an interview, Longo said PhRMA supports rural emergency hospitals being able to access 340B because they are treating “vulnerable patients in underserved communities” and are “true safety net providers.”
PhRMA, she said, wants to encourage a thoughtful conversation about “which types of hospitals should be in the program.” Last year, PhRMA formed an unlikely pact with community health centers to create the Alliance to Save America’s 340B Program, or ASAP 340B.
Vacheria Keys, associate vice president of policy and regulatory affairs at the National Association of Community Health Centers, said, “There is a new day of openness, from all parties.”
Use of the drug discount program skyrocketed after provisions in the Patient Protection and Affordable Care Act, passed in 2010, allowed hospitals and clinics to contract with an unlimited number of retail pharmacies, such as Walgreens and CVS, which are paid a fee to dispense the discounted drugs.
Adam J. Fein, president of the industry research organization Drug Channels Institute, reports that the 340B program is the second-largest federal drug program, trailing Medicare Part D. The flow of drugs purchased under the 340B program reached $53.7 billion in 2022, about $9.8 billion more than in 2021.
In response to the exploding use of contract pharmacies, pharmaceutical manufacturers have restricted the drugs they offer at a discount through the pharmacies. That throttling is affecting rural hospitals like Labette Health, a Kansas hospital whose president asked President Joe Biden for help in dealing with the pharmaceutical companies.
Rena Conti, an associate professor of markets, public policy, and law at Boston University’s Questrom School of Business, has studied the drug discounts for years and said she has “significant worries about expanding” the 340B program.
“There is a lot of money being generated in this program that we really can’t understand exactly how much that really is and exactly who it is benefiting,” Conti said.
At the same time, said Conti, a health care economist, giving rural hospitals access to the federal drug discounts “makes sense because they are hospitals that are serving particularly vulnerable patient populations.”
HURON — Blake Ellwein of Huron has been named as the 2026 South Dakota Mr. Basketball award winner by Hansen Anderson Basketball.
The 6-foot-10 senior guard and South Dakota State University recruit led Huron to a 20-4 record and the state Class AA boys basketball championship. He made 25 of 27 free throws in the state tourney.
Ellwein is the all-time leading scorer at Huron High School with 1,535 career points. He averaged 21.5 points per game in his senior season. He is a three-time Class AA all-state selection and three-time All-Eastern South Dakota Conference player who earned all-tournament honors three times at state AA tourneys.
Since the award was first presented in 1978, Ellwein is the third Huron player selected for the honor. He joins Rod Merriam in 1980 and Eric Hall in 2004 as previous honorees for the Tigers.
Other finalists included: Jackson Wadsworth of Hamlin, Samuel DeGroot of Sioux Falls Lincoln, Marvin Richard III of Pine Ridge and Will Kuhl of West Central.
The award is voted on yearly by all boys basketball coaches in the state and was presented at a ceremony held Thursday, May 14, in the Huron Arena.
Wagner standout and University of Nebraska recruit Ashlyn Koupal of Wagner recently was named South Dakota’s Miss Basketball for 2026.
Hansen Anderson basketball was founded in 1977 by Richard Hansen and Dave Anderson. The annual publication highlighsteams and players from across the state.
South Dakota’s Mr. Basketball Winners
2026: Blake Ellwein, Huron.
2025: Griffen Goodbary, Sioux Falls Christian.
2024: Jacob Mehrman, Harrisburg.
2023: Joe Sayler, White River.
2022: Kalen Garry, De Smet.
2021: Matthew Mors, Yankton.
2020: Ryder Kirsch of St. Thomas More.
2019: Noah Freidel of Tea Area.
2018: A.J. Piltzuweit of Vermillion.
2017: Matt Cartwright of Sioux Falls O’Gorman.
2016: Ty Hoglund of Dell Rapids.
2015: Bo Fries of Langford Area
2014: Steven Schaefer of Rapid City Stevens
2013: Zach Hanson of Pierre.
2012: Skye Warwick of St. Thomas More.
2011: Zach Horstman of Winner and Liam Duffy of St. Thomas More.
2010: Jared Hannigan of Aberdeen Central.
2009: Tony Fiegen of Madison.
2008: Louie Krogman of White River.
2007: Matt Malloy of Parkston.
2006: Zach Finley of St. Thomas More.
2005: Eric Krogman of Elkton.
2004: Eric Hall of Huron.
2003: Paige Paulsen of Custer.
2002: Matt Hammer of Elkton.
2001: Josh Mueller of West Central.
2000: Steve Anderson of Rapid City Central.
1999: Denver TenBroek of McIntosh.
1998: Austin Hansen of Brandon Valley and Mike Miller of Mitchell.
1997: Austin Ledeboer of Armour.
1996: Todd Schlekeway of Mobridge and John Sivesind of Sioux Falls Roosevelt.
1995: Chris Janssen of Emery.
1994: Chuck Welke of Warner.
1993: Jason Sutherland of Watertown.
1992: Lance Luitjens of Custer and Eric Lappe of Harrold.
1991: Eric Kline of Aberdeen Central.
1990: Brent Lindskov of Isabel.
1989: Eric Piatkwoski of Rapid City Stevens.
1988: George Bettelyoun of Pine Ridge.
1987: Kyle Jordre of Platte.
1986: Sam Goodhope of Winner.
1985: Bart Fredrick of Mitchell and Randy Leslie of Sioux Falls Washington.
1984: Todd Smith of Wakonda.
1983: Luther Hippe of Sioux Falls Washington and Troy Schaefer of Pierre.
1982: Lonni Stover of Webster.
1981: Alan Miller of Stickney.
1980: Rod Merriam of Huron.
1979: Mark Smidt of Sioux Falls Washington.
1978: Barry Glanzer of Armour.
RAPID CITY, S.D. (KOTA) – A free worship concert is coming to Rapid City this Friday night as part of the annual Homeschool South Dakota Conference.
The concert will take place May 15th at The Monument and will officially kick off the two-day conference event. Doors open at 7 p.m., with the concert beginning at 7:30.
The evening will feature praise and worship music from Mike Weaver, the lead singer of the Christian band Big Daddy Weave. Organizers say the concert is completely free and open to the public, no tickets or conference registration required.
The Homeschool South Dakota Conference brings together homeschooling families from across the state for educational sessions, guest speakers and community activities throughout the weekend.
Organizers say the concert is designed to be a community-wide event welcoming anyone interested in attending. Additional information about the conference and concert is available through Homeschool South Dakota.
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South Dakota knows how to slow down. Hot Springs runs an 87-degree natural mineral pool that has drawn visitors since 1890. Spearfish anchors itself with a working fish hatchery dating back to 1896. Mitchell rebuilds its Corn Palace exterior every year out of actual corn. These are six of the state’s most relaxing small towns.
Aberdeen
Aberdeen sits in the James River valley of northeastern South Dakota, known locally for being the closest thing the state has to an Oz theme park. Storybook Land, a free-admission public park on the north side of the city, is built around L. Frank Baum’s connection to the area. Baum lived and published in Aberdeen in the 1880s, and the park features a full Wizard of Oz land with a yellow brick road, the Emerald City, and Dorothy’s House. The same park complex includes a castle, fairy-tale attractions, and a small petting zoo.
Downtown, the Hagerty & Lloyd Historic District holds some of Aberdeen’s oldest homes and buildings, including the Margaret and Maurice Lamont House, a Tudor Revival. Richmond Lake Recreation Area, about 10 miles northwest of town, adds hiking, biking, and camping on a reservoir that is the local summer anchor.
Hot Springs
Relaxation is built into Hot Springs. You can soak in the warm natural waters of the Evans Plunge Mineral Springs, which have drawn visitors for over a century. Established in 1890, the spring-fed waters naturally hold a year-round 87-degree temperature. In addition to the thermal springs at Evans Plunge, you have hot tubs, steam rooms, slides, and more.
Beyond the soak, the Mammoth Site is an active paleontological dig featuring remains of Ice Age giants. Consider booking a stay at the historic Red Rock River Resort Hotel & Spa, a sandstone building constructed in 1891. Family-owned and located downtown, the hotel offers quality care and a well-preserved interior. It’s within walking distance of Evans Plunge and other hot spring locations.
Lead
A close neighbor to the busier Deadwood, Lead is a town every bit as historic and far more relaxing. It’s an old mining town at its core, with several modern amenities along its historic Main Street. The Black Hills Mining Museum showcases the area’s gold rush, while the Homestake Opera House, which hosts year-round tours, concerts, dances, and educational events, is a century-old building that once held a bowling alley, billiards hall, and more.
For families, the Sanford Lab Homestake Visitor Center takes a deep dive into the region’s history, its people, and the ongoing scientific research conducted in its underground laboratories. Lead is the right town for South Dakota’s Wild West history without the commercial trappings.
Spearfish
On the northern edge of the Black Hills, Spearfish sits at the mouth of Spearfish Canyon, a 19-mile limestone gorge cut by Spearfish Creek that drops several notable waterfalls along its length. The Spearfish Canyon Scenic Byway follows the canyon floor, past Bridal Veil Falls and Roughlock Falls, and provides one of the most reliably beautiful and uncrowded drives in the state. The D.C. Booth Historic National Fish Hatchery, established in 1896 and now run as a historic site, anchors the town’s history with restored buildings, raceway ponds full of visible trout, and the Von Bayer Museum of Fish Culture.
Downtown Spearfish has a walkable core along Main Street with local restaurants including Killian’s Food and Drink and Lucky’s 13 Pub. For shorter outings, Spearfish City Park features the hatchery at one end, a sculpture walk along the creek, and shaded picnic grounds. Combined with its easy access to Deadwood, Lead, and the rest of the northern Black Hills, Spearfish offers a strong base for anyone wanting to relax without giving up access to outdoor activities.
Custer
Custer is the gateway to Custer State Park, a 71,000-acre preserve in the southern Black Hills that holds one of the largest publicly owned bison herds in the country, roughly 1,300 head, along with elk, pronghorn, and mule deer. The Wildlife Loop Road runs 18 miles through open grassland and mixed pine, with frequent wildlife sightings. Jewel Cave National Monument, 15 miles west of town, has more than 215 mapped miles of passages, ranking it among the longest cave systems in the world.
Downtown Custer itself is compact, with Sage Creek Grille serving elk-stuffed mushrooms and other regional dishes; it has been a fixture on Mount Rushmore Road for two decades. The Crazy Horse Memorial, still under construction since 1948, sits 15 miles north on Highway 385. For outdoor activity, Custer is the closest town to both the 109-mile Mickelson rail-trail and the trailhead for Black Elk Peak, the highest point in South Dakota at 7,242 feet.
Mitchell
Mitchell is home to the Corn Palace, a civic auditorium on Main Street whose exterior is redesigned every year out of actual corn, grain, and native grasses by a rotating group of local artists. The original structure dates to 1892, with the current building completed in 1921. New murals go up each summer. The building hosts high school basketball, concerts, and the annual Corn Palace Festival in late August. Admission is free year-round.
Woolworth’s Caramel Apples, next door, has been making the same recipe since the 1950s. The Dakota Discovery Museum a few blocks away covers regional history with a restored 1886 one-room schoolhouse, 1900 farmhouse, and 1909 Italianate home, plus a collection of Native American art and early 20th-century prairie paintings by Oscar Howe and Harvey Dunn.
Visit Relaxing South Dakota Today
These six towns split fairly cleanly between two South Dakotas: the prairie side, Aberdeen and Mitchell, and the Black Hills side, Hot Springs, Lead, Spearfish, and Custer. The prairie towns are anchored by one or two strong local institutions and a quieter pace. The Black Hills towns are anchored by the landscape itself. Either side rewards a weekend, and together they give you a fuller picture of the state than Mount Rushmore alone ever could.
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