June 18, 2023

“Is medical care a right or a privilege?”

It’s the first question Dr. Dave Kapaska remembers being asked on his first day of medical school.

And it’s the one he asked me first earlier this week when we caught up for an overdue breakfast.

His answer that first day is the same as it is today. Medical care is a right, but in this county — “the richest country in the world,” as he put it, “it’s abysmal to have 10 percent of our people not have access.”

Dr. K, as he became known during his 16 years at Avera McKennan, where he served as president and CEO from 2010 to 2017, is about as an unlikely entrant into the political arena as he is a natural one. I remember one of my first impressions of him as we walked the hospital halls together was that he greeted literally everyone in his path by name.

It’s a sharp eye for the name badge gleaned from his years of military service, he told me.

The likability factor goes a long way in politics, of course. Still, “I’m not political,” he told me. “The whole point of this was to make something with staying power.”

About a year ago, Kapaska was approached to take the next step in what for him had been an effort more than a decade in the making — an attempt to expand Medicaid in South Dakota, one that likely would generate a public vote.

As a health care leader, he witnessed firsthand the thousands of people unable to access care. And it wasn’t just South Dakota. He’d ride in a cab, explain that he was a physician and end up being asked to look at the driver’s ailment.

“We’re all just people who have a series of opportunities in our life — some negative, some positive — and we just can’t hold that against folks,” he said.

So when the coalition to expand Medicaid in South Dakota came calling for a campaign leader last year to help pass a constitutional amendment, this retired CEO found himself in a new role.

“He speaks with a voice of credibility when we’re talking about health care,” said Chrissy Meyer, region senior director of marketing and communications for the American Heart Association.

“He understands how important health care is to individuals … but he sees the intersection of health care and the economy and workforce development and all the things we work toward in Sioux Falls to build a better community.”

With co-chair Sandy Frentz, he led the South Dakota Cabinet for Medicaid Expansion beginning last summer, an effort that resulted in a 58 percent win on the November ballot.

When he started the role, Kapaska began asking people around town: “Do you get any health insurance?” He asked at restaurants, gas stations and other small businesses, “and I realized how many people don’t,” he said.

These were people working two or three part-time jobs who just weren’t getting benefits or couldn’t afford coverage on the federal government’s marketplace, he said.

Under South Dakota’s Medicaid expansion, “we’re just assuring that people have a landing point for health care,” he said. “They don’t get a check every month. It’s nothing like that.”

He thinks of the story of a woman without insurance who was diagnosed with a cancer and her medical bills grew to hundreds of thousands of dollars in a matter of months.

“I don’t think I can afford to live,” she told him.

“We’re better than that, I think,” he told me.

In working toward the vote, “I tried to contact everybody I knew who could be influential, passionate and supportive,” he said.

Meyer remembers Kapaska was “always one of the first people to put his hand up and say ‘yes, I can do that.’ He was just very invested,” she said.

This week, those efforts were recognized on a national stage when Dr. K became the first South Dakotan to be honored with one of the American Heart Association’s National Volunteer Awards.

“I think the magnitude of Medicaid expansion coming to South Dakota is a big piece of why,” Meyer said. “For him to be involved from the very beginning and take such a leadership role in the last year to get it across the finish line … yes, he won the award in 2022, but really it’s a culmination of more than a decade.”

You can watch him receive the award in the video below at the 53:30 mark.

“Thanks to your advocacy, countless South Dakotans are living healthier lives,” retired Avera Health CEO John Porter said at the ceremony as he introduced Kapaska, estimating an additional 43,000 South Dakotans could be covered by the Medicaid expansion.

“I am in awe of your unique ability to engage a wide range of people from all walks of life.”

I often cross paths with CEOs who struggle in their post-professional life. Retirement brings a loss of identity and purpose for some. From the start, Dr. K has been a powerful example of the opportunities that can arise later in a career, from serving as interim leader of the Greater Sioux Falls Chamber of Commerce to his latest role leading an effort that will create a fitting legacy.

This month, South Dakotans began applying for Medicaid. In July, their coverage can begin.

Kapaska compares it to another health care initiative that became a passion for him: virtual care, extending access to those in remote areas of our region. In this case, it’s not geography but economics that limited care.

In both cases, “we brought something very special to people who needed it,” he said.

If you find yourself trying to figure out that next chapter, take a page from Dr. K’s life story. Find something that matters — to you, but more importantly to the broader world around you — and then give it some of the most critical resource we all have left. Time.