PIERRE —After months of negotiations, Rep. Stephanie Herseth Sandlin voted against the Democratic health care reform bill in the House of Representatives Saturday night.

The bill, which passed the House 220-215, must be reconciled with a different bill coming out of the Senate. Herseth Sandlin said she hopes to vote for the final bill if her concerns are addressed in the reconciliation process.

“Done right, health care reform will both ensure that more people have access to quality health care, and just as critically make the common-sense reforms that are necessary to fix an unsustainable system that threatens our fiscal future,” Herseth Sandlin said. “These twin goals of addressing access, quality and cost on one hand and solidifying our fiscal future on the other aren’t mutually exclusive. In fact, they’re complimentary. Unfortunately, the House bill misses this critical opportunity.”

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Herseth Sandlin said she had three principal objections to the bill passed by the House: The impact of expanded Medicaid eligibility on South Dakota’s state budget, the effect of Medicare cuts on long-term care facilities, and insufficient amounts of cost savings.

“Early analysis suggests that the House bill Medicaid provisions would impose at least $87.6 million more in new Medicaid costs on the state than the Senate Finance Committee bill would,” Herseth Sandlin said. “Given that budgetary impact, we have to consider the likelihood that dramatic service cuts would be the end result in South Dakota if the House bill was implemented, and that’s a source of serious concern for me.”

The health care bill produced by the Senate Finance Committee, Herseth Sandlin said, addresses many of her concerns. That bill’s tax on high-value health care plans, Herseth Sandlin said, would have a powerful cost-reduction component.

“I’m not thrilled about the proposal, but I think it’s a necessary dose of medicine we have to take here if we’re going to contain costs,” Herseth Sandlin said. “You can find a way to pay for this within the health care system by addressing the high-value plans that most health economists agree drive up utilization — that drives up costs for everyone else in the system.”

Though Herseth Sandlin joined 38 other Democrats and all but one Republican in voting against the final health care bill, she voted earlier in the day to bring the bill to the floor for final consideration. Twenty-three other Democrats also voted to send the bill to the floor and then voted against final passage.

The Senate is expected to vote on the bill in the next several weeks. If the Senate passes a health care bill, the two bills will have to be reconciled in committee, and the final bill must be approved again by both houses of Congress.

Herseth Sandlin said she is working with Sen. Tim Johnson and other senators from the Great Plains to make sure her concerns are addressed.