It isn't exactly the boldest stroke of leadership I ever saw, but SD Governor Daugaard's comments last week regarding expansion of Medicaid in South Dakota took an interesting turn. He basically told listeneners to WNAX radio that he would leave the decision about expansion up to the state's legislature. This is classic buck-passing, of course, but the intriguing part of the interview is in the fact that Daugaard, who up to now has been recalcitrant in his opposition to expanding Medicaid in South Dakota, didn't utter a peep about his position on the matter. Last December he told the SD Legislature that "there are far too many unanswered questions for me to recommend adding 48,000 adults to the 116,000 already on our rolls." His December speech was part of a pattern of hostility and opposition to the idea of expanding Medicaid in South Dakota, an opportunity that was created by the Affordable Care Act (ACA, also known as Obamacare).
I've always thought this position was irrational, if not altogether dumb. By not signing up for Medicaid expansion, South Dakota is turning its back on a multi-billion dollar windfall, basically refusing to spend $157 million (with an "m") between 2013 and 2022 in order to receive $2.1 billion (with a "b") in federal Medicaid disbursements during that same period. Concerns about the federal government's ability to sustain its share of 90% of the cost of Medicaid funding after 2022 has been an oft-cited reason for opposing the expansion, but that argument hasn't held much water. SD receives $2 billion a year from the federal government through a myriad of programs and nobody has ever suggested that those programs be rejected for fear that the federal government won't have the money to fund them down the road. So why is Medicaid expansion so suddenly on shaky fiscal ground?
I believe the hostility toward Medicaid expansion has been strictly political, part and parcel of the anti-ACA fixation that has been festooned to the Republican Party for years now. As indications of ACA's acceptance and integration into the mainstream of America's economy and culture continue to mount, I think its politically driven antagonists will soon soften their attitudes and begin to work with, rather than against it.
One manifestation? Governor Daugaard's categorical handover of the decision on Medicaid expansion to the state's legislature. Granted that Daugaard flubbed an opportunity to show some leadership by taking a position on expansion--but the fact that he simply said it's a legislative decision to be made, not an executive one, is to me a signal that he won't be vocal about the matter for the time being. I think at this point the simple arithmetic of the money involved has finally sunk in. It's hard for me to imagine an executive of any organization turning his back on billions of dollars.
Anti-ACA diehards in South Dakota's legislature will continue to press their fight against expansion, but the winds are blowing against them. A poll last January found that 63 percent of South Dakotans favor Medicaid expansion. Joining in that support is the South Dakota Medical Association. Meantime, South Dakota's Wellmark, the state's Blue Cross Blue Shield provider will be joining the insurance exchanges created by ACA, a further signal that ACA is becoming a fixture in South Dakota's healthcare landscape. All in all, stubbornly holding out against Medicaid Expansion is looking a lot like (to coin a phrase, sort of) the foolish partisan consistency that is the hobgoblin of limited political minds.