Saturday, June 14, 2014

Governor Daugaard Is Still Kinda Milquetoasty On Medicaid Expansion, But At Least He Didn't Diss It When Interviewed Last Week.

      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.  
     
     
     
     

9 comments:

  1. Passing the buck indeed, it's also an election year, and in usual Daugaard fashion he won't make any decision that might make anyone to his right mad. Not sure what people see in him, or Rounds either for that matter, we can do much better.

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    1. Daugaard has definitely chosen the path of least political resistance.

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  2. All you have to do is look who is bankrolling him. He was against it, before he was for it because he was worried about his primary.

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  3. It's impossible to make a rational case against Medicaid expansion. Daugaard is backing away from a leadership role on this by essentially turning "neutral" and letting the legislature handle the political heavy lifting.

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    1. John, anybody from either party in the state should be able to see what Daugaard is doing, if they don't, they're not paying much attention.

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    2. Tim, they don't realize what Daugaard is doing, that's why he won in the primary by 81%. If Lora Hubbel could have debated DD and if the Independents could have voted in the Republican primary, I believe Lora Hubbel would have garnered over 30% of the votes.

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    3. Great blog article. Just 2 questions if any reader can answer...1) I can only assume that the 48,000 eligible for Medicaid Expansion are delaying medical care...but if not...who is paying for that care? Counties (taxpayer funded) or the medical care providers through uncompensated care?...2) Have my Federal Income Taxes been reduced because S.D. has not taken advantage of Medicaid Advantage? Oh BTW, if the Federal Govt. is not to be trusted with our tax dollars and the expenditure of same...then who can we trust?...after all...they be us...I know that because I vote.

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  4. Well said, anonymous. "Adding the 48,000 to the 116,000," the latter figure which I have never heard before, simply means that we have the same percentage of people without their own healthcare coverage or the means to provide it as we do of children in SD going to bed hungry or in other words, 1 in 5 or 20%. In the 21st century, that is disgraceful.

    Lost in the whole discussion, is the idea behind healthcare reform in the first place, to get everybody covered and thus lower the cost by having very limited use of the emergency room, which quite naturally costs exponentially more than regular visits to the doctor for preventative healthcare. Why the Governor and the same State government that sends its own retirees to sign up for the ACA, rather than their own insurance program, can't see the reason to taking advantage of all of the nuances of the ACA, escapes my poor brain's ability to cypher.

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