Tuesday, December 15, 2015

Daugaard Needs To Talk Financial Turkey To The Legislature If He Wants Them To Support Medicaid Expansion In SD

     It's encouraging that Governor Daugaard has finally come around to supporting and
Can We Afford To Do This?
Can We Afford Not To?
(graphic from healthinsurance.org)
proposing ways of expanding Medicaid in South Dakota.  
His piece in yesterday's Rapid City Journal included 3 caveats.  The first two, getting the Feds to take over the costs of medical services given to Indians who for any number of good reasons get care outside the Indian Health Service and convincing the state's tribes to go along with the plan are challenges that seem meetable.
  I can see the Obama administration's HHS going along with taking over the $67 million/yr obligation (which I understand is consistent with the federal obligation to pay for Indian medical services in the first place) to pick up the cost of Indian health care as a condition for expanding Medicaid (an Obamacare feature) into South Dakota. Daugaard notes that transferring the $67 million cost from the state to the Feds will cover the state's share of Medicaid expansion costs through 2021. I won't presume to speak for the Indian community, but note that from the tribes' points of view, it doesn't look like anything will change in the delivery of non-IHS health care, the only difference being which government entity will pay for it. Of course, anything dealing with the IHS is a topic of considerable discussion and concern, so there's no telling how the Indian community will react to a proposal that affects its status as a significant stakeholder in Daugaard's plans.
    Those caveats duly considered, though, it seems to me that the more formidable task will come in getting the third condition met.  Of it, Daugaard unequivocally says  that he "will not support expansion unless the Legislature supports it."   My general observation is that our state legislature has a fair number of committed Obama-haters in it, and their reflexive reaction to the Obamacare-spawned program of Medicaid expansion will be opposition.  That about fifty thousand South Dakotans who now make too much money to qualify for conventional Medicaid but don't earn enough to pay for private health insurance will qualify for Medicaid if expansion occurs hasn't been a convincing enough reason for our state government to take this deal. That's actually pretty sad, considering that even Daugaard acknowledges that although this pool will include those who become government-dependent, it also includes "the single mother of three who cannot work enough hours"  to afford private healthcare.  
     My take?  The cost of letting system-gamers into the Medicaid expansion pool isn't enough to dissuade us from accepting the plan.  It just comes down to the greatest good for the greatest number of people.  When GOP Governor Chris Christie implemented Medicaid expansion
It Just Makes Too Much Sense
We Need "Smart" not "Stubborn"
(graphic from credomobilize.com)
in New Jersey in 2013 he said, "expanding Medicaid is the smart thing to do for our fiscal and public health."  In order to convince South Dakota's conservative legislature that this is the right way to go for us, I emphasize the words "fiscal health."  It is such an obvious financial windfall for our state that it seems amazing that political intransigience has been so willing to forgo billions of dollars over the next decade to nurture our legislature's hatred of everything Obama.  A couple of billion dollars pouring into South Dakota's economy during the next few years will generate a few times as much when the money rolls over.  You don't need to be an Economist to understand what that will do for state tax revenues in an era when we're scrambling to find enough money to pay teachers competitive wages and keep our infrastructure functioning properly.

     Governor Daugaard has some well thought-out reservations going into this, but it's clear that he's coming to the same conclusion.  We have to find a way to make this deal work.  


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