Monday, March 14, 2016

SD Rep Conzet Wants Us To Wait And See How Things Work Elsewhere Before South Dakota Decides. Okay, Let's Apply That Standard To Medicaid Expansion

     When Republican Kristin Conzet recently arose from her seat in the state legislature to rebuke a family that had the temerity to live in South Dakota she set an interesting standard for
Putting It Off?
Plain Ridiculous.
our state's collective decision-making process.  
Conzet at the time was informing this family, which was urging legalization of a cannabis-based medication that controls the epileptic seizures of their toddler, that they could move to any one of 39 other states where such medications are legal. The "tough cookies" approach was heartless, insensitive and ignorant (WebMd last year cited work that showed significant drops in seizures using liquified marijuana), but it was common enough among her fellow reps to cause the legalization measure to fail.  

      Though that fight isn't over and will eventually be won by those who use objective science (there are plenty of other studies supporting WebMd's optimism, some more, some less, but all seem positive) as the basis for introducing new medications into the state, Conzet did bring up a point that's worth pursuing.  Claiming that the bill was "not for South Dakotans" because "we're different cats . . . we have to wait and watch the rest of the country . . . we sit back and pause and we make decisions . . ."  Conzet celebrates our collective reluctance to lead and takes pride in being a follower.  Not much to brag about there, but using that as a basis for making decisions important to the state, I suggest we embrace that principle and apply it to the coming decision about expanding Medicaid.
     On that basis we're foolish not to use Conzet's cat-like approach and check results in states
that have expanded Medicaid.  
By making it available to about 50 thousand otherwise uninsured South Dakotans who earn too much to much to qualify for existing Medicaid benefits but not enough to purchase conventional medical insurance, we have a "gap" of uninsured in this state that depend on the kindness of our social safety nets to take care of their healthcare needs.  After coming out against Medicaid expansion for "able-bodied adults" when addressing the program a couple of years ago, Daugaard has finally accepted the simple reality that Medicaid expansion makes sense for South Dakota.  Apparently Daugaard's conditions for acceptance have been met and it looks like our state's legislature is likely to consider expansion in a special session later this year.

     Applying Conzet's wait-and-see principle, let's take a look at Colorado's results since Medicaid was expanded there in 2014.  The results are in and they're good.  A study that was conducted by the Colorado Futures Center at Colorado State University found, among other gains: because of Medicaid expansion a full percentage point has been added to the state's GDP, household incomes have increased by more than 600 bucks/yr, and that the state's general fund will incur no increased expenses associated with Medicaid expansion.  The authors of the CSU study conclude that
Tell 'em, Gov.
It Just Makes Sense
(photo from
"in addition to providing health insurance to nearly 400,000 Coloradons, expanding Medicaid has proven to be a fiscally sound decision."  Looking farther afield, Ohio expanded Medicaid under Republican Governor John Kasich, also with positive results, including a $2.5 billion economic boost, vastly improved healthcare and a significant reduction in uninsured residents.

     These results are just too compelling to ignore, so much so that we South Dakotans are looking kind of foolish in being so late to come to the Medicaid expansion table.  There's no question that Daugaard has looked around and seen the healthcare and economic benefits that come with expansion.  Now if only Conzet and her fellow cats would accept reality that expansion is a good deal, I imagine we'll all come out purring.  

Addendum (added 3/14/16 @ 1245):  In the comments section below, 3500Mom posted the url for a site that notes New Mexico is having budgetary problems with Medicaid expansion.  Here's the Albuquerque Journal piece from 3/5/16 that the site draws its information from.  I'm adding a piece by a New Mexican last November who contends that expansion there has been a good deal.  You can read that here.


  1. I disagree. We have no idea what ACA is going to look like in 2018. Waiting until after the election makes much more sense. If there is an expansion for 2017 in SD, how many people will actually gain coverage? In Pennington County, the bottom number for a subsidy is $12K, which gives someone making $12K (MAGI) free coverage with a $5000 deductible. For $20, they can get a $250 deductible, thanks to the cost sharing reduction. How many people are actually under the $12K and not eligible for other government programs? Expanding Medicaid doesn't actually help that many people. And the long term costs can be massive. I understand that it worked in Ohio (Go Kasich!) and Colorado. Those states have significantly higher populations to pay the "Obamacare Tax". Look what happened in New Mexico. They have 2 million people(compared to SD 900K) and can't figure out where to find the $417 million for the rest of the expansion. I'd rather states use the money for vocational training to get people who make less than $12K a livable wage. In any event, waiting until after the election is the right thing to do.

  2. Oops. I forgot to post a link:

    1. Thanks for adding to the conversation, 3500Mom. I posted the Albuquerque Journal article that your site draws from in the body of the post above so readers can link directly to it. The piece notes that authorities were caught off guard by the unexpected rise in Medicaid enrollment that has occurred in NM in recent years, to the point where roughly half the state's population is enrolled in Medicaid. Because the Medicaid expansion is presently 100% paid for by the federal government, enrollees brought into the program by expansion aren't creating the shortfall. NM's portion of the Medicaid expansion will indeed add to the state's Medicaid budget, but that figure was already programmed into the budget. The article notes that budgeting for the state's share of Medicaid expansion gradually increases to 10% of the total cost of expansion, but that appears to be a relatively small part of a much larger Medicaid problem that doesn't seem to have a parallel in SD. Here's a NM writer who contends that Medicaid expansion in NM has been a good deal. I think the overwhelming evidence is that expansion has been a good deal for the 30+ states that have taken the step. NM's issues may have some applicability to our situation here in SD and should be considered, but I stick with my belief that expansion will be a benefit to our state and I admire Governor Daugaard's insistence that he won't advance the plan unless it's budget-neutral to South Dakota. (Note to readers: I've also put the url regarding the benefits to NM of Medicaid expansion into the body of my blog post above.)

  3. Wishful thinking! "We have no idea what the ACA is going to look like in 2018!"
    What that assumes is that Congress will evolve out of gridlock and dysfunction and either amend the ACA or get rid of it entirely. They've been working on that now for the better share of 6 years and two court challenges and haven't gotten it done yet. To think that present day political empty headedness is going to change direction for either Medicare of Medicaid is the same thought process that believes congress will be generous and restore financial viability to Social Security. If it hasn't happened already, it isn't going to. If the Governor and his group of staffers have evaluated the pros and cons of this and decided it is meritorious for South Dakota, contributive analysis from "The Blaze" is hardly substantive argument in opposition.
    Where have we heard "wait until after the election to decide." Does that obviously partisan suggestion bare resemblance to the edict; "don't bother making any appointment to SCOTUS until after the election so the people have a voice in the selection." That doesn't even make it to the level of circular reasoning.
    Stall tactics in combination with wishful thinking....... That is no way to run a railroad and it certainly isn't any responsible way to serve the public interest and conduct the affairs of state.

  4. The thing that gets lost in this discussion is the savings to be reaped by those who are insured. My Medicare Supplement has several different options. The one that I have, the premium per month went down from 79 to 74. The copay for primary went from 10 to 0 and for specialists went from 20 to 10. My out of pocket for major care outside the US while traveling went from 2500 to 0. The company from which I buy my insurance is a semi national company but has large numbers in Minnesota and other states that have accepted the medicaid expansion, which has benefitted me.

    It's a no brainer the same savings are out there for everyone, if we can get everyone covered, because it cuts down on the use of the emergency room for basic healthcare, which has been the case for many folks for a long time, ever since healthcare and insurance costs started soaring.

  5. Wow, half their population on Medicaid. That's shocking. An expansion from 560k to 925k so it would seem South Dakota would also experience significant increase in their numbers. My gripe with the ACA my individual policy has risen from $300 a month to $458 in one year possibly because a higher risk group in the Medigap enroll in individual policies. Having just made a call to NM a comparable plan is $290 to $340 (all without subsidy.) It's too bad in one way the ACA couldn't have fully nationalized Medicaid. Your link says if South Dakota expands Medicaid 44,000 adults would be newly eligible. These are big numbers. Still it seems the fairest way to expand coverage for those who can't afford it by most of the money being federal and a shared expense.