Saturday, June 4, 2016

How About Some Leadership On Medicaid Expansion, Governor Daugaard?

     Our Governor Dennis Daugaard's politically passive approach to Medicaid expansion in South Dakota is frustrating and dismaying.  Last week he was on KSFY television in Sioux Falls
Daugaard Pushing Expansion
He Made A Case,  Now He Has To Push It
(photo from
explaining that he has all the financial ducks in the necessary row  that he'd earlier set out as his condition for expanding Medicaid.  Mainly, the gov wanted South Dakota's payment into the program to be offset by federal payments to Indian Medicaid enrollees, money that up to now has been provided by the State of South Dakota.  By turning the cost over to the feds, the amount saved by SD would be roughly equal to the amount that our state has to pay to get Medicaid expanded. 

     As the federal government has agreed to do just that, the holy grail of "budget neutrality" has been found.  Daugaard's long-famous disinclination to expand Medicaid has lost its sole support, so from the Governor's point of view, all systems should be "go."  But as he meekishly explained to KSFY, it still depends on whether the state's Republican-dominated legislature will go along with the plan.  Governor Daugaard apparently hasn't got the rhetorical or logical wherewithal to make it clear to the legislature that this plan is a good deal for South Dakota. Telling KSFY that he'll call a special session of the legislature if the plan "appears politically viable," it  seems clear that Daugaard's fixation on the partisan challenges have diminished the power of principle that should be driving his commitment to expansion.  
     That Medicaid expansion is a good deal for South Dakota has been self-evident for several years.  The arithmetic is simple enough:  In exchange for spending less than $200 million through 2022, South Dakota gets slightly over $2 billion in Medicaid payments to about 50,000 newly eligible enrollees.  The numbers haven't been lost on several Republican governors (Kasich, Christie, Pence and ND's Dalrymple) who've figured out that the practical pluses outweigh the political minuses on a plan as good as this one.  
    As to the people themselves, a January 2016 poll by Public Opinion Strategies found strong support for Medicaid expansion in all quarters of South Dakota.  The poll (Project #16035) came up with some eye-popping numbers, with support ranging from the mid-60s to the mid-80s around 5
It's A Done Deal Up North
What Are We Waiting For?
(photo from
distinct regions of the state. I've looked for other polls to support or challenge this one in order 
to give these dauntingly favorable numbers some context, but haven't found any. Regardless, if the numbers on this one are anywhere close to matching attitudes in the state, recalcitrant legislators should be paying close attention to just what it is that the majority of their constituents want.  
     In the meantime, there's the practical reality of how this will affect South Dakotans to consider.  The Governor himself made the case for compassion last Winter when he noted that "we have to remember the single parent with three children.  Between work and child care, a parent in that situation sometimes can't work enough hours to get insurance."  Daugaard gets it.  I just wish he would convert his compassion and common sense into a compelling enough case to override his political misgivings and lay them on the legislature.  


  1. Leadership? Daugaard? Seriously?
    If there is to be leadership on this issue, we the people we need to provide it.


    Read the above link and see how well Medicaid expansion is working out for Montana,how the promises of the feds were NOT kept, how many more are enrolling than expected, and how they are looking for new sources of revenue (taxes) to cover the costs. Medicaid expansion in SD is based on the fed's promise to fix IHS, and we know how well we can rely on the promises from the fed govt in this regard(especially this administration).

    "I received an out-of-the-blue letter from Montana State Senator Roger Webb, and it confirmed every reason I’ve ever had for opposing Medicaid expansion in South Dakota. Montana expanded Medicaid last fall. Senator Webb serves on the Joint Appropriations Subcommittee on Health and Human Services in Montana, so he would be able to give great insight on what to expect. I called him to follow up on the allegations in his letter, and he encouraged me to re-use his words to get the message out.

    Senator Webb and the Montana legislature were promised that Montana’s Medicaid Expansion would be “different” and that the state could negotiate the plan they wanted with the Federal Government, including small co-pays and premiums to make sure that able-bodied Montanans would still have “skin in the game” to help control costs. The Federal Government also promised Montana that people enrolled in Montana’s Medicaid expansion would have to work to get taxpayer funded benefits. That was rejected almost immediately, and replaced with an optional training program, which is completely voluntary, and has no effect on Medicaid eligibility. Senator Webb reiterated “We told our constituents that somehow, Montana’s Medicaid expansion would be different and better. Instead, we were left with ObamaCare in disguise.”

    Now to the numbers. Montana’s experts predicted 18,600 people would sign up the first fiscal year. On the first day, they broke the threshold of 20,000 enrollees. After predicting year two enrollee numbers at 41,900, the first year isn’t even over and the numbers are ready to cross 40,000. Already there are talks of spending cuts or tax increases to fill the holes in the Medicaid budget."

    You are correct in one thing - Daugaard should be leading on this issues, but he should be leading to NOT expand Medicaid.

    1. According to this recent report, the Montana official in charge calls Medicaid expansion there "a tremendous success" that has already saved the state's general fund $3 million.

  3. Big whoop. I read the NPR article, and it was ecstatic that so many people had signed up. Couple of problem though. With regard to copays, even though mandated, many have no incentive to pay them.

    "Montana's Medicaid expansion was a compromise written to win support from enough Republicans to get through the GOP-controlled legislature so that Democratic Gov. Steve Bullock could sign it. That meant negotiating a federal waiver that requires co-pays and premiums to be charged to recipients with incomes above 50 percent of the federal poverty level. They can be charged up to 2 percent of their quarterly income to get coverage... We have already collected to date 68 percent of the amounts billed for premiums..." Failing to pay premiums does not result in immediate loss of coverage in most cases. Recipients between 101 and 138 percent of the federal poverty level get a 90-day grace period, and college students, veterans and people engaged in job training programs cannot be dropped from coverage if they don't pay premiums."

    And tell me how long the feds are going to continue to pick up 100% of the tab? What happens when they renig; we all know how well we can trust the feds' promises with regard to health care. There is no mention in this article of what the cost is to the state, just that they saved some money this particular year (supposedly); what the future costs to the state will be; how these additional costs will be paid for.