Monday, March 27, 2017

Okay, Back To Medicaid Expansion In South Dakota

Making The Case
Let's Get 'Er Done
     Now that President Trump's campaign promises to end the Affordable Care Act couldn't get past his own Republican party's tumultuous rejection of them, it's time for South Dakota to move ahead on one major aspect of the law.  That would be expanding Medicaid coverage in our state, a plan that our Governor Daugaard did a pretty admirable job of crafting a year ago before everything went on political hold.  The postponement, of course, was a by-product of the presidential campaign and subsequent election of Trump, whose fervent promises of doing away with ACA (also known as "Obamacare") seemed achievable, considering his party had Republican majorities in both houses of Congress.  But calling the program "toast" was way premature, and Trump's failure to push its repeal and replacement through Congress leaves everything intact.  As a chagrined House Speaker Paul Ryan put it in his concession speech last week, "ACA remains the law of the land."
     As tough as that fact is for many Republicans to swallow, it does give South Dakotans a shot at using ACA as a vehicle for advancing healthcare opportunities and giving our state a much-needed economic boost.  First off, recent history demonstrates that the in-state political fallout isn't as potentially ominous as first meets the eye. Consider that 16 Republican governors have already expanded Medicaid in their states.  That they were probably part of the reason that a fair number of GOP reps in Congress couldn't get behind Trump's rush to destroy ACA is one thing.  That Vice-President Pence, when he was Governor of Indiana, expanded Medicaid for his state is another. Indiana's decision should make it pretty clear to recalcitrant Republicans here in South Dakota that expansion has some tangible benefits.  
     Those benefits are twofold.  The general consensus is that about 50,000 South Dakotans will become eligible for Medicaid benefits under Daugaard's expansion plan, which in the governor's words last year had the support of "80 hospitals and clinics, as well as 50 other organizations in South Dakota." There's no organized opposition that I can find coming from the healthcare industry
A Great Deal For SD
Too Good To Pass Up
in the state. On the second front, political opposition seems to be focused on ideological and partisan issues, which on a broader scale turned out to be hopeless when the entire ACA came under consideration in Congress. The same was true when Medicaid expansion specifically was adopted by so many GOP governors, Pence of Indiana included, around the country. Rejecting literally billions of dollars of federal Medicaid disbursements that will support this plan over the next few years makes no sense to me, especially as our Governor Daugaard's proposal makes it revenue-neutral for state budgeting purposes.    


  1. For all my sins, I await the assertion that Medicaid expansion should await the conclusion of a new Constitutional Convention. (possible sarcasm)

  2. My best friend went for two years without health insurance and with limited health care after her disability was approved by Social Security before her Medicare kicked in because there is a two year waiting period before you receive Medicare benefits after you've been approved. She would have had insurance and health care during that time if South Dakota had approved the expansion, but as it was, since she should have been covered by the expansion, she didn't qualify for the low income vouchers to help pay for insurance since she was supposed to be getting Medicaid instead. During this time her health deteriorated because she couldn't afford proper care and in the long run it has almost certainly cost the government more covering repeated surgeries that might not have been necessary if the first one had been done sooner. I really fail to see the economic logic in that, let alone the compassion.

    I am not sure what had happened to the final bill after all the tweaking before it was pulled, but at one point, as I understand it, the only states that would have been eligible to continue to receive Medicaid expansion funding were the ones that had already approved it, which would have meant South Dakota would have been permanently left out since we had not expanded at this time. As I said, that may have been changed before the bill was pulled, but it is certainly something our legislators should be thinking long and hard about. If I am right about this it is very possible that they can either approve the expansion now, or forgo these funds forever, hurting the poorest of our citizens in the process.