Tuesday, September 26, 2017

Can South Dakota Handle The GOP's Healthcare Plan?

     At this point it's a matter of trust.  My native Republican instincts tell me that the latest GOP effort to replace Obamacare (Affordable Care Act, or ACA) is one I could
But It'll Resurface.
 Though likely to fail on this try, it’s bound to come up again.  I can certainly understand our Governor Daugaard 
enthusiastically getting behind it.   For one thing, the current bill renders moot South Dakota's stubbornly irrational rejection of Medicaid expansion, an offer under ACA that would provide a couple of billion bucks to our state over the next few years.  Heck, the status quo is such a good deal that then-Governor Mike Pence figured out a way to expand Medicaid into Indiana, making him one of eleven Republican governors who understood the value of insuring a sizable portion of their state populations who make too much to qualify for Medicaid but not enough to afford conventional insurance.  Adding in the economic gains from the rollover of those billions of dollars only reinforces the fiscal sanity of saying yes to expansion built into ACA. 
     Daugaard himself had even come up with a plan to bring it into South Dakota, an effort he abandoned after he apparently was convinced that a Trump administration could easily overturn ACA.  Trump's vision has of course been exposed as a hallucination, but Governor Daugaard is dutifully following up on his responsibilities and political affiliations by giving Republican leadership the attention and lip service it merits.  His Chief of Staff and son-in-law Tony Venhuizen was quick to address the Medicaid expansion funding issue a few days ago, when he told the Mitchell Daily Republic that one of the main reasons Daugaard supports the latest GOP plan is that it brings  "funding parity" between expansion and non-expansion states.  
    This is actually a back-door way of acknowledging what has been obvious for years:  states like South Dakota, stubborn as they've been in their resistance to Medicaid expansion, have really been getting the short-end of the stick when it comes to federal healthcare spending.  But by going along with this concept of federal block granting, South Dakota effectively gains what it has been giving up by disdaining expansion.  Block grant money would amount to a yearly gain of nearly $1 thousand per resident (almost a billion dollars) to South Dakota according to a New York Times analysis.  That would more than make up for the money we've been leaving on the table up to now.
     And, as a business-type who sees the value of money pouring into the state, regardless of whether the source is named Obamacare or Trumpcare, I love the idea.  The only caveat now is the matter of trust that began this missive.  We've seen what's happened to federally-supported and sanctioned programs in this state during the past decade or so, and it hasn't been pretty.  EB-5 and Gear-Up have set pretty poor examples of our current leadership's ability to manage Washington-sanctioned programs.  Before the Daugaard administration gets totally wound up in its enthusiasm for this block grant or the next one that’s likely to be proposed, some assurances that another fiasco won’t materialize are in order. 

1 comment:

  1. John, You can ever go further back than your two mentioned federal programs to see that South Dakota misuses fund from other sources as well as taxes that it collects and earmarks for one issue in the proposal and then switches use after it has gotten the voters to go along with their scheme. Three of the schemes of which I speak are, the tobacco settlement, the increased to a buck a pack state tax on cigs and of course the one we always forget about, the video lottery and Deadwood gambling.