Wednesday, August 28, 2019

Expanding Medicaid In South Dakota Means Expanding Opportunities Throughout The State

Here’s a pop quiz.  What Republican governor said expanding Medicaid in his state would be
South Dakota, 
It's Time To Get With The Program
an "innovative, fiscally responsible program" that would "improve outcomes, improve lives and improve the fortunes" of his state's residents.  Give up? I admit it’s a toughie. It was (then) Indiana Governor Mike Pence, who successfully expanded Medicaid coverage in 2015, adding more than 300,000 Hoosiers to the state’s pool of insured residents and reducing the uninsured rate by 41%.  Whatever you think of Pence and his politics, he ain’t no dummy. Pence's successor, Republican Eric Holcomb has said, "I've not seen a more successful program."
     So why are we South Dakotans dragging our feet on this? If we were to expand Medicaid, between 40 and 50 thousand of our residents would qualify for coverage. Even with the expense of running the program amounting to 10% of its cost, our state would get a net inflow of $3 billion from the federal government over the next 10 years. Governor Noem's predecessor Republican Dennis Daugaard (like Mike Pence in Indiana) could see what a good deal this is and subsequently created a plan a few years ago that would have expanded Medicaid in South Dakota.  The momentum for it was lost when Donald Trump became President, partly on the promise that he would dismantle the Affordable Ceare Act, which authorizes Medicaid expansion. Since Trump was unable to accomplish that task, expansion is still a great opportunity for South Dakota to extend Medicaid coverage to about 50,000 of its residents who earn too much to qualify for conventional Medicaid, but don’t make enough to pay for standard coverage.  As Governor Daugaard understood, this is a good deal for our state.  
And it’s a good deal on more than just the “healthy outcome” front.  The non-partisan Center on Budget and Policy Priorities finds that expansion has produced net budget savings among the states that have adopted it.  CBPP has found that higher-than-expected enrollments in some states have not harmed budgets and that “expansion continues to save states money.” There is probably also a positive macro-economic outcome that will accrue from all those federal dollars coming into our state, which should be a welcome boost as we slog through a minimal growth period created by the currently tough agricultural economy
Last January our Governor Kristi Noem flatly rejected Medicaid expansion, but common sense and the experience of other states should make her rethink her opposition. As Indiana and other states have found, waivers make it possible to tailor a plan that works locally. Noem should, like former Governor Daugaard, find a way to make this happen. A flat out rejection is irrational and it makes no sense to institutionalize irrationality.  


  1. I shall warrant the institutionalization of irrationality is the lodestone of the Noem Administration.

  2. Obama's not President, anymore. It's OK to expand Medicaid. Really,it is. The money SD is refusing is being split up among those that did. Thanks from CO. We don't really need it but would be foolish not to take it.