South Dakota Attorney General Marty Jackley strives mightily to spin some consolation out of yesterday's crushing defeat of his Tea Party intentions. In his press release on the Supreme Court's general rejection of his lawsuit against the Affordable Care Act, AG Jackley trumpets the only part of the Court's ruling that he can remotely call a "victory," the determination that the feds cannot take away our current Medicaid funding just because Jackley, Daugaard, and the SDGOP want to deny low-income South Dakotans the benefits of an expanded Medicaid.

Read that again: South Dakota conservatives are celebrating the fact that they get to keep lots of federal funding while denying South Dakotans the benefits that citizens of other states will enjoy. I'm not hearing in that a resounding affirmation of conservative principles.

But let's get real. Jackley's argument was never about principles, conservative or constitutional. It was about money. Jackley continues to claim that participating in the Medicaid expansion would bust our budget. But this Kaiser Family Foundation analysis explains the real cost to South Dakota:

  • Assume folks would participate in the expanded program at about the rate they participate in the current program.
  • From 2014 to 2019, South Dakota would see 31,317 new Medicaid enrollees.
  • Total Medicaid enrollment increases by 25.9%.
  • These new enrollees would include 18,594 who previously didn't have insurance.
  • We thus reduce the number of low-income folks without insurance by 51.9%.
  • From 2014 to 2019, South Dakota would spend $32 million on this expansion.
  • Over the same period, Uncle Sam would kick in $717 million. (One word: stimulus.)
  • The total increase in state spending on Medicaid by that point would only be 1.1% higher than the baseline.

Jackley whimpers about cost when he should whoop about benefits. For a 1.1% uptick in state spending, we get a big tub of new federal dollars to support our state's health care industry. We slash the number of uninsured folks, which means we slash the hidden tax we all pay in hospital costs and insurance premiums to cover currently uncompensated care and emergency room visits.

Even after 2019, when the federal-state funding ratio goes to 90-10, South Dakota still comes out ahead, providing benefits to low-income folks that are worth the investment.

AG Jackley's portrayal of yesterday's ruling as a victory for states' rights is silly. The only right he's protecting is South Dakota's right to cling to federal dollars while declining to take better care of its citizens. The ACA's Medicaid expansion is still law, it's still Constitutional, and it's still good policy.