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Hunhoff, Adelstein File Medicaid Expansion Amendments; Uncle Sam Pays 97.5%

David Montgomery transcribes (!) and posts the list of 72 amendments being considered for the 2014 state budget (House Bill 1185). Among them are two amendments to expand Medicaid in accordance with the Affordable Care Act. The amendments from Rep. Bernie Hunhoff (D-19/Yankton) and Sen. Stanford Adelstein (R-32/Rapid City) differ only in that Sen. Adelstein calls for a trigger mechanism that would withdraw South Dakota from the Medicaid expansion if the feds renege on their funding.

But the dollar figures are the same: $1,499,492 in state money, $58,294,779 in federal money.

Spend a buck, get 39 bucks from Uncle Sam to do good for your people. Why is this such a hard deal to take?

41 Comments

  1. Steve Sibson 2013.03.07

    "Spend a buck, get 39 bucks from Uncle Sam"

    Not true 16 bucks is passed on to your children and grandchldren as debt.

  2. Michael Black 2013.03.07

    I welcome more affordable and accessible healthcare for everyone, but right now the federal government cannot pass a budget. Until they finalize their spending, we cannot move forward with confidence.

  3. Brett 2013.03.07

    Because socialism. Why do you hate freedom, Cory?

  4. Jerry 2013.03.07

    This could and would be a lifesaver for so many of our citizens here. If you consider the cost to taxpayers for not doing anything and letting people suffer immensely before getting emergency assistance, this is a bargain and would be cost neutral in the long run. It is especially difficult to understand given the background of our governor. He is noted as saying that as a governor he should be doing more for the disabled. At least that is what he said in Washington recently, more or less. Unless he has his eye on a bigger prize for his future and found that being a US representative pays a lot better and you get a lot more perks. Here, the only way you get to do that is to beat up on Indians, women and the poor. It is a trifecta that just about assures you a win. I forgot, toss in some abortion opposition and you have a winner. So far, ole Denny is on that road successfully.

  5. owen reitzel 2013.03.07

    "Because socialism. Why do you hate freedom, Cory"

    So Brett. We should let those less fortunate have the freedom to die because they can't afford insurance or because of a pre-exsisting condition they can't get insurance? Nice

  6. Dave 2013.03.07

    South Dakota's slogan: Live free AND die.

  7. Steve O'Brien 2013.03.07

    Steve, I have some sympathy for your deficit hawking. We disagree with how it should be handled. Putting the country back on sound economic footing his how we reduce the deficit - not the other way around. Too many make the argument that cutting debt helps the economy, and that only works to dampen the economic growth that has the proven track record of success. You have to spend money to stimulate the economy - from there, from that strength you move forward. No country, no economy, ever shrank its way to success.

    Never mind that helping poor people get access to health care is just a decent thing to do.

  8. Brett 2013.03.07

    Owen--I'm just playing. In any complex policy discussion, I love asking people why they hate America and/or freedom. Obviously everyone deserves medical care and we should definately expand Medicaid, especially with the federal money involved.

    Ezra Klein makes a good case here demonstrating that the fed gov't has consistently funded Medicaid obligations:

    http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/05/theres-no-precedent-for-feds-dialing-back-medicaid-dollars/#.UTjNilTPOdE.twitter

  9. Steve Sibson 2013.03.07

    "Too many make the argument that cutting debt helps the economy, and that only works to dampen the economic growth that has the proven track record of success."

    And tell a heroin addict to take more drugs if you need a pick me up.

  10. Winston 2013.03.07

    Having South Dakota embrace ObamaCare means that the State accepts a minority share of the cost of health care for the working poor, who presently do not qualify for Medicaid under current guidelines.

    If South Dakota is truly the land of solvency and fiscal responsibility then maybe its time our State accepted a share of the financial costs of offering the basic needs of life like health care for a significant group of our population.
    This can be done with the state of South Dakota accepting ObamaCare rather than ignoring it; which in the absence of State participation causes the Feds to pick all of the costs of health care for the working poor through the establishment of tax subsided network health insurance plans in the absence of an expansion of Medicaid through the Obamacare provisions for those you would fit into the working poor income guidelines.

    Since, South Dakota relies heavily upon a low wage image to attract outside businesses and economic growth, and is extremely dependent upon Federal farm aid and a Federal transportation bill to maintain the financial validity and stability of its two largest industries, agriculture and tourism, it is only then fair for our State to accept some of the costs of providing opportunity and care for all of its citizens........ that is if it truly wants to continue to bask in the self proclaimed sun light of fiscal responsibility and solvency.

  11. Douglas Wiken 2013.03.07

    "I'm just playing. In any complex policy discussion, I love asking people why they hate America and/or freedom. "

    Then you just love making yourself look like an irrelevant ignorant idiot.

    Compare the "return" of this spending on care with the "return" on dumping money into crony capitalism projects in ways already demonstrated to serve little purpose or in fact add even more costs to other taxpayers for little or no real benefit.

  12. Michael Black 2013.03.07

    Playtime is over.

    Until the Congress passes a budget, we can't depend on their contribution.

  13. Brett 2013.03.07

    Douglas--I think we are saying the same thing? Good Lord, I'll stop trying to be humorous, since obviously it isn't coming through.

    I don't dispute that I am an irrelevant and ignorant idiot, but one that sides with Douglas in this policy debate.

  14. Mark 2013.03.07

    Slowly, I think, we're getting to a consensus. As more GOP governors who insisted they would never go there, change their minds, I think it's a matter of time that the practical realities of political life will change in South Dakota, too. There will be some who'll still insist on calling it socialistic, but I think it will eventually be considered a bona fide public service that is at once altruistic and economically beneficial to society. After all, aren't we paying the cost (in more ways than one) already?

  15. Steve Sibson 2013.03.07

    "Compare the "return" of this spending on care with the "return" on dumping money into crony capitalism projects"

    Doug, The corporate medical establishment and big medical insurance are also part of the crony capitalism.

  16. larry kurtz 2013.03.07

    Yeah, Doug: faith healers are the only way to save tax dollars.

  17. larry kurtz 2013.03.07

    send sibby a check and he'll come pray over your pancreas.

  18. Jana 2013.03.07

    Mark is right about we pay for it one way or another. The GOP knows that too and that's why they are adopting it for their states.

    There was a column I read that said the reasons behind rejecting the expansion had more to do with ideology and meanness than for the economic guardians that the GOP claims to be.

    Think about it. Those who would benefit from the expansion only gain health. They don't get money to buy a new car, a flat screen...nothing. What they do get is health care that prevents more serious problems that are passed along in the future.

    So who does the money go to? Doctors, nurses, drug companies and health systems. That money goes straight into the private sector.

    Now the Governor can primp and posture that he is against Medicaid expansion to keep his GOP crazy street cred, but people get hurt, economies get hurt...heck, everyone gets hurt.

    Those who posture against this are just plain mean and have a very limited intellect about the consequences of their actions.

    Oh wait...aren't these the same people who are championing SB235 in the legislature and screaming on their soapboxes that government doesn't create jobs and making fun of "you didn't build that?"

    GOPHers - the Grand Old Party of Hypocrites

  19. caheidelberger Post author | 2013.03.07

    Brett, I appreciate your satire. :-)

    Sibby, what's this about children and grandchildren? Baloney. My plan is to jumpstart the economy, get us roaring again, keep electing fiscally responsible Democrats, and pay this bill off with healthy workers who will bring the deficit down before my daughter graduates from high school.

  20. grudznick 2013.03.07

    The Mexican tribes are clamoring for medicaid expansion.

  21. caheidelberger Post author | 2013.03.07

    And Brett, I appreciate even more your empirical evidence from the Wonkblog. Uncle Sam has never reneged on Medicaid. Daugaard's fear is based on nothing.

  22. Dennis Taylor 2013.03.07

    But the dollar figures are the same: $1,499,492 in state money, $58,294,779 in federal money.

    Spend a buck, get 39 bucks from Uncle Sam to do good for your people. Why is this such a hard deal to take?
    Let's look at where this logic takes us. Why not just double those numbers and decrease the cost we all pay for health care? Or maybe quadruple those numbers and help us pay our mortgages? So what if the feds will borrow 40% or more of their share. In fact why put a limit on it at all. How much to get us all to the 2% level? Of course this ignores the fact that physicians refuse to see Medicaid patients because the reimbursement they receive is less than the expense of seeing the patient.

  23. Douglas Wiken 2013.03.08

    Brett, sorry if I missed your comment as being satire. I see so much of that as actual posts intended to be read as written. With a dozen first names, etc. here I don't always keep track of posters' histories.

    A cartoon yesterday indicated the problems of too literal communication. Character1, "How'd that blind date you were talking about work out?", Character2, "Not good at all, her guide dog attacked me."

  24. Brett 2013.03.08

    Thanks Doug--no worries. You're right that there's too many making that kind of comment seriously, and I should have known better than to flippantly make it in jest, especially as an infrequent poster.

  25. caheidelberger Post author | 2013.03.08

    The flippancy works itself out, Brett. Fire away!

  26. Curtis Price 2013.03.09

    who will bring the deficit down before my daughter graduates from high school.

    The deficit has decreased every year since the President took office. We're well on our way already -- if the House decides to stop playing mumbled-peg.

  27. Jana 2013.03.27

    Just saw these stats and wondered how the Governor and the rest of the GOP felt about screwing our military veterans with his (their) political partisan posturing on the medicaid expansion.

    That's right...South Dakota veterans and their families are going to be hurt so the Governor...or whoever is pulling his strings...can earn a merit badge for standing up to the black man in the white house. You know the socialist marxist from Kenya.

    If I'm reading right, Governor Daugaard is denying health care to over 2,200 veterans and their spouses adequate health care coverage.

    That's basically like giving the finger to entire towns like Ft. Pierre, Custer, Wagner, Lemon, Deadwood, Webster. Only it's not an entire town...it's veterans and their spouses who will suffer.

    Remember that the next time he waves the flag and asks all the veterans at the $100 a plate dinner to stand up and be recognized.

    Sorry Gov...it's time you stood up and paid more than self serving lip service to our veterans.

    http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf405143

  28. grudznick 2013.03.27

    Ms. Jana, apparently that option is now in the mirror and we all have to look forward to how to cut cut cut and reduce our taxes together. It is time for all of us, GOPer and Libby alike, to pull together in South Dakota. Looking back and whining or crying about "what ifs and candy or nuts" is not productive. I'm just sayin...

  29. Les 2013.03.27

    I'd like to know who isn't getting health care in our state? I"ve been in ER twice in the last few months. With my 10K premium Blue Cross policy I will have spent close to $8,000 when visits are all paid and done.
    .
    I've sat with many that had no policy and no money to buy one. They paid nothing for the same service I received.
    .
    I am now believing every one of you here has fed or state funded policies with no deduct or no policy and have never paid a dime for ins or a deductable. Am I wrong?
    .
    Those of us who pay our own plus yours and theirs want to know.

  30. Jana 2013.03.27

    Les, is that the American exceptionalism the right keeps shrieking about?

    And no. We will pay over $9K for our health care before insurance kicks in.

    Have a good friend who works for the state and her contribution with a $1K per family member deductible is about 33% of her salary, so your "free rider" meme for government employees is off by about 333%.

    Try again Les.

    But I'm a little concerned that you feel that you are getting nothing back from the state that you would bitch so much about state employees having benefits. Have you talked to the people running Pierre about that? Tell us again what party they belong to?

  31. Jana 2013.03.27

    Les, you seem to be making the argument that there should be universal care. Thanks.

    Now, can we get back to the GOP and the Governor saying "bite me" to our veterans and their families?

  32. Jana 2013.03.27

    Les, check these charts out and then tell us again about American exceptionalism.

    Although I will say that I am either impressed or distressed that you know how much the people around you were paying or not paying for their health care.

    How did you ask them? Or were you just stereotyping?

    Hope you are feeling better.

  33. Les 2013.03.27

    Jana, answer the question. Who isn't getting healthcare in our state?

  34. Jeremiah Corbin 2013.03.27

    Everyone gets healthcare. It's just us lucky(?) few that get to pay for it.

    Good argument for single payer if you ask me.

  35. Les 2013.03.27

    Your over inflated reply still hasn't answered who isn't getting health care in SD. I know the costs, I pay them. My point that you choose to ignore is, who is not getting health care in SD?
    .
    My family has been in and out of health care for over 40 years. I've never seen or heard of anyone being refused care, and, I don't have to stereo type anyone to understand that process at check in.
    .
    I've got a brother and a friend who both got that same cancer at a similar time. My brothers state university policy got him no better treatment than the friend with no policy.
    .
    Bitch so much? Bitch much?

  36. Jana 2013.03.27

    Good question Les. Apparently you think that having emergency rooms is health care for everyone.

    Be curious and look it up yourself...you know they are out there. Here's a hint. There's a lot more than you think.

    Here's some starter info for you when you get done with the link I sent you earlier.

    http://www.statehealthfacts.org/profileind.jsp?cat=3&sub=40&rgn=43

    And you should read Steven Brill's epic piece in Time Magazine "The Bitter Pill. Why healthcare is killing America" when you get off of your high horse.

    I know I won't change your mind. After all during the Republican debates there was a standing ovation for letting people die that couldn't afford health care.

    Happy Easter.

  37. Jana 2013.03.27

    I'm also guessing that the one without insurance was sued by the hospital for his bills, bankrupted, financially destroyed and the uncollected costs passed on to the rest of us as a shadow tax.

    What a country!

    How many people do you think are out there that can't afford preventative care that ends up costing us all more and destroys families along the way?

    You still haven't answered about the vets that are uninsured and denied coverage by our governor's slave like devotion to dogma.

    Oh yeah...that's a little uncomfortable for the GOP to talk about screwing over vets. I forgot that they were only good for political posturing.

    Go ahead and ask some of the folks in the GOP that held their party brethren accountable for their treatment of vets.

  38. Les 2013.03.27

    Who ever said our healthcare system was right Jana? How about you read what I wrote. Obviously cancer isn't treated in ER..
    .
    Same brother has an employee that didn't like the 66/month premium and goes to ER after hours. No waiting in line and no payments, or whatever payment he chooses to make, obviously less than 66/mo.

    Who do you know is not getting health care in SD Jana. It is so personal that there must be some ONE. Am I wrong?
    .
    I will take that Happy Easter and give you one back Jana. Happy Easter.
    .
    I need to live it,(from a friend):I guess I look at it this way. Everything of this world will pass away. Our opinions, our political affiliations, Facebook, Supreme Court, America...etc... In the end when He asks if you acknowledged him before men and you believed and repented and did the best you could...well that's what I hope we look for.
    .
    I am happy I can pay Jana and I'm spending money on my body like a drunken sailor.

  39. caheidelberger Post author | 2013.03.30

    Les, to be clear, I've never had a health insurance policy with no deductible. I've never had a health insurance policy with a deductible low enough to make me feel like I can stroll into the doctor's office at any time without incurring serious expense. When our daughter was born, we paid $12K out of a $24K bill for her delivery and three-day stay in the NICU. Before and since, I've avoided the hospital like the plague, afraid that any significant medical event could turn into a bankruptcy event.

    I doubt I'm the only one with that mindset. The same South Dakotans who soldier on, working for low wages and not griping about low/no benefits and minimal labor protections, tend toward the same mindset that says they should not just take advantage of the emergency room, that it doesn't really hurt that bad, that they can get by another day without bothering the doctor. That's a big chunk of South Dakotans not getting health care.

    Of course, those folks are choosing not to get health care, just like South Dakota teachers are choosing to stay here and work for the lowest salaries in the nation, so there's no moral imperative to improve either the health care system or the education system, right?

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