Gubernatorial candidate  Joe Lowe is on the same page as South Dakota doctors and Democrats (and at least one Republican!) in supporting the Affordable Care Act's Medicaid expansion:

Are we really going to leave 48,000 without Medicaid?

I question why our Governor will not invest $1.5 million in state funds to receive $214 million in federal dollars for the Medicaid program. He states it is because he does not trust the promises of the federal government in future years to come [Joe Lowe, letter to the editor, 2013.12.17].

In his December 3 budget address, Governor Dennis Daugaard deemed other elements of the ACA too "unpredictable and chaotic" to permit investing in the Medicaid expansion, which the federal government will ultimately bankroll in a 90-10 cost share after 2016. In the same speech, Daugaard promises to continue regular Medicaid funding, for which the unpredictable and chaotic federal government offers only a 52-48 cost share.

Lowe wonders how Daugaard's logic allows him to accept any of the federal funding on which South Dakota depends:

If the Governor does not trust the promises of the federal government then our state has much to worry about. This state is a beneficiary state when it comes to federal tax dollars. Our state residents pay less in federal taxes than the federal government spends in our state. In Fiscal Year 2011 we received almost $2 billion in federal government contributions, this accounted for nearly half of all state budgeted spending. So the excuse that he does not trust the promises of the federal government is very disturbing to me. He would be shutting down most state government programs based on that assumption. It appears he just does not want to support those needing Medicaid [Lowe, 2013.12.17].

Governor Daugaard's FY 2015 budget proposal counts on Uncle Sam to contribute 40% of the total state government budget.

Not supporting a Medicaid expansion will cost all of us money. In a survey released by The American College of Emergency Physicians, it was reveled that the uninsured patients treated in the ER tend to be sicker and have more serious medical conditions than patients who have insurance. A majority of those surveyed (74%) say that uninsured patients are more likely to die prematurely and overwhelming number of physicians (94%) agree that arranging follow-up care is more difficult in those patients without insurance. Also federal law mandates that when these uninsured individuals show up in the ER, they cannot be denied access to care. The costs of their care is eventually shared with the county directly (our community), and other insurance companies indirectly, through increased health care for those with insurance. Our Community hospitals also bear the brunt of having to treat uninsured patients in the Emergency Room. They will sustain losses by having to treat those without any health insurance [Lowe, 2013.12.17].

Senator Stanford Adelstein and others have pointed out that we are already paying the hidden tax of uncompensated medical costs for folks not currently covered by Medicaid or private insurance. Taking advantage of federal funding for the Medicaid expansion for however long it may last would be no financial loss for South Dakota; it might even save us money.

It is time to support the Medicaid expansion and help the 48,000 fellow South Dakotans that needs Medicaid. Call this governor and your legislators and tell them to support the expansion of Medicaid. It is about our people not fabricating excuses [Lowe, 2013.12.17].

We don't have to wait for Lowe to become governor to do the right thing and expand Medicaid. But if we can't talk sense into Governor Daugaard, and if we can't sway a veto-proof majority of the Legislature to make a sensible and moral policy choice, we voters will have a chance to expand Medicaid by electing Joe Lowe governor next November.