Could Medicaid expansion happen this year? South Dakota has already given up two of the best years of the federal government's offer under the Affordable Care Act to cover most of the cost of putting 48,000 low-income South Dakotans on affordable public health insurance. But John Tsitrian notices that Governor Dennis Daugaard is hinting at a shift from his ideological excuses to an openness to accepting some form of the Medicaid expansion.

And Democrats are working hard to make that possible. AP reports that our man Bernie (that's Senator Hunhoff, D-18/Yankton) is working behind the scenes with health care providers to bring some sort of Medicaid expansion to South Dakota.

Hmm... just a thought: if health care philanthropist T. Denny Sanford can kick in $25 million to match state funds and launch Governor Daugaard's scholarships for welders, might we be able to persuade Sanford to spend a fraction of that money each year to bring hundreds of millions in the Medicaid economic stimulus to South Dakota?


Senator John Thune chirps mindlessly over Senator Chuck Schumer's supposed regret over the push for the Affordable Care Act.

The only thing we Democrats have to regret about pushing for the Affordable Care Act in our best window of opportunity is that we committed the very sin that Rick Weiland and Elizabeth Warren and other progressives are clamoring to rectify: we gave in to big money and the Republican narrative. We didn't go far enough.

We didn't fight hard enough for a public option to increase competition and lower costs.

We didn't fight hard enough to rein in the power of private insurers, who are still coming between patients and their doctors and playing death panels.

We didn't fight hard enough to lead a conversation on the merits of a single-payer system, a solution that several industrialized countries have adopted without falling into the grip of Stalinism... and a solution that one candidate for South Dakota Democratic Party chair advocated in 2012.

Regrets about the ACA? Yeah, you bet. We regret that we compromised and adopted RomneyCare and didn't fight harder for a more comprehensive solution.


Here's the tough call of the morning. Jonathan Ellis reports that South Dakota implemented a new rule on September 1 requiring Medicaid patients to get authorization from the state to seek medical treatment more than 50 miles from South Dakota (with the exception of folks headed to Bismarck for service, which makes perfect sense for folks all along lonely Highway 12). The rule is a reasonable cost check, used by many states as well as private insurers. The state hasn't been wielding it too avidly: Ellis says in the first two months of the rule, the Department of Social Services denied only 14 of 483 requests for out-state care.

Enter Nicole Cook, 31, mom of six, from Madison:

Cook originally went to Mayo in August after repeated doctor and hospital visits in Madison and Sioux Falls, she said. She was rapidly losing weight, was exhausted and in pain.

Testing at Mayo determined that she has a lung tumor, scarring in her lungs, bone lesions and other health problems. She was scheduled to return to Mayo in October with the hope that doctors there could find a cause for her maladies.

But this time, she was unable to go because the Department of Social Services would not authorize payment for the visit [Jonathan Ellis, "Medicaid Rule Drives Woman from S.D.," that Sioux Falls paper, 2014.12.01].

Cook says the state says South Dakota doctors can provide the care Cook needs. But South Dakota doctors evidently couldn't provide the diagnosis Cook needed. Nicole's husband Ryan says on his fundraising page that Nicole's local doctor actually dropped her, saying her case is too complex for him. One can thus understand her lack of confidence in her local docs and her preference to seek treatment from the Mayo docs. According to Ellis, Cook's Sioux Falls doctors are recommending Mayo for treatment.

But who gets to pick the piper: the patient or the payer? Cook or us, the taxpayers?

Cook is relieving us of that choice. She is moving to Minnesota and applying for Medical Assistance. As far as I can tell, Minnesota has no rules against moving primarily to qualify for public benefits. Minnesota's residency rules say that once she's physically present in the state and made clear her intention to stick around, she can qualify.

So how do we feel, South Dakota, about driving away someone who needs help?

p.s.: Cook's fundraising page shows about $4,800 raised toward a $150,000 goal. Please don't tell me that private fundraising is an effective way to pay for everyone's medical bills.


That Sioux Falls paper is dribbling out a new Mason-Dixon poll that finds South Dakotans want to expand Medicaid under the Affordable Care Act. The poll finds 45% in favor, 37% against. Hey, if that margin is enough to elect a U.S. Senator, it should be enough to make a policy decision.

That's a remarkable drop from a January 2014 poll, conducted by GOP pollster Glen Bolger, that found 63% of South Dakotans favoring the Medicaid expansion. Perhaps so close to an election, a large chunk of voters can't help noticing the cognitive dissonance between their thoughtful values and their ingrained, automatic, inertial reach for the "R" on the ballot, and they resolve that psychic tension by following their leaders. Sigh.

Jon Walker's report notes that fiscally, the numbers add up in Susan Wismer's favor:

Susan Wismer, the Democratic candidate for governor, said the state is leaving a fortune on the table by dragging its feet on expansion. Wismer, a state legislator from Britton, argued in a debate in August that South Dakota hospitals are losing more than $250 million a year from federal money that would flow into the health care system if Medicaid were expanded here. Daugaard said in the same debate that expansion would be a new $95 million burden on the state budget from 2017 to 2020 [Jon Walker, "Poll: More S.D. Voters Back Medicaid Expansion," that Sioux Falls paper, 2014.10.25].

Notice that even reaching out for four years of budget impact doesn't come close to beating one year of the fiscal boost South Dakota would get from Medicaid expansion. Let Governor Daugaard have all the "No more free stuff for poor people!" voters quoted in Walker's report (one from her lofty perch at Dakota Dunes). Even the modest support shown in the Mason-Dixon poll is one more bit of evidence that South Dakotans would elect Democrats if they integrated their policy thinking into their voting.

Related Reading:

  1. The lagging Republican Senate candidate in North Carolina is U-turning his position to welcome the Medicaid expansion.
  2. The only problem with Nevada's expansion is a doctor shortage and a high percentage of already scarce doctors refusing to see Medicaid patients (because, you know, health is for the rich, kind of like how I should only teach kids whose families are big tippers).
  3. Republican Ohio Governor John Kasich still wants to repeal the Affordable Care Act, but not the Medicaid expansion. Kasich told AP the opposition to Medicaid expansion in the Ohio statehouse "was really either political or ideological.... I don’t think that holds water against real flesh and blood, and real improvements in people’s lives."
  4. In nine states that have expanded Medicaid under the ACA and where Democratic governors face strong Republican challengers, none of those GOP challengers have advocated repeal of the ACA's Medicaid expansion.

The Affordable Care Act is improving and saving lives by expanding Medicaid:

Charles McClinon, a 50-year-old Ohio resident who lives with epilepsy, told ThinkProgress, “The peace of mind is worth more than anything. I could be a millionaire, but if I don’t have peace of mind, what good is it? And that’s one thing this type of insurance is good for. I know I can get the kind of care I need.”

In 2010, McClinon’s epileptic seizures intensified, making it too difficult for him to hold down a job or complete the university classes in which he was enrolled in at the time. To make matters worse, his student health policy dropped him under a pre-existing condition clause. After that, McClinon struggled to afford the treatment he needed, especially after his medications started to give him debilitating side effects. He eventually became homeless.

After Ohio’s governor became one of the first Republican leaders to accept the Medicaid expansion, however, McClinon gained coverage in February. He can now afford the multiple medications he needs to manage his condition — and this summer, he also had a cutting-edge surgery that will hopefully prevent his seizures and eliminate the need for all the drugs he currently takes. Thanks to his Medicaid coverage, he didn’t have to pay for that procedure out of his own pocket.

McClinon, who worked his whole life before his seizures worsened, is looking forward to feeling like his old self again. “It’s not even just about medical care — it’s also been helpful for me on the mental health side,” McClinon said, referring to his newfound peace of mind. “I don’t know what I would have done if I lived in another state” [Tara Culp-Ressler, "Meet The People Whose Lives Have Been Transformed By Medicaid Expansion," ThinkProgress, 2014.10.16].

Read Culp-Ressler's full article, then remind why anyone is voting for the South Dakota Republicans like Mike Rounds, Kristi Noem, and Dennis Daugaard who want to take such health and peace of mind away from their fellow South Dakotans.


Not quite 5,000 people have died in this year's Ebola outbreak. One of those deaths has taken place in the United States.

In response, Senator John Thune is advocating bigger government, specifically in the form of banning travel to the U.S. from Sierra Leone, Liberia, and Guinea. Senator Thune says he would consider expanding those restrictions.

Ebola spreads only through direct contact with infected bodily fluids. In other words, to catch it on the bus or plane, an Ebola carrier would have to bleed, pee, or poop on your broken skin or mucous membranes.

An estimated 43,000 Americans have died of influenza and pneumonia this year. (The CDC will say that number is hard to pin down and probably less than that, but from 1976 to 2007, influenza killed between 3,000 and 49,000 Americans each year.) Influenza can spread through the air, via coughing, sneezing, or talking.

Guns have probably killed a good 9,000 Americans this year. Drunk driving has put another 27,000 Americans on a permanent travel ban. Yet Senator Thune is not advocating any big government solutions to those deaths.

Senator Thune has a very selective freak-out-o-meter, and an equally selective aversion to big government.


Democrat Ellee Spawn is running for District 12 House. The first-time candidate took time Friday after Democratic Forum in Sioux Falls to tell me about teacher pay, health care, the minimum wage, and other issues that have propelled her into the public arena.

Ellee Spawn, Democrat for District 12 House, 2014.08.22

Ellee Spawn, Democrat for District 12 House, 2014.08.22

Spawn puts teacher pay at the top of her agenda. She says last place in salaries is unacceptable if we're serious about retaining the best and brightest teachers. Her own daughter can testify to this economic fact. Spawn's daughter studied elementary education at SDSU. She wants very much to stay and teach in South Dakota, but she has a five-year-old son and a student loan to pay off. South Dakota's teacher pay won't cut it, so she and her fiancé from Watertown are moving to Minneapolis.

Spawn sees a certain cognitive dissonance in South Dakota's inability to recognize the harm we do to ourselves with our low teacher pay. People don't like to face hard truths, says Spawn, but we have to deal with them.

Of course, we also have to find the money to deal with hard truths. Spawn doesn't jump to new taxes. Instead, she says a statewide effort to boost teacher pay should start with our budget surplus. next, says Spawn, we should stop giving out Benda bonuses. (Hmmm... put Ellee and Charlie Hoffman together, and we just might move the needle on teacher pay!)

Spawn currently manages the Sioux Falls office of M4 Roofing. She has worked in management and sales, served as a virtual assistant, and run her own restaurant. Spawn says her self-employment experience instilled in her a sense of self-accountability and a commitment to getting the job done.

Running a restaurant also shaped Spawn's view on the minimum wage. Spawn says she paid her servers $8 an hour, plus tips. Her kitchen staff got $11 to $12 an hour, and that was nine years ago. Spawn says paying more than other restaurants never hurt her business; it helped her draw and keep experienced and happy workers. It's a bad business practice to pay workers too little. Pay a living wage, says Spawn, and your employees feel less stress, pay more attention to customers, and steal less. Spawn recognizes that South Dakota's minimum-wage initiative, to raise our base wage to $8.50 an hour, is still somewhat shy of a living wage, but she supports it as step in the right direction.

Spawn shows further support for low-income workers with her support for Medicaid expansion. Governor Dennis Daugaard is leaving 48,000 South Dakotans (49,000, said this January 2013 study) without coverage because he'd rather dig in his heels on a specious objection to federal money, which, Spawn points out, already subsidizes 39.6% (yes, she had that number in her head) of the Governor's state budget. The Governor's refusal is "a slap in the face to hard-working South Dakotans."

Spawn says she jumped into the District 12 House race last winter because she was mad. She was sick of her District 12 Reps. Hal Wick and Manny Steele helping the state GOP embarrass South Dakota with their impractical and fringe-nibbling proposals to require everyone to carry a gun, get fluoride out of our water, hold a Constitutional convention, and promote anti-gay discrimination. A friend asked her, "Why don't you run?" Spawn replied, "Why don't I?"

And a candidacy was born. Rep. Steele was term-limited out, and Rep. Wick chose not to run for reëlection, so District 12 is already headed in the right direction. But Spawn wants to make sure her district gets some sensible, unembarrassing leadership. She and fellow Democrat Susan Randall are running against GOP challengers Arch Beal and Alex Jensen.

Spawn is assembling a noteworthy team for her legislative campaign. She just hired John Gossom as her campaign manager and Nebula Group USA as her strategy team. Nebula Group USA is also working for District 33 House candidate Robin Page. Nebula Group USA is run by Bajun Mavalwalla, who like Gossom was involved in the early stages of Corinna Robinson's Congressional campaign.


Corinna Robinson is working to reverse that downward Q2 fundraising trend. The Democratic candidate for House is speaking at a fundraiser tomorrow (Friday) evening at the Rapid City home of Dr. Nancy Babbitt and Steve Babbitt. Team Robinson staffer Valerie Parker tells me all interested parties are invited. The campaign tweets the where and when:

  • When: Friday, July 25, 5:00 – 7:00 p.m.
  • Where: 1121 Settlers Creek Place, Rapid City, SD 57701

Dr. Babbitt and Team Robinson would like a heads-up on how many people are coming, so please RSVP to campaign staffer Adam Schantz at

offers this statement from Dr. Babbitt explaining her support for Robinson:

“I’ve become a big believer in who represents us in Washington has a major impact on how physicians get to deliver healthcare," Dr. Babbitt said. "And as someone who is frequently called upon to give input on healthcare reform issues, healthcare legislation, and questions of how we provide quality, affordable healthcare for South Dakota seniors, children, veterans etc., I've found Corinna Robinson to be an open- minded, common-sense voice on this issue. We're excited about the event and we're honored to host it" [Robinson campaign, press release, 2014.07.23].

Dr. Babbitt has publicly challenged Senate candidate Mike Rounds's false scare tactics and Governor Dennis Daugaard's detachment from reality on the Affordable Care Act. Now let's see if she can help Robinson set Kristi Noem's bad record on health care reform straight.



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