Last updated on 2014.12.04
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.
He is sure is cute, tho.....
Jackley and the other jackass GOP attorneys general who've pledged to obstruct in the courts any initiatives passed by Democrats deserve the egg on their faces this week. They chose to abuse their access to the legal system to play petty politics. When they lose, they have nobody to blame for their pinheaded behavior but themselves.
I remember a lot of people who knew him in private practice were surprised and delighted when Jackley got his political appointment to become attorney general. First, they didn't think Marty had political ambitions. Second, they thought he was too fair-minded and normal to be a hack. They've been proven wrong on both counts as Jackley has been the worst partisan hack to serve as AG in several decades.
The fact he has yet to investigate the flaming scandal just upstairs in the Secretary of State's Office demonstrates how committed he is to doing the job citizens of South Dakota expect from a faithful public servant.
"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."
Money stolen from future generations, is that moral?
Cory I disagree with you that it is about the money. I think it is all about the politics. Being against "Obamacare" is a winner for them and showing even an inkling of support of the law is a loser. The election in Nov. will be a turning point either way. If Dems can hold the presidency or the Senate then the law will hold and the States will fall in line because of the economics. Until the election they will be relentless against this law and if the Republicans take control, the Country will have to wait until 2016 for any relief. maybe 2014 as fickle as Romney is.
Democrats have done a lousy job of selling this law to the American public that has to change and fast, until the polls show that it has changed being against the law is a winner.
Does this mean that the law doesn't apply to states that don't implement it?
Barry, the reason the bill hasn't "sold" to the general public is that it's not been implemented fully as yet. The slowness of implementation is probably the biggest enemy of the bill right now.
Bill is right. Fear of change and unknowns are fueling debate.
I agree with you Bill . People still don't even know really what the law is about because it hasn't affected them yet. If it had been rolled out in one year like Romneycare was that probably would have made a big difference - it did in Mass.
98% of MA now covered
"Fear of change and unknowns are fueling debate."
Unknowns? We have Medicare, Medicaid, and IHS as examples of the disaster that is awaiting us. If fact those programs are responsible for the high insurance rates.
I don't know if this is going to be a boon; already we've seen an increasing number of physicians refusing to see Medicaid patients because the program significantly underfunds reimbursement of services.
Effective Jan 1, 2013, States are required to increase Medicaid fee-for-service payments to a level equivalent to what Medicare would have paid for that service, but we still see a diminishing number of docs willing to take Medicare patients because that reimbursement rate isn't much better.
While it may tout "coverage", will we actually see a dramatic increase in ~access~? If people on Medicaid cannot find a physician willing to take them, then they're stuck with the ER visit anyway and we're back to where we started.
The real challenge is actually reducing overall cost of health care delivery... and to ensure we have access to it. I'm afraid the rules surrounding Medical Homes and ACOs are going to force small Critical Access Hospitals to merge with large systems which will then gut them of most services. This will force rural people to pay more out of pocket to travel to medical hubs for anything other than primary care.
Barry, I think your assertion is correct that Democrats did a lousy job explaining the Act. In their defense, it was nearly impossible for members of Congress to say anything because the Tea Party steered their disruptors to every public meeting to scream and jeer any Democrat member. You may recall the whackjobs who pounced on Stephanie at the Farm Fest. Now that the Tea Party has acquiesced to the establishment GOP with Romney's nomination, there is a new opportunity to explain the benefits of health care reform ... and more importantly point out why Republicans want people to die and suffer needlessly by killing health care reform and making it more costly and inaccessible to young people and those with pre-existing conditions.
I don't entirely blame the Tea Party, though. I've never been impressed with how Democrats in D.C. react to controversy. Their first instinct is to run for cover. Their second instinct is to acquiesce to the obstructionists and nasty special interests like the NRA. They've emasculated themselves which only further empowers their political enemies, or as Eleanor Roosevelt said: "No one can make you feel inferior without your consent.â€
Will they stand up for their health care reforms now? I don't think so. The ridiculously cowardly House Democrats who voted (Collin Peterson and Tim Walz from Minnesota) to hold the U.S. Attorney General in contempt of Congress are an example. And the cowards who won't go to the Democratic National Convention are more proof.
If the GOP wins in a year when the top contenders took a pass on running against Obama, they deserve to win and the Democrats deserve to lose. I will be at the head of the line to urge Democrats to abandon these loafs in Congress and form a real party.
Recall that RomneyCare came from a study and subsequent proposal from the right wing Heritage Foundation in the late 1980s. Then Governor Romney made it RomneyCare and said he was very proud of the individual mandate. Now RomneyCare is the law of the land.
It's virtually repeal proof due to the senate's filibuster rule. It's merely a step to eventual single payer / Medicare for all.
"I don’t know if this is going to be a boon; already we’ve seen an increasing number of physicians refusing to see Medicaid patients because the program significantly underfunds reimbursement of services. "
Those same doctors or doctor ancestors opposed Medicare and then set about trying to milk it in every way possible.
Doctors who refuse to take Medicare and Medicaid patients should lose their medical licenses. One less trip to the tropics or Europe is not going to kill them or their trophy wives.