Last updated on 2012.12.01
Governor Dennis Daugaard is trying to get out of signing on to the Affordable Care Act's sensible and Constitutional expansion of Medicaid by saying it would cost South Dakota too much to take care of more low-income workers and families:
South Dakota officials have said expanding Medicaid coverage to more people under the law would force the state to spend an additional $99 million between 2014 and 2019. During those six years, the federal government would pay most of the cost of direct medical care for people added to the program, but the state would be responsible for extra administrative costs. [Lyn Taylor Rick, "Governor, Local Docs Respond to Supreme Court Decision," Rapid City Journal, 2012.06.29].
$99 million... that's triple the $32 million I found in the Kaiser Family Foundation's analysis, but let's run with it. $99 million over six years is $16.5 million a year. Compare that with costs we incur now on folks the Medicaid expansion would serve:
Dave Hewett, president of the South Dakota Association of Health Care Organizations, said the hospitals, nursing homes and other medical facilities that belong to his group have supported the law. If more people have private insurance or are covered by Medicaid, more patients will be able to pay their medical bills, he said.
South Dakota hospitals were unable to collect about $89 million for patient care in 2010, either through charity cases or bills people did not pay [Taylor Rick, 2012.06.29].
$89 million in uncompensated medical costs each year. That money has to come from somewhere. Hospitals build those costs into the bills they send their paying customers: the insurers, the government, us, us, us.
So if expanding Medicaid and covering over 18,000 currently uninsured low-income folks eliminated even a fifth of those uncompensated costs (one-fifth of $89 million is nearly $18 million), we'd break even.
Quit whining, Denny. Obama won. America won. South Dakota won... and we win even bigger if you reduce the hidden tax we pay on uncompensated care and expand Medicaid.
"That money has to come from somewhere. Hospitals build those costs into the bills they send their paying customers: the insurers, the government, us, us, us."
Now you understand the real problem...sluggards. By transferring it to Medicaid then those paying for the sluggards go from us, us, us to future generations via the further expansion of the federal debt. Is that moral?
Good point Cory, but then all the Republican kids on the playground would make fun of him and he and his staff wouldn't get their merit badges for being good R's, not to mention having their feelings hurt.
Guess I can see how that could be pretty harsh for those guys to deal with, not to mention the possible shunning at the ALEC conference...oh the horrors!
Oh well, I guess we see what priorities the Republicans value.
It's like they are saying, "Sorry Grandma, you pesky poor people and single moms, but we've got to keep up our Conservative street cred...you just aren't that important to us...I mean, c'mon we're talking street cred here."
Jana, which Republicans are you talking about? The ones that are going to be lining their pockets with ObamaCare money like former Governor Mike Rounds via his insurance business? The ones that are part of the corporate medcical establishment? The ones who are supporting the inventor of Obamacare, Mitt Romney?
And Jana, Grandma already has Medicare and single mothers have Medicaid. The ones that will be paying for this are Grandma's grand children and the single mother's kids via the federal debt.
Sibby, when you and some of the others that are bucking the current leaders who have been voted into office by the voting public, it will be the Governor and Republican leaders that some may call RINO's.
Good luck to you guys that are trying to change that, but right now it seems you are a minority of the party.
Just out of curiosity, if you were Governor, what would you do with regards to taking the money up front, complying with the law, etc.
"Just out of curiosity, if you were Governor, what would you do with regards to taking the money up front, complying with the law, etc."
I would be thanking Obama for doing what Romney did in Massachusetts, instead of playing political theatre causing South Dakotans to fight like cats and dogs...or Democrats and Republicans. If these Republicans where truly against Obamacare they would not be supporting Mitt Romney for president.
Sibby, you say that the people I mentioned are already covered...not so fast buddy boy. There are plenty of them that are employed, but underpaid, that fall into those categories.
SD Republicans boast about, and recruit companies, based on our "affordable" workforce without calling it cheap labor. But these are the exact people that PPACA will benefit...unless you would like to mandate a living wage instead of a minimum wage or low wage.
SD Republicans like to talk about the importance of having two parents in the home for the good of the children, but then promote and brag about, the low wages that make that impossible. To the point where far too many parents have to have two or three jobs are lucky to just to make ends meet...
Have you checked what health insurance costs for a family of 4...now deduct health insurance...rent...food...a cheap car and state mandate car insurance. What's left? (for a reference point figure $7.50 an hour X 120) That's a lousy $900 a month...gross, before any deductions. You do the math.
But back to you saying that all grandmas, single mothers and the working poor already have these benefits. You are flat out wrong.
Jana, I agree the working poor are getting screwed. I just do not believe the solution should be passed on to future generations via expansion of the federal debt. Second point, instead of us fighting like Democrats and Republicans or liberals and conservatives, I would rather we stop, lay out the facts, and work toward solutions. The solution needs to be us, not more government. The government is the problem, not the solution. I am not going to let the Republican Establishment mislead conservatives into thinking they are conservatives without throwing up a red flag. They like big government just as much as Democrats.
Medicaid was actually a Republican program meant to counter President Johnson's more expansive health care program. Johnson would have preferred a total federal program, but medical assistance to the poor and disabled had always been primarily a state responsibility. Republicans put forth a state/federal partnership proposal (that later was incorporated into the same bill as Medicare and called Medicaid).
Every expansion of health care since then has had to follow Republican dictates, ie., it had to be added to Medicaid rather than Medicare. Thus, if states want to blame anyone for the rising costs of Medicaid, the blame rests squarely with Republicans.
The way around all this, of course, is to put the costs and control of medical assistance onto the federal government (ie. a public option with sliding scale premiums to account for income). Then the states could stop bellyaching. Unfortunately, Republicans have always wanted their Governors to be in control of the payouts to the medical profession. Wonder why?
Why does it seem the new-Right no longer looks at cost-benefit analysis of any issue: instead they look only to IF there is a cost (or can one be invented), then ANY cost becomes the singular reason to reject any policy initiative. Doing good doesn't matter in the Tea Party philosophy.
I also reject Steve's premise that any new spending HAS to be added to the deficit and therefore put on the backs of our children. America, and SD in particular, is UNDER-TAXED. America's children should not bear this burden, its top earners (both individual and corporate) should.
Bingo, Steve O. I contend we can do this Medicaid expansion with no increase in debt and no net decrease in the money in citizens' pockets. Expand Medicaid, cover more people, they go to the hospital sooner before their health problems get critical, their treatment costs less, they pay less, the hospitals have lower uncompensated costs, we don't get stuck with the hidden tax of covering those uncompensated costs in our premiums, and the common taxpayer might even have more money left in his/her pocket at the end of the year. Deficit argument here ignores the fiscal benefits.
Mr. Sibson, I am old but I am only as fat as you. I'm lots older though. So who pays for me? I say I have to pay for me. What say you, and keep your insanity to a minimum or I will undergod on you.
Cory, As I was driving home the other night, this was the point I thought needed to be made. The current uninsured cost society as well. If we care about people we will pay for them. If not Sibson can start pushing a wheel barrow around calling out, "Bring out your dead!"
So in my mind the question that has to be asked is which system of caring for our people is the fairest and most effective. If we care it will cost.
@ Frank--- Bingo!!!!!
Will cost-shifting go down if uninsured pull more of their own weight? I get that currently medical facilities shift the cost of treatments that are not paid for to customers who do pay - a business reality that I am sure they argue is essential to them keeping tier doors open (or at least their bottom line where they want it to be). If the Affordable Health Care Act does what we expect and everyone pulls more of their weight paying for their costs, will the cost of services really be reduced across the board, or will this be only the newest opportunity for bring even more money into the health care coffers? I continually hear the uninsured are a big reason for my health insurance premiums rising so fast - now will that abate? Was this a cause for the health care cost increases or only an excuse for them?
"“That money has to come from somewhere. Hospitals build those costs into the bills they send their paying customers: the insurers, the government, us, us, us.â€
Now you understand the real problem…sluggards. By transferring it to Medicaid then those paying for the sluggards go from us, us, us to future generations via the further expansion of the federal debt. Is that moral?"
Ok Steve how would you fix the healthcare problem? Maybe you don't think there is a problem. Again how would you and your fellow republicans solve the problem? Ideas please.
Mr. Sibby emailed me a response that he does not have ready for blogging yet. He will be responding soon on his blog. He is wearing less tin foil than Hubble so I expect it to be a good analysis.
personal disclaimer: I don't know if 'less tin foil than Hubble' means three layers, five layers or almost the whole roll. I just know it's less.