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Math Trumps Ideology: Daugaard Can’t Say No to ObamaCare Medicaid Expansion

Last updated on 2013.02.22

Why are Republican governors giving in and embracing the Medicaid expansion created by the Patient Protection and Affordable Care Act? The answer is obvious: money!

It all comes down to dollar signs. If states choose to expand Medicaid, the federal government will cover 100 percent of the costs from 2014 to 2016. The feds' contribution will begin to decrease in 2017, but will never be less than 90 percent, under the ACA.

"For many states, it's going to be very difficult for them to leave that money on the table," Linda Blumberg, a health economist and senior fellow at the Urban Institute, told Governing on June 28, the day of the Supreme Court ruling. "I think there is going to be considerable financial pressure -- both from providers and the reality of state budgets -- to go with this" [Dylan Scott, "Why GOP Governors Are Coming Around on the Medicaid Expansion," Governing, 2013.01.16].

The same thing happened, says Scott, with Medicaid in 1965:

In the program's first year, only about half of the states signed on. But within a few years, 49 had come onboard (Arizona was the last to join in 1982). Political will gave way to fiscal realities.

"They all did the math and had to ask, 'Why am I leaving all this money on the table?'" [George Mason University health policy prof Len] Nichols told Governing. It’s a deal that most states will not be able to refuse in the long run. That’s why the administration is acting confident that all states will come in" [Scott, 2013.01.16].

Nichols says math usually trumps ideology. Scott says even GOP ideologues Rick Perry, Scott Walker, and John Kasich appear to be hedging their ObamaCare resistance in favor of the same welfare-state philosophy that keeps South Dakota afloat.

Expect Governor Daugaard to say yes to the Medicaid expansion by the end of his first term. And expect me to say, "Thank you, Dennis"... and "I told you so."


  1. Dana P. 2013.01.17

    Come on, Governor D, you can do it!

    (remember the ole Happy Days show? When Fonzi had a tough time admitting he was w-w-w-r-r-r-o-ng ... )

  2. Rorschach 2013.01.17

    The governor's own constituency - the hospital industrial complex - is gonna make him take the money. The benefits will flow to:

    1) the working poor who won't be hounded by bill collectors and driven into bankruptcy by medical bills

    2) hospitals that will reduce bill write-offs and will be paid, albeit at a lower rate than they would like. Something is better than nothing.

    3) anybody who pays for health insurance or healthcare won't have to subsidize as many uninsureds (though I question whether hospitals and insurance companies will pass along much if any of these savings to paying customers);

    4) the SD economy will benefit from more jobs, more money coming into SD and being spent in SD. Even state government will collect tax revenue as this money circulates.

    Expanding medicaid is less speculative and more promising than paying some out-of-state company $5 million to import workers. It is more beneficial to SD than giving a Canadian company millions in tax breaks to build a pipeline they were going to build anyway without tax breaks. It is better policy than taking millions in contractor excise tax paid by thousands of small businesses and giving it out as gifts to a few big businesses. And expanding medicaid - unlike these other harebrained schemes - will generate money for the state rather than draining state coffers.

    Go get 'em, Big Hospital Industrial Complex, and give 'em their marching orders!

  3. Steve Sibson 2013.01.17

    "It all comes down to dollar signs. If states choose to expand Medicaid, the federal government will cover 100 percent of the costs from 2014 to 2016."

    Not true, the federal government has no money. It has to be borrowed and we have a debt celing that says that the math doesn't work.

  4. Bill Fleming 2013.01.17

    "the federal government has no money"

    Absolutely not true.

    The Federal Government has as much money as it wants to have.

    In fact, any money you think you have, Sibby, is totally dependent on the full faith and credit of the Federal Government.

    Read the notice on the dollar bill in your pocket.

    It's a "Federal Reserve Note."

    In other words, if our government doesn't have any money, nobody does.

    All in all, just one more reason for you to try to grasp how completely misinformed and delusional you are.

  5. larry kurtz 2013.01.17

    Sanford's expansion into North Dakota explained, R: thanks.

  6. Steve Sibson 2013.01.17

    "All in all, just one more reason for you to try to grasp how completely misinformed and delusional you are."

    Bill, have you heard about the debt ceiling yet. In the real world that means that the can't spend no more money such as this Medicaid expansion. So you need to get off your meds, they are making you delusional.

  7. Richard Schriever 2013.01.17

    Steve - get your head out of the media spin zone and grab ahold of a text book or two. 90% of the money "pwed" by the federal government is owed to eithetr somemother branch of the Federal government to congress - or to every day US investors who hold ordinary Treasury bonds. I.E,, we owe ourselves - not some nebulous "other entity".

  8. Richard Schriever 2013.01.17

    Excuse the typos - have a wounded finger.

  9. grudznick 2013.01.17

    Math trumps all the liberal arts. That's why in math and science teachers would have gotten bonuses. Math is hard.

  10. owen reitzel 2013.01.18

    so since I'm a liberal I'm anti-American??? Nice Sibby.

  11. Steve Sibson 2013.01.18

    "so since I'm a liberal I'm anti-American?"

    Since you are against the Second Amendment and other Constitutional principles.

  12. caheidelberger Post author | 2013.01.19

    Fix that finger, Richard! And Steve, it is not anti-American to point out flawed interpretations of the Constitution and to suggest that portions of the Constitution may need to be changed. It was not anti-American to pass either the 18th or 21st Amendments.

  13. caheidelberger Post author | 2013.01.19

    Nor is it un-American to form a more perfect union, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity by expanding a public health program that will keep our fellow citizens and ourselves healthier and save money.

  14. caheidelberger Post author | 2013.02.04

    Dana! Kasich is huge! What does Gov. Daugaard have to wait for Scott Walker to cave?

    Perhaps the most important part of that HuffPo article is the explanation that Gov. Kasich talked to the White House, asked for flexibility, and the White House agreed to work with him. That doesn't sound like tyrannical government to me. That sounds like statesmen working together to solve problems.

  15. Dana P. 2013.02.04

    Couldn't agree more, Cory. And after reading all of that, I think Kasich is going to lose his GOP secret de-coder ring (re: Gov Chris Christie complimenting the President in helping him work together for a solution after Hurricane Sandy) For whatever reason, "they" don't like it when their side works with this President!

    But that being said.....I was impressed that Gov Kasich went out of his way to highlight the process and how it got done. Kudos! That's good ole politics, working together, for the betterment of the citizens. That IS what it's all about.

    Paging Governor Daugaard!! Please come to a bi-partisan paging phone to take your call from folks that want to work together to govern. That is what you are getting paid to do!

  16. Dana P. 2013.02.21

    Another GOP governor sees the light! As of yesterday, add Governor Rick Scott of Florida to the list of folks that are "accepting" Medicaid expansion!

    Governor Daugaard?? Hello? Once you have a second to take a break from your "cheesy politics", it would be nice to see you jump on board. Will you ever tire of South Dakota's race to the bottom?

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