Ryan Casey gave a rousing speech to the Sioux Falls Rotary Club on Monday. My somewhat biased source (o.k., Ryan himself) says the speech unsettled the Sioux Falls complacentariat... which makes it my kind of speech.
Casey's whole text is about 5,000 words. The speech encompasses national political history and generational theory (conservatives! it smells like historical inevitability! run the Marxism critique!) and frames them in the context of pressing Sioux Falls and South Dakota issues like economic development and Medicaid expansion. Casey says that the willful blindness of South Dakota leaders to the benefits of Medicaid expansion makes South Dakota look less attractive to the the young, growing generation of Millennials whom we should be trying to recruit:
We have a great and active Chamber of Commerce in Sioux Falls. But what has our Chamber said on Medicaid expansion? That we should "consider" it…maybe… someday… eventually. Really? I suspect many of you here are on the Chamber Executive Committee, if not the Board. Given the no-brainer math, I was so curious I actually contacted the Chamber a couple weeks ago to ask what kind of economic analysis was done to arrive at the position…to take no position. You know what the answer was? None. They haven't crunched the numbers. And the governor's own Medicaid Expansion Task Force that looked at the issue last summer came out with a report in September that made no attempt to put hard numbers to the overall economic benefit of accepting federal dollars for expansion.
But the South Dakota Association of Healthcare Organizations did crunch the numbers. A couple of P.h.D economists from the University of Nebraska-Kearny delivered a report to state legislators in Pierre last month. Over the next 7 years, they found, the net impact on the State of South Dakota revenues alone is estimated to be $64 million dollars! That's even taking into account funding for the state's share of expansion expenses! But it gets better when we calculate the economic benefit for the state that Medicaid expansion would bring. That number is $1.04 billion over 7 years. And oh, by the way, we get to provide health care for more than 48,000 South Dakotans who don't currently have it, in case that means anything to anyone. So I dunno. For a Chamber that's supposed to be concerned with "commerce," a billion dollars in economic activity might be something worth checking into. And yet the Chamber hasn't bothered to crunch the numbers, or take a position. I'm sorry, but this is unacceptable, folks. And I promise you Millennials don't want to live in a place that insists on willful ignorance in crafting public policy that the Chamber has displayed on this issue [Ryan Casey, speech to Sioux Falls Rotary Club, 2014.03.31].
South Dakota is resisting the expansion of Medicaid out of sheer ideological pride and spite. And the Millennials for whom Ryan Casey speaks aren't terribly interested in grinding that axe. They just want to solve problems, and contrary to their preceding generation, they see government as a perfectly acceptable tool with which to solve problems.
Step aside, ideologues. We have work to do.
Pitching the economic argument is the only way to get Republicans' attention on this. You just cannot ignore the impact of a $2 billion windfall on this state.
Another astute observation by Mr. Tsitrian notwithstanding, the economic argument has been presented, restated, explained, touted and shouted - all to no avail. We knew the 'vision thing' would never work, and forget about compassion. It's probably just too late for some haters to recognize that there was a pressing need to address the health care issue and one Party refused - and still refuses - to do so.
But will your party do just that Mr. Tsitrian? Ignore $2 billion?
Or do they hate the President so much that they'll rather hurt the state of South Dakota?
Expansion would save Minnehaha County a million dollars a year. Republican commissioners I serve with are "unable" to speak out.
I'll keep pressing it, but Lowe and/or Wismer should be hitting this one as hard as they can. Lowe pointed out to me on the Constant Commoner that "The Catastrophic County Poor Relief Program (CCPR) was established under South Dakota Codified Law (SDCL) 28-13A in 1984 to assist counties with the payment of catastrophic medical expenses incurred on behalf of individuals who are medically indigent and who have no ability or only limited ability to pay the costs of hospitalization. Under the program, the hospitals send unpaid bills to the county to pay. The county can negotiate the bill down or paid the submitted charges. This costs taxpayers money that could be used for other county needs." This gets the message down to the nitty gritty local level where it might do some grass roots good.
Medicaid expansion in its proposed form, will eventually increase taxes for South Dakotans. The short-term funding by our already-bankrupt federal government will fall on the South Dakota taxpayers in a few years. We need more leaders like The governor that have the long-term interests of the state in mind.
Remind me, Mr. Madsen - what fraction of the current annual SD operating budget is supplied by federal sources? Are you proposing that our state refuse all federal funds? Or just some?
The governor of Montana is pushing Medicaid expansion for his red state.
http://missoulian.com/news/state-and-regional/bullock-mclean-sign-petition-for-medicaid-expansion-initiative/article_9497014c-b53c-11e3-ab1d-0019bb2963f4.html
Commissioner Barth makes a point that needs to be repeated over and over. We are paying for medical care now, it's just being paid by the counties in the form of indigent health care and the bill is being presented to all the property tax payers.
Foreigners are more confident about the United States being able to meet its obligations than Mr. Madsen and others in the state, considering that overseas holdings of U.S. debt reached an all-time high last year. http://www.usatoday.com/story/money/business/2013/04/15/foreign-holdings-us-debt/2083855/ There's more faith and confidence in the United States overseas than there is in many quarters here in South Dakota. The Chinese, in particular, no slouches themselves when it comes to business and making money, continue to hold sizable amounts of American securities. What do they know that many of our elected officials in Pierre can't seem to grasp? I would ask Mr. Madsen why he believes we should continue to rely on $2 billion/year in federal payments for services here in South Dakota if the U.S. is in such dire financial straits.
Pennington County does not pay the bills incurred by the Rapid City indigent, or the last time I was involved in the Community Health Center of the Black Hills, they didn't. I don't think it has changed. It is strange that the county commissioners would make that distinction between county and city residents.
When people with limited or no healthcare options go to the ER for treatment, the follow up is usually referred to the community health center. CHCBH does not pay for the bills incurred at Regional Health, they only provide follow up.
CHCBH will than try to get them insured or put them on a sliding fee scale, many don't qualify for Medicare and Medicaid, or for state health programs.
This is just one of the reasons Regional Hospital has openly advocated for ACA and Medicaid Expansion, they have long recognized financial benefits to the city and the region.
Senator Adelstein recognized the Medicaid Expansion windfall years ago, but his efforts fell on deaf Republican ears.
Great speech. This is something that's needed to be said for quite some time, but forget these folks crunching numbers to see what the general benefit to the state is, or even to themselves down the line. If there's no immediate payoff for them, they ain't interested. And forget political ideology. These "conservatives" will be all for chasing millions of federal dollars so they can set up South Dakota for a nuclear waste dump, provided it's stuck out near Indian country. There's a fairly close circle jerk going on between the folks who will get the money and the politicians, who will get their cut. But Medicaid money just ain't as politically fungible.
Conservative folks play well at Rotary...Those with a more open agenda do not. That is why I canceled my membership...Everybody sitting on the right side of the dinner table.
Why isn't Ryan Casey running for public office?
Yeah, Ryan Casey! Excellent speech. Yes John T, we need to hear Democratic candidates saying those words.
There are a number of Constitutional Offices for which there are no Democrat declared candidates. I encourage Ryan to run and use this as his stump speech.
Medicaid sucks. The reimbursement doesn't cover the costs. The more people on Medicaid, the more hospitals will have to cost-shift onto the backs of their paying clients , who will be reduced in number as people give up their health insurance to go on Medicaid.
Furthermore, the number crunchers never take into account the extent to which people will alter their behavior to qualify. I have been amazed by the behavior of co-workers I've had over the years: they commute from Minnesota in order to keep their Medicaid. They don't marry the fathers of their children in order to keep their Medicaid. And they turn down extra shifts and overtime because if they make too much money they'll lose their Medicaid. And the ultimate in nutso behavior: a woman who quit her job, left her husband, and moved back in with her parents so that she would be eligible for Medicaid when her baby was born.
mooooo.
Whoa Corey and Ryan - you'll get no where pitching m a t h, s c i e n c e, and R O I at a SD chamber punch drunk on crony capitalism.
Seriously, nice try, keep it up - perhaps someday we will all be surprised with the results.
Nice rant, Ms. Beal! So the hospitals (and other health care providers) who support Medicaid expansion failed Math and/or Econ?
Back up a minute and remember that the law we have is a product of attempts by Democrats to appease various interest groups and not implement what many of us have advocated - a single-payer system. I believe you are making a strong argument in favor of the single-payer, Medicare-for-all, public option. Do you have a better plan?
Well said, Curt, neither Ms Beal's nor Mr Madsen's arguments hold water. The whole idea behind the ACA, which as you pointed out was settled for even by those who favor Universal Single Payer, is to bring down the cost of healthcare by having everybody covered. Those on the right won't even listen to their US Senator Thune, who said last December, that the expansion of the percentage of our GDP taken by healthcare to 20% is not sustainable. ACA and expanded medicaid to cover all so that they don't get treated at the emergency room at many times the cost of preventive healthcare, should and will reverse the trend of the past 15 or 20 years.
Anne Beal using the tea party and FOX "News" logic, or rather illogic, in saying "Medicaid sucks". She points out that there is alleged fraud by users to either qualify or to maintain their enrollment in Medicaid.
Anne, is there greater fraud from users or from the doctors, hospitals, health organizations, suppliers, etc.? Just as there is likely fraud in SNAP, the farm subsidizes, government health insurance, filing income tax, big oil and corporate subsidizes, there is going to be some level of greed and fraud from those receiving government checks. Is that justification enough to deprive 48,000 South Dakotans of Medicaid coverage?
The behaviors Ann is describing illustrate the lengths people are forced to go to in order to have medical care. And they are wrong to find a way to get the care they need?
On the other hand, the single payer solution would bring an end to such struggles, as others have already said. No changes in the health insurance system will keep those people in the same, untenable predicament.
In addition to the fraud which is miniscule compared to the following. The same government that is paying AHCA also wrote the checks to bail out the banks, bail out General Motors, the Home Loan industry in the 80s the low or no interest overnight lending to the banks prior to the bailout and the Quantitative easing to keep the interest rate near 0 to the banks since. It is the same government that funds a military to do the bidding of corporate America and even other corporations around the world, as well as other governments no matter how corrupt around the world.
Mr. Madsen, your assertions have been challenged and questioned. Care to come out and respond?
I am one of the 48,000 uninsureds, at age 63 I guess I'll wait it out till 65 and medicare. Most folks don't know what us uninsureds go thru to get medical help. I can drive to Wessington Spring to Horizon- Dr. Dean or the clinic - Falls in Sioux Falls- My enrollment in ACA could not happen because my social security which I took early due to health problems- is below the poverty line. I'd like to sit down with the governor and just tell him how I live- maybe he has forgotten his humble beginnings he likes to use in his campaigns. Maybe I'd like some financial support from his political war chest to afford hgas money to get to the clinic I have to drive to to get help- THEY just don't know what us uninsureds go thru. PS I am on FB if you care to respond also....
Ronald, Unless I am mistaken, you are covered by SD Medicaid, for your preventive healthcare, if you are under the poverty line.
ronald fuchs,
There are 48,000 plus South Dakota citizens with similar stories as yours.
Keep telling your story and encourage others to tell theirs. President Obama always used personal stories of the lack of healthcare coverage or inadequate coverage to sell the the Affordable Care Act.
Republicans in Pierre need to hear your story, Democrats already know them.
Good luck to you sir.
Lanny, Ronald is not covered under Medicaid and most likely falls into precisely the "coverage gap"--between the existing Medicaid program and the federal subsidies provided under the ACA--that Medicaid expansion is/was designed to address. But when the Supreme Court ruled that expansion is up to the states, many people in this gap are now left to the mercy of governors. But yes, Ronald should absolutely share his personal story far and wide.
(Psst! Curt! 40%!)
I apologize, Ronald and Ryan. Ryan is absolutely correct. I called my experts on the subject and dug out my brochure on SD Medicaid expansion and looking at it again, is enough to make one angry. If Ronald were making a little bit more than the Federal Poverty Level, he would qualify for federal subsidies under the ACA. Being he is less than the FPL, he does not qualify for buying insurance, and the State of SD refuses to cover him with Medicaid. Consequently his health suffers, the county is responsible for his healthcare if he has a catastrophe and the expense gets to be great enough and the rest of those of us who are insured, can pony up the rest in higher premiums to cover what the county negotiated down with the hospital and doctor.
I hesitate to do this because of the religious stuff that has crept into a couple of other threads on this blog, but I would suggest that any that think that SD Medicaid need not be expanded, read John Chapter 12 vs 47-49.
Psst! Thx, Cory. I would probably pursue this discussion if Madsen had ever responded.
Curt: you have a feed in Cory's sidebar still:
Use it like a weapon to drive DWC to the bottom. Fire up Badlands Blue, too?