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South Dakota Voters Support Medicaid Expansion; So Does Fiscal Sense

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.


  1. Tim 2014.10.26

    Cory, you missed Daugaard's most important reason for not expanding, that black guy in the White House supports it.
    Daugaard could care less about the poor people in this state, he only cares about his rich contributors, cronies and standing up to the President.

  2. JeniW 2014.10.26

    I wonder if Gov. Daugaard would be able to look into the eyes of someone who does not have health insurance or Medicaid, and say to that person, "you are not good enough to deserve to be covered by Medicaid, so just buck up, and learn to live with your suffering."

  3. jerry 2014.10.26

    Add one more republican state to the addition of Medicaid Expansion, Utah.

    Thankfully, the Koch brothers have their ace in the hole (can be said very quickly to get further meaning) Daugaard to continue the hate on for the working poor and their plight. Yes, the I got mine and the hell with you, partner in crime to Mike Rounds is denying healthcare to 50,000 fellow South Dakotans. Bad enough that he stole taxpayer monies from everyone, but now he singles out the poor for real vengeance. What a guy, what an out of touch, corrupt, hateful man. Vote Wismer for some common fiscal sense.

  4. Tim 2014.10.26

    Jeni, in answer to your question, when was the last time you seen Governor Daugaard on the reservation?

  5. Ryan Casey 2014.10.26

    Who knows if or how it affected the result, but the wording of this poll question is very confusing. I have a Master's degree in public policy and I honestly don't know how I would answer it. Either the poll authors were careless or they genuinely don't understand the issue from a policy standpoint, along with the Supreme Court's June 2012 decision, which leaves it up to states to opt in/out of expanding Medicaid. Read literally, this poll question seems to suggest an expansion beyond even that called for by the Affordable Care Act. Obviously that's not at issue here, and it's not what the poll was trying to get at. At any rate, it's a poorly-worded question, though it would've been a simple fix from an attentive editor before the poll was conducted: "not covered" should've been changed to "would be covered."

  6. Lynn 2014.10.26

    Could it be that residents of South Dakota are getting tired of the phone ringing almost nightly with political polls? At first I was eager to answer the polls but after I while they were just a nuisance and I quickly hung up.

    Keep in mind the political poll phone calls are added to the illegal medical alert and card member services auto dial scam calls that we get daily that the FTC is constantly going after.

  7. Douglas Wiken 2014.10.26

    Today the rightwing McLaughlin Report on SDPB-TV discussed the affordable care act, etc. McLaughlin presented data on the quality and costs of health care systems. Of the US, Canada, and European democracies, the US has the lowest care rating and the highest cost rating. The primary difference noted is the lack of universal healthcare in the US.

  8. JeniW 2014.10.26

    ck, I saw that and read the comments. What is amusing to me is the concept of raising the taxes during the summer/tourist months. It is an attempt to shift the responsibility of supporting education to visitors from out of state and from other countries rather than South Dakota owning up to that responsibility.

    The visitors from other states and other countries will not have any benefits from the increased taxes that they will pay.

    There are many unmet needs in South Dakota, if the sales tax is going to be increased, it should be for all year, and used to addressed the unmet needs instead of expecting the federal government to send SD so much money.

    If the federal dollars sent to SD is less, it will help slow the federal debt.

  9. Anne Beal 2014.10.26

    Argus LeAder or USAToday or whatever that paper has turned itself inside out to become had an article lAst week with an interesting factoid: Medicaid enrollees use hospital emergency rooms 2x as much as uninsured people and 3x as much as insured people. That's because Medicaid isn't real insurance and people on Medicaid have trouble finding willing providers. So, having nowhere else to go, they go to the ER

  10. jerry 2014.10.26

    Anne Beal, your hero George W. Bush, mandated that emergency rooms treat anyone who comes to them. So, anyone, being those without healthcare coverage, go to the emergency room. I am sure that even you can see the great expense we have to absorb because of the lack of Medicaid Expansion. Thanks for pointing that out.

  11. JeniW 2014.10.26

    Below is what I copied from the SD state government web-site regarding ER visits by those covered by Medicaid:

    "Can I go to the Emergency Room?

    When you have a serious health problem that could cause lasting injury or death, you can receive care at the emergency room (ER) and Medicaid will assist with payment.

    Examples requiring ER care:

    Severe bleeding
    Severe shortness of breath
    Severe pain
    Severe allergic reaction
    Broken bones
    Chest pain
    Loss of consciousness
    If a medical problem arises that may not be an emergency and you are not sure what to do, call your PCP or on-call provider if it is after hours. If the PCP or on-call provider contacts the ER and refers you prior to a non-emergent service, Medicaid will assist with the payment of these services.

    If you go to the ER for a non-referred, non-emergent service, you will be responsible for payment of these services.

    I took my child to the ER due to my PCP being closed; it was midnight on a Saturday. I am now being billed by the hospital for not providing a referral. I thought ER visits were covered by Medicaid?

    If you did not obtain a prior referral to go to your PCP and the visit is not determined to be an emergency by ER staff, you may be billed for the services. Only emergent visits to the ER are covered by South Dakota Medicaid without a PCP referral."

  12. caheidelberger Post author | 2014.10.27

    Ryan makes a good point about the wording of the question. "Would you support or oppose expanding Medicaid coverage in South Dakota to include those not covered under the provisions of the recently enacted federal health care reform law?" asks the poll. Indeed, as written, it sounds like the question is talking about expanding Medicaid beyond the provisions of the ACA. That could explain the gap between this poll's 45% Aye and the January 2014 Bolger poll's 63% Aye.

  13. caheidelberger Post author | 2014.10.27

    So Anne, your point is... that we should increase funding to Medicaid so more doctors will accept it and help more low-income folks get care outside the ER?

  14. caheidelberger Post author | 2014.10.27

    JeniW, how distressing! Is that ER-non-reimbursement policy in all states?

Comments are closed.