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South Dakota’s ACA Exchange Balk Costs Customers $300 More in Annual Premiums

Thousands of South Dakotans are paying the price for Governor Dennis Daugaard's and the SDGOP's intransigent opposition to expanding Medicaid under the Affordable Care Act. We are all paying the cost of turning away hundreds of millions of dollars of economic stimulus that the ACA Medicaid expansion would bring our state.

Governor Daugaard is imposing additional costs on the thousands of South Dakotans who are buying insurance on the federal health insurance exchange. States could go four ways to set up ACA marketplaces: active purchaser, open clearinghouse (Minnesota's MNSure), federal partnership, or totally federal (the South Dakota model, in which we do nothing and leave all the work to Uncle Sam).

A new study in Health Affairs shows that the Minnesota model, the state-run clearinghouse, is offering customers lower premiums than the federal exchange:

Using publicly available premium data and other sources, Health Affairs found state-based clearinghouse models had lower premiums compared with active-purchaser states, partnership states and federally-facilitated states. The journal found no difference between federally faciliated exchanges and federal partnership exchanges.

Policies from all exchanges come in four levels, with the lower ones costing less in monthly premiums with higher cost-sharing when someone seeks medical care. The lowest is bronze, followed by silver, gold and platinum, which Health Affairs didn’t score because of inconsistencies in availability.

The lowest-cost bronze plans in state-based clearinghouses average $157.53 per month versus $179.49 in active-purchaser states; $196.92 compared with $225.37 for the lowest-cost silver plans; $205.30 versus $245.27 for the second lowest silver plan; and $233.96 compared with $266.91 for the lowest-cost gold plan.

Looking at differences between clearinghouse states and federal exchange states, the lowest-cost silver plan was $196.92 compared with $229.87 in partnership exchanges and $224.02 in federally facilitated exchanges [Chris Kardish, "Which health Exchanges Have the Lowest Premiums?" Governing, 2015.01.07].

Generally, the Minnesota model saves customers over $300 a year compared with the South Dakota surrender.

Governor Dennis Daugaard may think the Affordable Care Act is a lemon, but he could try a little harder to make some lemonade.


  1. jerry 2015.01.09

    As the governor is a cash based politician, you can bet the greenbacks that fill his pockets is the ideology that drives him. This probably ranks right up there close to the EB-5 that surrounded him.

  2. Wayne B. 2015.01.09

    While it may be true states with state-run exchanges have lower premiums, it's probably not a causal relationship, but rather a correlating variable.

    States which chose to run their own exchanges are more populated and tend to have more insurance companies competing for business (hence lower premiums).

    States without the population base tend to have fewer insurance companies and therefore less competition. Even if South Dakota ran its own exchange, what would encourage Dakotacare to reduce their premiums?

  3. oldguy 2015.01.09

    Jerry are you saying that DD is somehow getting some type of a kick back? Please explain as this is the 1st I have heard of this..

  4. jerry 2015.01.09

    I am saying that with the tax paid by higher premiums has a direct effect on judgments. I am also saying that as more money is being made by insurance companies, who do you think they contribute to? How about the insurance agencies?

  5. 96Tears 2015.01.09

    Call it DD's health care tax.

  6. Happy Camper 2015.01.09

    Causal? My guess yes because those states who chose to run exchanges were more hands on, regulated, likely to be Democrat and supportive of the bill. Democratic states already had laws (and policies) more in line with the ACA. Republicans are still hoping to overturn, successfully scaring away cautious near retirees afraid they would lose their new coverage as well as possible new entrepreneurs who would love to jump off their ship. Some of that is just conjecture although I myself decided to keep my old policy at a higher rate over an ACA policy from the SD exchange.

  7. CLCJM 2015.01.10

    Wayne, not sure what motivated Dakotacare but their premiums went down this year. Last spring when I enrolled, they were higher than the others. This time I switched from Sanford to Dakotacare, added vision and dental, and still saved about $150/mo. Oh, and Sanford actually went up another $20.

    Right now, I'm pretty scared. I'm on disability and have insurance under the ACA. If the Republicans have their way, in the next year or two, I could lose my health insurance and have my disability benefits cut by $200 or more a month. Sounds like a very bleak future to me. Without the subsidies under the ACA, I couldn't afford health insurance even if my disability wasn't cut. If they cut my disability,I may lose my house! How much more do the Republicans need to take away?
    There's this ridiculous idea that everyone on disability is some kind of slacker/faker. I worked at the SD Developmental Center at Redfield for 26 years! People who are born with severe disabilities(yes, plural, many have multiple diagnoses) don't deserve to be forced into ever deeper poverty! Their SNAP benefits have already been cut. Apparently, Republicans think the most vulnerable in our society should be without healthcare and homeless and starving. Everyone will someday be held to a higher accounting but Boehner and McConnel refuse to believe this. Such a fools.

  8. JeniW 2015.01.10

    CLCJM - I worked at the Developmental Center in Redfield for 15 years. Perhaps our paths crossed along the way, including in the "tunnels?"

  9. Bill Fleming 2015.01.10

    CLCJM, powerful post. Thank you.

    Cory, that's quite a testimony, don't you think?

  10. mike from iowa 2015.01.10

    CLCJM-check out theWingnut Bistro posted above,if you haven't already. Sums up wingnut policies you mentioned.

  11. daleb 2015.01.10

    the cost of one of my medications was up from 160ish to 210ish. which pushed it into another bracket so instead of it costing me 30 every few months its now 50. Its not really a big deal since I dont have to take it everyday. I cant imagine im alone in costs going up. Oh well, at least I have cheap gas...

  12. CLCJM 2015.01.11

    JeniW, what years did you work there? I was there from 1973-1999. Over all those years, I worked a lot of different areas and shifts but about half was overnights.

  13. JeniW 2015.01.11

    I was there from 1980 - 1995.

    Worked at the Cottage 6 for a while, then to Norgello, then to Meadowview.

    I was a Case Manager. When I was on call, I went to where ever I was summoned, so I had been to most of the areas, including Willhite 3rd Floor.

  14. CLCJM 2015.01.17

    JeniW, As I recall, I was working in the school for the first part of your stint there, then Clark for several years, then Meadow View nights, then 3-11 after the death of my first husband and then on Cottages 3-11. I can't say as I can place you but if I saw your face I probably would. I used to use my name, Connie Mogen, on here but switched to my initials. My first married name was Jungwirth. I've been enjoying your comments!

  15. JeniW 2015.01.17

    Oh, indeed Connie, I remember you!! There were many times that we worked together, and I remember your first husband as well, though I forgotten his name, but I think it started with the letter "J."

    My first name is Jenneil. Oftentimes people would call me "Jennifer" because Jennifer and I are friends.

    I enjoy reading your comments as well.

  16. CLCJM 2015.01.19

    Hi, Jenneil! I ran into you at one of the legislative coffees last year. Are going to be at them this year? Would be good to see you, again! And you were right, my first husband's name was Johnny, though most called him John.

  17. JeniW 2015.01.19

    Hi Connie, yes, I remember seeing you at the Coffee.

    I am not sure if I will be attending the Coffee this year or not. Are you?

  18. CLCJM 2015.01.21

    I plan to. Hope to see you there. I'm on Facebook, too, so you could find me that way. But, fair warning, I post a lot of things so if you do a friend request you may get inundated! LOL!

  19. T 2015.02.14

    Johnny Jungwirth? , the security officer? I worked there CT 3 and Ct4 7-3 CT 2 3-11 1990-1995 then CT 7 2000-2002. I used to sing for memorials,even staff going away parties like Janna Rae Padgett My Sweet, Annie's 80th bday.

  20. clcjm 2015.02.18

    Yeah, T, Johnny was my husband. What is your name? Cory is gonna think I'm turning his blog into old home week! LOL!

  21. Wayne B. 2015.02.19

    Well, if we're dredging up this forum, I can now kvetch a bit again; I just found out we lost our health insurance plan because the ACA limits the number of plans health insurance companies can offer. My out of pockets just increased $1000.

    Thanks Obama.

Comments are closed.