After forgoing two years worth of health benefits and economic stimulus for South Dakota, Governor Dennis Daugaard may finally be surrendering the permanence and logic of the Affordable Care Act. James Nord reports that Governor Daugaard is presenting a plan today to the HHS Secretary Sylvia Burwell to finally expand Medicaid in South Dakota.
But wait: even though South Dakota can afford to cover the meager state costs itself, Governor Daugaard still sounds determined to make sure that his administration doesn’t spend one red cent on Obamacare:
The proposal, which is in its early stages, would make about 48,500 South Dakota residents newly eligible for the program.
It’s expected to cost the state between $30 and $33 million starting in 2020, which would be offset by federal funding, said Kim Malsam-Rysdon, a senior adviser to the governor [James Nord, “South Dakota Proposes Plan to Expand Medicaid,” AP via ABC, 2015.09.28].
As described by Nord, the plan appears to get Uncle Sam to pick up the tab in part by improving IHS care to get Indians off the state Medicaid rolls:
The proposal pays for the state’s share of the expansion in part by expanding access to services that are fully funded by the federal government, with the goal of freeing up enough state funding to pay for the addition of more residents to the Medicaid program.
Officials are focusing on people who are eligible for Medicaid but can get services through the Indian Health Service. The goal is make services through the Indian Health Service more accessible so that people don’t have to go an outside health care provider, which can happen if the IHS is unable to offer a specific service.
Those services at the IHS are fully funded by the federal government through Medicaid rather than through the typical split in financing between the state and the federal government. Venhuizen stressed that the money would come from Medicaid, and wouldn’t drain the IHS budget [Nord, 2015.09.28].
I can see the Governor’s logic. We have a treaty obligation to pay for health care for our Lakota neighbors. We have designed the federal IHS to provide that service. The feds should ensure that IHS can fully provide that service, rather than allowing costs to devolve upon the states. If the feds can pick up their own slack and free up the funds we need to cover our end of ACA-Medicaid expansion, then let’s roll!
But the Governor’s logic boils down to, “If Uncle Sam doesn’t take care of Indians, we’re not going to take care of 48,500 other South Dakotans.” Nuts to that tit-for-tat! The overarching logic to expanding Medicaid remains: we have the money and the moral obligation to expand Medicaid and help 48,500 South Dakotans get health care, regardless of how well or poorly other federal programs are currently providing care to various populations.
If this plan is what it takes to get Grandpa Cheap to expand Medicaid, then fine. Getting Uncle Sam to boost IHS services will help South Dakota right alongside expanding Medicaid. Letting Governor Daugaard cling to his miserliness is a small price to pay for improving health care and cementing the Affordable Care Act as beneficial, unrepealable policy in South Dakota.
So – the good governor is embracing a plan that seems to say that the BIG bad Federal government (IHS) is a better entity re: providing for the people than are the state/local governments. Hmmmm.
Okay, riddle me this then. Why are tribal people told to go sign up for Medicaid, administered by the state, in order to cover their IHS costs?
Is this what he is trying to stop? I don’t have a problem with that.
However, I am not aware that just going to IHS will foot the bill to some Medicaid thing somewhere with the feds. Those funds are separate. The BIA via IHS will pick up the bill. Not Medicaid.
Right now, IHS pushes people to apply for state Medicaid.
After attempting to go to IHS, many give up and just head to what local doctors might be around. The quality of care with these revolving door IHS doctors is a crapshoot.
do you suppose his deaf parents got free health care back in the day?
A wise man,a conservative Christian Republican,recently told me that, If Daugaard was on fire I wouldn’t piss on him to put out the fire.” LOL
Tim Rave will be in for a hefty raise from Sanford this year, he was brought on to help Sanford get Medicaid expansion, and it looks like he will be achieving that.
On the IHS bit, the IHS encourages their patients to seek out Medicaid because they are able to bill Medicaid for services to help make up for their woefully inadequate funding from the government, getting reimbursement from these extra sources are what keep the IHS in business. Otherwise, the IHS has a per capita health care expenditure of $2,800 per year versus $7,700 per capita for the rest of the United States. It is hard to make up that gap, especially when you have to send a non-Medicaid/Medicare/Insured IHS beneficiary off reservation for services, oftentimes they have a limited budget for off reservation services that is eaten up in the first few months of the year. (See the “Don’t Get Sick After April” stories)
This idea makes sense if they can bring the right services to the reservation, but I have my doubts. Sanford/Avera/Black Hills Lifeflight/Dale Aviation are always willing to fly their airplanes out there at $7,000+/Medevac flight to make up the difference.
Yes, MD, that’s of course why they do it. However, our treaty rights were never based on our future ‘income.’
Of course, medical benefits at time of treaty weren’t based on future medical care, either.
Single payer for all including veterans, Native Americans, et al. would seem to make the most sense and also be the fairest.
No single payer for veterans, never ever. The veterans administration needs to be fully funded to complete its mission of healthcare for veterans. Veterans fall into a whole different class of those who need care that is much more directed at dealing with the medical issues suffered under service to this country. No ordinary facility or those that provide service there, understand all the implications these wounds carry.
Regarding the IHS and its mission to Native people. In my opinion there should be no cost incurred by Native people for the treatments required. IHS is like the VA in that it has never been fully funded for its mission. The caregivers at the IHS should be fully vetted to insure the fact that they are not kinds of doctors that Tehran John, EB Rounds and the Dust Bunny would go to for services. IHS should do exactly like Wellmark, Dakotacare and the rest do when they need to raise money for services rendered, show the need and be granted the funds needed to complete the task. The insurance companies go to the state to show need and the state says, good deal, now tell your insureds to kick in 44% more in premiums and all is well. In IHS’s case, they should be able to do that as effienctly as the insurance companies do as they are in fact acting like an insurance company with doctors and hospitals, much like Avera and Sanford. Instead of the state, go to the fed.
A politician needs a situation that looks like they gained on the deal to make a change or they look bad even if they made an improvement. If the worker did something like that, they would be told to become honest or hit the road. He could just say that he found a good thing to do. If he wanted to make it more affordable he could have put on the stipulation that it become single payer to save the cost of having an insurance industry.
The Natives need health care to satisfy the treaty. Would be a glimmer of hope for them if we actually lived up to a treaty. I told Sen. Dorgan when he was here thirteen years ago campaigning for Johnson, when Dorgan was chair of the Native Affairs committee, that if we gave the Natives full health care that we might be able to stop the fear the kids have of continuing racial genocide by proving to them that we would keep them all alive as long as possible. Kids do not need the fear of genocide when they are young because it messes up their minds. But the Natives also pay into Medicare and Medicaid in their payroll taxes so they could get the money from either and still be doing it proper.
There is another source of perfectly proper funding of the states part of the ACA. We did get a big pot full of money from the Tabaco payout which was to go for health care. This was to be yearly payments so it would quite properly be used in that yearly amount. It was not intended by the courts to be a new pot full of gold to just sit on like we do with our trust funds. So that money could be used up in twenty five years or whatever the time of it was supposed to be and that would be proper. I know that in this conservative poor state they would rather just sit on piles of money just in case it does not rain someday. But those with that mindset will never have enough money to sit on. It is an addiction for them.
I’ve long suspected that Daugaard would go for the Medicaid Expansion but thought he wouldn’t do it until after the 2016 election.
Now he wants to do it in a blatant discriminatory action on the backs of Native Americans. When Native Americans are sick and don’t have access to IHS services they can’t wait for D.C. to make changes to satisfy Dennis Daugaard.
Like every other agency in state and federal government, running out of money is not a good enough excuse, they have the money and choose to spend it on layer up layer of bureaucracy.
From the big shots in D.C. to the IHS regional center in Aberdeen to local service units, money is eaten up in administrative costs.
There are medical services at Sioux San that cannot maintain doctors and core staff and patients have to see MD’s for what otherwise would be specialized care.
More and more patients at Sioux San are referred to specialty clinics in Rapid City because IHS can’t provide care because they are so short on core staff.
Keep in mind that many Indians that use IHS also private insurance, Medicare and Medicaid, all of which they have paid for in one form or another.
Daugaard’s attempt to blackmail IHS is disgusting and I hope the feds tell him just that.
I swear.. Why does the political machine pay any staff when the Democrats do their job for them? Dauggard’s staff caste the idiot notion out there that Denny was frugal even as he has increased spending and state government 3 out of 4 budgets! He increased spending towards the crony programs that helps keep the machine trucking along, and yet you help blow smoke to cover his trail.
30-90 south dakotans died per year waiting for daugaard’s delay to expand medicaid, based on earlier discussions here and estimates at that time.
As a provider on the reservations there is also a big difference between IHS facilities and 638 tribal facilities. And councils are way to involved at both.
Pretty amazing proposal. I’m at a loss. IHS is underfunded, is a obsolete system that cannot support itself even with subsidized funding. A few years ago I read Sioux San in Rapid City was funded at 26% of its need. When people with Medicaid are told to leave a health facility and go to IHS for your primary care than we are discriminating aren’t we? IHS can leave a lot to be desired when it comes to health care. I don’t think the Governor can wag his finger at HHS and IHS will be magically fixed. Forcing people to go to IHS is pretty rotten.
Signed
A tax paying native