Hey, Dennis! Primary’s over! Where’s the special session?
Rick Knobe says it’s time to convene the Legislature to expand Medicaid. He says the Republicanism that has stalled South Dakota’s participation in this good portion of the Affordable Care Act hurts the poor and everyone else in South Dakota:
Our state Republican Leadership has chosen to be a low tax, low service, low wage state. While attractive to some greedy business people who give money to campaigns electing folks holding that neanderthal philosophy, it is costing us millions of dollars supporting people thru social service programs, and charity. Also we are paying higher costs in law enforcement and mental health care, because poor people have a tendency to become desperate, depressed, mentally ill and find themselves on the wrong side of the law. Take a look at the pathetic state of the mental health programs, particularly in the state run Human Services Center in Yankton. Low service, low tax, low wages, hurt not just the poor, but all of us [Rick Knobe, “It’s A No-Brainer Governor Daugaard Should Call Special Session On Medicaid,” KSOO Radio, 2016.06.03].
A new report from Georgetown University Center for Children and Families summarizes research showing that Medicaid expansion is saving states and hospitals money:
Although opponents of Medicaid expansion warned of new state costs, others anticipated that the substantial commitment of federal funds would allow states to save. Data from a recent study of 11 states bears out the promise of significant budget benefits from expansion. Expansion had significant fiscal effects on state budgets with savings ranging from $25 million in Kentucky to over $100 million in Washington State. Hospitals have experienced positive fiscal effects from state Medicaid expansions. A study of a single nonprofit Catholic multi-state hospital system with 131 acute care hospitals in 23 states and the District of Columbia compared performance between states. In Medicaid expansion states charity care costs decreased 40.1 percent compared to only 6.2 percent decrease in nonexpansion states. Research across states for all hospitals shows similar changes. In expansion states the rate of uninsured patient stays in hospitals typically declined by nearly 36.9 percent while the rate in non-expansion states of decline was slight: 2.9 percent. Other research reporting on major hospital systems in multiple states shows comparable declines in admissions of uninsured patients. For example, Hospital Corporation of America (HCA) members in expansion states had a 48 percent decline in uninsured admissions from 2013-14 as compared to HCA hospitals in non-expansion states where there was only a 2 percent decline in uninsured admissions. Research in specific states like Kentucky mirrors these studies, showing large drops in uncompensated care for hospitals compared to neighboring states that did not expand [links added; Adam Searing and Jack Hoadley, “Beyond the Reduction in Uncompensated Care: Medicaid Expansion Is Having a Positive Impact on Safety Net Hospitals and Clinics,” Georgetown University Center for Children and Families, June 2016].
The Georgetown report proceeds to show that Medicaid expansion helps hospitals and clinics serving the poorest Americans stay in business and provide better service:
These safety net institutions in expansion states report using this increase in reimbursement to hire new clinical staff, open new health centers and clinics, buy new equipment, and improve existing facilities. One health center executive referred to the impact of Medicaid expansion as a complete reversal of financial fortunes. “We were at risk of laying off staff and closing health centers. The ACA has put us back in a growth position and has allowed us to build back up our reserves, give staff raises, and add staff to keep up with the volume of patient visits” [Searing and Hoadley, June 2016].
Giving raises and adding staff… hmm… might that have some economic development implications? You bethca:
Some non-expansion state executives noted the lack of expansion was leading to layoffs and closures. A hospital executive in one state reported that the system had to lay off “several hundred” positions in the last year and attributed these layoffs directly to lack of Medicaid expansion. Another referred to a “brain drain going on in [my state]. Folks say all things being equal I’d rather work somewhere else.” Media reports in some non-expansion states reinforce this story, with a hospital association executive in Missouri reporting 2,000 layoffs as a result of the state not expanding Medicaid. By contrast, leaders in expansion states reported on opening new facilities and expanding services in existing facilities. As a result most of those we interviewed told us they have hired new staff.
…An FQHC director put the impact on the community in a broader context. “One of the concerns is [whether] new business and employers want to come to a state that does not have an expanded Medicaid system . . . We are an unhealthy state so you are going to be hiring a lot of unhealthy people” [link added; Searing and Hoadley, June 2016].
Once again, even if I put on my old Republican hat and think business über alles, I look at the positive business effects of Medicaid expansion and the economic drag of our ACA foot-dragging and see that we must expand Medicaid.
Special Session, Dennis. Now.