The Legislative Research Council just issued the July and August reports on Medical Services Data and Trends, which tell us how much South Dakota and Uncle Sam are spending on Medicaid and for how many South Dakotans. Total enrollment in Medicaid, child Medicaid, and CHIP dropped 1.7% from March to July, then bounced back a bit (half a percentage point) in August, but remains below the 12-month average of 119,424—about 14% of South Dakotans getting their health coverage from government.
62,824 South Dakotans used those government-financed health care services at a cost of $79.1 million. That’s 9% higher than the twelve-month average of $72.6 million. Uncle Sam covers nearly 62% of that bill and the $1.03 billion we’ve budgeted for all Medicaid services this fiscal year.
In the sheer coincidence department, in the eight fiscal years from FY2002 to FY2009, the years we may describe as the Bush II economy, the average yearly rate of increase in Medicaid enrollments in South Dakota was 4.37%. From FY2010 to FY2017, the years we may describe as the Obama economy, Medicaid enrollments increased at an average yearly rate of 1.81%. The highest enrollment increases under each President happened immediately post-recession: 10.42% in FY2002 and 6.20% in FY2010.
This health care brought to you and tens of thousands of your neighbors by your government and by taxpayers like you. Well done, citizens!
The goal should be to get people off of Medicaid. The goal should be to get people in jobs and working and raise their incomes so they can have their own insurance plans, and that’s really what the bill that I voted for does [Rep. Kristi Noem, transcribed from audio, “Noem Says People Did Not Get All the Facts on ACA Repeal,” Hub City Radio, 2017.07.31].
The Republican Party’s efforts to gut former President Barack Obama’s legacy health care law came to an abrupt—if temporary—halt Monday night.
Just hours after the Senate was gaveled back into session, Senate Majority Leader Mitch McConnell was handed two more public defections on his health care bill to overhaul Obamacare. The dramatic and simultaneous announcement from Sens. Jerry Moran of Kansas and Mike Lee of Utah means McConnell officially does not have the votes to even begin debate on his legislation to overhaul the Affordable Care Act [MJ Lee et al., “Latest Health Care Bill Collapses Following Moran, Lee Defections,” CNN, 2017.07.18].
Senator Moran nor Senator Lee blindsided the President, who was having steak with veteran lawmakers last night to discuss TrumpCare. Senator Moran issued this statement explaining that he opposes the current bill because it came from a “closed-door process” and “fails to repeal the Affordable Care Act or adress healthcare’s rising costs. Senator Moran calls for starting fresh “with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs for Kansans.” That’s a pretty good list of everything the Republican plans (including the one our Rep. Kristi Noem voted for) do not do.
Senator Lee complains that the current bill does not go far enough: “In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations.”
Moran from Kansas and Lee from Utah avoid mentioning the impact that the proposed cuts to Medicaid would have on their states. Rapid City blogger John Tsitrian nicely fills that gap:
Those of us who understand how tough this bill would have been for rural states like South Dakota, which stood to lose billions of dollars in Medicaid if the bill became law, can breathe a bit easier–at least for the time being. The bill’s reduction in Medicaid funding to South Dakota–which I calculate to be about $100 million a year over the course of the next few years–would leave a substantial hole in our state’s budget. This is an issue that has had rural medical providers seriously concerned and seems to be what prompted three of the aforementioned naysayers to turn thumbs down on it. Maggie Elewhaney, speaking for the National Rural Health Association, says the bill would “exacerbate the rural hospital closure crisis.” The Kaiser Family Foundation notes that Medicaid is an essential component of rural healthcare, where the proportion of Medicaid recipients is higher than in urban areas. According to Kaiser, rural areas actually had net gains in coverage under the ACA. Those gains, and then some, would be given up by the GOP bill [John Tsitrian, “Hey! What About Us Country Folk?” The Constant Commoner, 2017.07.18].
Last month, Rep. Kristi Noem voted for the American Health Care Act, which would repeal the Affordable Care Act’s Medicaid expansion. Kaiser found that, nationwide, 84% of Americans want that Medicaid expansion to remain in place. Amazingly, that support is pretty much the same in non-expansion states like South Dakota as it is in expansion states like Minnesota and North Dakota:
Trumpcare’s other big whack at Medicaid, cutting funding with per capita caps or block grants, also enjoys only 26% support.
Senate Republican leaders are signaling they may not get a health care bill done this year. Their failure to act will demoralize their base, which rallied to six years of “repeal and replace” promises that the election of a Republican President on top of a Republican Congress was supposed to bring to fruition. But for voters outside that sad base, Republicans have already hung their hats on anti-Medicaid provisions that are even less popular than the Tweeter-in-Chief. Even if the Senate saves us from Trumpcare, voters won’t look at House members like Kristi Noem who voted for such woefully unpopular and damaging policies and simply forgive and forget.
Democrats, health care can be your #1 issue in 2018. Run with it.
To many, health coverage for children seems like a bipartisan no-brainer. Research increasingly shows the economic benefit of investing in children’s health early. The government recoups much of its investment in Medicaid for children over time in the form of higher future tax payments, a 2015 study published by the non partisan National Bureau of Economic Research found.
Children who had been on Medicaid also collect less in the Earned Income Tax Credit and the women who were on Medicaid earn more money by the time they are 28. Children who were eligible for Medicaid also live longer and are more likely to go to college, the report found.
“From a cost-benefit perspective, investments in children have enormous payoffs,” says John Graham, who was rule-making chief at the Office of Management and Budget in the George W. Bush administration. “But children don’t vote and are not politically organized, so it’s not as easy to defend their interests in the political process as it is for senior citizens” [Jayne O’Donnell and Ken Alltucker, “Obamacare Replacement Threatens Kids’ Health Coverage,” USA Today, 2017.05.13].
Noem is on break right now, but she has scheduled no town halls to hear voters’ concerns about health care policy or explain why she thinks taking health coverage away from millions of low-income kids is good for kids, the economy, or the budget. She’s headed back to Washington this week, but perhaps she’ll at least send some staff to Aberdeen to take notes on what participants in the March for Healthcare want for Medicaid and broader health care policy.
Congresswoman Kristi Noem gets to celebrate her heartless, self-interested backing of Trumpcare with an eleven-day break, which I’m sure she will not use to hold town halls every day to explain what she voted for yesterday and why.
School districts rely on Medicaid, the federal health care program for the poor, to provide costly services to millions of students with disabilities across the country. For nearly 30 years, Medicaid has helped school systems cover costs for special education services and equipment, from physical therapists to feeding tubes. The money is also used to provide preventive care, such as vision and hearing screenings, for other Medicaid-eligible children.
…The new law would cut Medicaid by $880 billion, or 25 percent, over 10 years and impose a “per-capita cap” on funding for certain groups of people, such as children and the elderly….
…Under a little-noticed provision of the health care bill, states would no longer have to consider schools eligible Medicaid providers, meaning they would not be entitled to reimbursements.
“School-based Medicaid programs serve as a lifeline to children who can’t access critical health care and health services outside of their school,” said the letter sent this week by the Save Medicaid in Schools Coalition, which consists of more than 50 organizations, including the American Civil Liberties Union, the Disability Rights Education and Defense Fund, and the School Superintendents Association [Erica L. Green, “A Little-Noticed Target in the House Health Bill: Special Education,” New York Times, 2017.05.03].
Medicaid’s role in schools goes beyond ensuring that students with disabilities have access to the medical services they need to succeed. Medicaid provides support for health care services delivered in school, which benefit all children — not just those enrolled in Medicaid. In a recent survey of school superintendents, almost half reported that they use the reimbursement their districts receive for services provided to Medicaid-eligible children to expand health-related services and supplies. This includes programs that monitor the health care needs of eligible children with certain conditions such as asthma and diabetes as well as operating clinics within schools to provide dental care to Medicaid-eligible children [Jessica Schubel, “Medicaid Helps Schools Help Children,” Center on Budget and Policy Priorities, 2017.04.19].
If Noem is thinking about anything other than doing Trump’s bidding to bolster her chances of winning the Republican gubernatorial primary next June, she probably thinks that she can make up for cutting medical services by giving kids bigger, fattier school lunches.
A new report from the Legislative Research Council shows how many South Dakotans are put at risk by Trumpublican politics. In March 2017, the total number of South Dakotans enrolled in Medicaid grew to 120,189. Over the past year, growth in the program has come largely from kids on CHIP:
We can look at the number of enrollees and say, “Holy cow! One in seven South Dakotans are on Medicaid!” it’s important to note that only 50% of kids on CHIP and 60% of all Medicaid enrollees actually used received Medicaid services in March (just like private insurance: a lot of us paid premiums last month but didn’t go to the hospital, thank God, Gaia, good living, or dumb luck):
$446 per child on CHIP and $1328 per other recipient—that’s we spent to keep our low-income neighbors healthy last month.
Medicaid historically had been reserved for only the poorest and sickest, but the ACA opened it up to the lower middle class. States that expanded the program have experienced many benefits. For example, uninsured rates dropped — dramatically in some states — as did uncompensated care.
“Medicaid is such a fabric on the health system. Now, there are very few — if any — policy reasons not to expand,” says Adam Searing, associate professor at Georgetown University’s Center for Children and Families.
Medicaid expansion has been a highly partisan issue. But the debate at the federal level has revealed that there’s more bipartisan support — among voters and policymakers — for expanding Medicaid than previously thought. Republican governors arguably scored the biggest win with the demise of Paul Ryan’s plan because now they will likely take less political heat for expanding Medicaid and can claim credit for insuring more of their residents [Mattie Quinn, “Failed Health Bill Fuels New Momentum for Expanding Medicaid,” Governing, 2017.03.29].
After our Veto Day conversation, Republican Representative Drew Dennert was willing to sit for another 20-minute chat about some bills that did pass during the 2017 Legislative Session. In addition, my co-host Spencer Dobson and I talk about Medicaid expansion (open again thanks to the failure of Trumpcare!), Kristi Noem and school lunch, the New York Times at Mount Rushmore, and immigration and South Dakota’s workforce shortage.
Republican blogger John Tsitrian agrees with me that the spectacular, tremendous triumph of ObamaCare over TrumpCare signals that South Dakota should finally get on with expanding Medicaid:
The general consensus is that about 50,000 South Dakotans will become eligible for Medicaid benefits under Daugaard’s expansion plan, which in the governor’s words last year had the support of “80 hospitals and clinics, as well as 50 other organizations in South Dakota.” There’s no organized opposition that I can find coming from the healthcare industry in the state. On the second front, political opposition seems to be focused on ideological and partisan issues, which on a broader scale turned out to be hopeless when the entire ACA came under consideration in Congress. The same was true when Medicaid expansion specifically was adopted by so many GOP governors, Pence of Indiana included, around the country. Rejecting literally billions of dollars of federal Medicaid disbursements that will support this plan over the next few years makes no sense to me, especially as our Governor Daugaard’s proposal makes it revenue-neutral for state budgeting purposes [John Tsitrian, “Okay, Back to Medicaid Expansion in South Dakota,” The Constant Commoner, 2017.03.28].
Tsitrian makes a good point about the lack of political consequences for Republicans who back ACA-Medicaid expansion. Republican governors who have expanded Medicaid have generally seen their party hang onto their governor’s seats post-expansion. Terry Branstad of Iowa, Rick Snyder of Michigan, Brian Sandoval of Nevada, Chris Christie of New Jersey, Susana Martínez of New Mexico, John Kasich of Ohio all expanded Medicaid and then won reëlection.
Voters have rejected some Republican governors who resisted Medicaid expansion. Republican Tom Corbett of Pennsylvania supported an alternate, limited expansion plan but then lost to Democrat Tom Wolf, who put in motion a standard, broader Medicaid expansion. Republican Pat McCrory considered but rejected Medicaid expansion, then lost last year to Democrat Roy Cooper, who is pushing expansion. After Republican Bobby Jindal refused to expand Medicaid, the state legislature passed a veto-proof expansion plan, and Louisianians elected an expansion-favoring Democrat to replace Jindal.
Dennis Daugaard is done running for office. But, beyond doing the right thing for health and the economy, if Daugaard wants to bolster his party’s nominee for his job win in 2018, he should take away one big stick from the Democrats and expand Medicaid.