If Governor Dennis Daugaard offers to expand Medicaid in his budget address next week (and I contend that’s still a big if), he won’t do so happily. He’s held out for three years against hundreds of millions of dollars in dirty Obamacare money. He’s determined to get the feds to pay for it by relieving South Dakota of the burden of paying for Indians getting health care through Medicaid.
And now his Health Secretary says he may only expand Medicaid if he gets to take a gratuitous shot at the low-income recipients (voters, taxpayers, fellow South Dakotans) as lazy bums who need to get a job:
State Health Secretary Kim Malsam-Rysdon… said the governor remains interested in requiring work for new Medicaid recipients who would start receiving services under the expansion. The matter is in discussion with the federal Centers for Medicare and Medicaid Services, she said.
“We want people to work,” she explained. “I would expect us to look at that further.” She explained it was a value statement on the part of the governor. “We need workforce across our state,” she said [Bob Mercer, “Gov. Daugaard Might Pursue Work Requirement as Component of Medicaid Expansion, Aide Says,” Mitchell Daily Republic, 2015.12.04].
Um, Governor? Remember that the ACA Medicaid expansion is meant to extend public health coverage to people making between 100% and 138% of the poverty line. Making even that meager sum doesn’t just happen; it usually requires work. The majority of the people this expansion would serve are already working. Your own 2013 task force on Medicaid expansion (oh, yeah, remember that? Governor calls a task force on a major policy issue to delay action, receives the report, then takes no action? Yeesh.) told you so:
Most of the uninsured up to 138% of FPL are employed. 54% of people up to 138% FPL are working, and 57% of working individuals are employed full time [Medicaid Expansion Challenges and Opportunities Task Force, final report, 2013.09.16, p. 25].
National data updated this year tells you so, too:
The work status of people in the coverage gap indicates that there are limited coverage options available for people in this situation. More than six in ten (61%) people in the coverage gap are in a family with a worker, and half are working themselves (Figure 5). While workers could potentially have an offer of coverage through their employer, nearly half of workers in the coverage gap (47%) work for small firms (<50 employees) that are not subject to ACA penalties for not offering coverage. Further, many firms do not offer coverage to part-time workers. A majority of workers in the coverage gap also work in industries with historically low insurance rates, such as the agriculture and service industries [Rachel Garfield and Anthony Damico, “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update,” Kaiser Family Foundation, 2015.10.23].
The working poor who would benefit from Medicaid expansion aren’t the scapegoats or the solution to South Dakota’s workforce shortage; they already are our workforce.
Let’s drop the distractions, Dennis. Medicaid expansion is right for South Dakota. Just do it.
last night thune hovered in the blurry background under the capitol dome to the left as mcconnel said:
“Today, a middle class that’s suffered enough from a partisan law will see the Senate vote to build a bridge past Obamacare and toward better care.”
daugaard, obviously on the “values” side of whoever crafted this bit of hyperbole, has a hard time saving face from a position his GOP has voted to repeal more than 50 times, FIFTY TIMES (kinds like GOP resistance to Roe v. Wade).
Daugaard needs to go a step further and have the state require that employers that hire the working force provide complete health coverage.
I don’t know if any tribal, national or state Indian organizations have taken a position on Daugaard discriminatory plan, but I hope and courage them to do,
Just like jeebus would do,right? Can’t treat the least among us with any dignity. Just keep kicking them. How the hell do these cretins get elected? There ain’t a shred of human kindness in these weasels.
Is it possible for Daugaard to be that out of touch with the government programs he is supposed to administer, and with the very task force he appointed? Is the man acting here, or is he really a complete intellectual bumpkin? In either case, isn’t his vilification of people who are at the bottom of society, and his joy at further putting his boot on their throats until he suffocates the life out of them something that deserves removal from office?
What has the Governor done personally to lift people out of the poverty that would allow them to pay for their own medical care? Does he support a minimum wage that is equivalent to a living wage? Has he looked as far has his own “company?” Are state government wages for folks at the lower levels contributing to the very problem he points to? Is he willing to hire on folks for more hours for higher wages?
A good leader leads by example. Yet the examples we are getting from state government under his leadership and the last governor seem to be to launder money so corruption in fat cat Republicans circles can grow ever larger. Why don’t we hear words about Melmer working for his rather ample paycheck? How about clawing back some of that money, and giving back any money Daugaard got in campaign donations from these crooks?
I guess I could see where a gutless Republican officeholder has to playact about getting tough on “those lazy bums.” Satisfying an intellectually challenged base that probably has no idea that most of the Medicaid folks work, or are disabled, probably is a not an easy job. When you lack guts, you do these kinds of things, and make these kinds of statements.
Why doesn’t Daugaard grow a pair and act like Jesus for once in his disgusting life?
Porter and lanny where are you.
Thanks Donald – you took the words out of my mouth.
The minimum wage of $8.50 means that if you work 40 hours a week, you will receive for the year $17,680.00 assuming you do not miss work for sickness or anything like that. The level for the minimum amount of subsidy eligibility for a single person is $11,700.00 so the $17,680 would be in the 150% of the Federal Poverty Levels guidelines.
What Daugaard is not saying is that those who are now working should be getting a minimum wage of $8.50 so they would not qualify for Medicaid Expansion, but would qualify for subsidies under the ACA.
But, if he expands Medicaid and the same workers staying on the job they have, they would now qualify for the Medicaid Expansion that is actually more lucrative for the state of South Dakota. The taxpayer paid Medicaid is more beneficial than the taxpayer paid subsidy. So who gets butt hurt by the whole deal? Mike Rounds and the insurance industry that sell the subsidized policies. Who pays more campaign donations to the crooks and liars? It sure is not the working man and woman.
But I thought Thune was genuine in his intent to repeal Obamacare? He must not be, if his fellow South Dakota Republican leader is trying to implement it in South Dakota at the same time… Even if it is in Daugaard’s own creative way. Or, is it better yet, merely a Thune smoke screen on the issue… Perhaps that is where the true political creativity lies (or would that be “lied?”)…?….
Can you imagine community health with these? Do it yourself monitoring. http://shows.huffingtonpost.com/shows/now-what-with-ryan-duffy-shw519084593-519296787?context=SH:SHW519084593:PL6103:1449280579783
A slight correction, not meant to derail the good conversation: Medicaid expansion covers adults with incomes between 0% and 138% of the poverty line. So some folks without paying jobs would be covered by the expansion. I have met some who would like to have jobs and might just be able to — if only they could get their health problems taken care of! I agree that denying healthcare to the sick and suffering is kicking them when they’re down.
Like I posted on the article covering this in yesterday’s on line RC Journal, Are you paying attention Governor Daugaard. The folks that you would expand medicaid to cover, are already working. That is the point. They make too much to be above the poverty line requirement to qualify for medicaid, but don’t earn enough to buy health insurance, and thus either get sick and die or become a burden for the rest of society’s health insurance. If they are covered by medicaid they will get the healthcare they need at the Dr’s office not the emergency room where the rates go through the roof.
If only the governor gave a good rat’s ass about the millions pilfered by his comrades in State government from the taxpayers and from the Chinese would be green card bearers as he does about the poor and disadvantaged, such as many of the homeless veterans, teachers and school kids.
Anyone who thought that this state had hit rock bottom when Bill Janklow was governor, has gotten a rude awakening in the last 15 years.
South Dakota already has a program that provides Medicaid to the working poor, irrespective of gender or parental status. It’s so little known (so poorly promoted) that even Gov Daugaard appears to be unaware of it. I can’t tell you the name of the program. I have disabled clients who work part-time to very part-time who are on this program. To qualify, you apply to DSS.
Point well taken, CBrecht! Thanks!
Gov. Daugaard may not have legal authority to impose a work requirement on Medicaid expansion:
http://www.healthlaw.org/issues/medicaid/medicaid-expansion-toolbox/Medicaid-expansion-work#.VmMAPNAhzzJ
As Jerry mentioned, a full-time worker at SD’s minimum wage earns enough to qualify for subsidized insurance on the exchange. The governor often mentions this. But that works only for family size 1 or 2. What if the worker has a couple children? Without coverage through his/her job, there is no program or subsidy to help that worker. None. South Dakota has a lot of these workers with families. We need Medicaid expansion for them.
Thanks Jerry and Cathy for your more defined guidelines.
Wonder how many of the working poor are welders?
Is 20/hour for a dad welding, out of the poverty group, Owen? Probably if mom leaves the kids home for another job.
Hi Catherine! Do you mean County Poor Relief? Or possibly Medical Services to the Indigent at SDCL ch 28-6?
See e.g. SDCL 28-6-1: “The Department of Social Services may provide medical services and medical or remedial care on behalf of persons having insufficient income and resources to meet the necessary cost thereof, if the person has exhausted all other possible public and private medical and remedial care programs, income, or benefits, with the exception of county poor relief. . . .”
Most of the dang people in this country are the working poor, and and as far as us Native people go, you’re not going to be able to fix that problem because you’re the ones that created the problem in the first place. Duhhhh
You are right, Raven, that we’ve let the corporate colonialists gut the middle class and turn more and more people into the working poor.
Umm… if we created the problem, aren’t we well-positioned to fix it, or at least stop creating more of it? If the problem is IHS, and if we have a treaty obligation to provide such health care, don’t we have an obligation to fix it? I’m open to suggestions.