Press "Enter" to skip to content

Expand Medicaid, Depress GOP Donor and Voter Turnout? Make It So!

Rep. Lee Schoenbeck (R-5/Watertown) is looking at Medicaid expansion from a partisan political perspective, so why don’t we?

In his December 8 budget address, Governor Dennis Daugaard justified expanding Medicaid in return for the feds’ fully funding health care for Indians in South Dakota with this cost-benefit analysis:

Now this is a complicated decision, and we are going to have to all weigh the positives and negatives. In my mind, the opportunity to end this longstanding IHS reimbursement issue, to gain coverage for more South Dakotans, to improve the health care for Native Americans, to save money for counties and Medicaid providers, and to potentially save millions in state dollars, I believe those things outweigh the negatives [Governor Dennis Daugaard, FY2017 budget address, Pierre, SD, 2015.12.08].

Understated in that cost-benefit analysis is the fact that the Governor’s IHS–Medicaid trade-off by itself, without taking into account the incredible job-creating stimulus impact, actually saves the state budget $158 million over the next five years and $10 million each year after that (all figures in millions of dollars):

Fiscal Year SD savings by shifting costs to IHS SD cost to expand Medicaid Net SD savings
2017 67 12 55
2018 67 28 39
2019 67 34 33
2020 67 46 21
2021 67 57 10
total: 335 177 158

Saving money and improving health care aren’t enough for Rep. Schoenbeck, who says the Governor (who won re-election last year by the largest margin in South Dakota gubernatorial history and has a vast pile of unspent political capital) has failed to include the political cost to his party in his cost-benefit analysis of Medicaid expansion:

I am concerned about what this Medicaid/Obamacare expansion will mean for both our state, and our party. If expanding the welfare rolls by adding 10% of our state’s population passes in an overwhelmingly GOP dominated legislature, there will be a lot of us asking: what’s the difference? And that will be a future challenge for the GOP in organizing and recruiting.

I would really be surprised if it didn’t affect the enthusiasm of the people we ask to go out and organize and sell tickets to our large network of Lincoln Day Dinners [Rep. Lee Schoenbeck, blog comment, Dakota War College, 2015.12.23].

Daugaard surrenders to Obamacare, right wing stays home—there’s the Republican agony we were expecting.

Governor Daugaard has affirmed the reasons that Democrats have been giving to expand Medicaid for the last three years: we can save money and save lives. It’s the right thing to do. The fact that Medicaid expansion could make arch-conservatives like William and Anne Beal stay home from the polls and not write checks to Schoenbeck and other Republican legislative candidates is pure gravy. I don’t need gravy with my potatoes, but if that’s what right-wingers want to make it, then that’s all the more reason for the Obama Administration to make the IHS–Medicaid trade-off work and for our Democratic legislators to line up 100% behind the Governor’s plan.


  1. larry kurtz 2015-12-24 10:18

    This is just posturing by Schoenbeck’s extremist wing of SDGOP to deny as many people their basic human rights. Lee is a typical catholic and NRA member.

  2. Rorschach 2015-12-24 10:43

    Lee is ambitious. He feels the need to posture for the party faithful who he will ask to put him in higher office. I wonder what higher office he’s running for? My guess is congress in 2018 against freshman Rep. Paula Hawks.

  3. Donald Pay 2015-12-24 10:48

    Schoenbeck and most of the Republican “leadership” are cowards. They “lead” a group of folks who really have no clue about how the world works. Certainly, they never heard of Jesus, who healed everyone, rich, poor, sinners. I suspect, he might have even, my Heavens, healed a Republican. Oh, the horror of Jesus’ socialized medicine. Can’t have that in South Dakota Republicanland.

    Get, real. There won’t be any blowback because their base are going to benefit from Medicaid expansion, if not directly, then through lower premiums on their own insurance. Greed and Self-Interest, Not Jesus. Republicans don’t know Jesus.

    Here’s a clue about how to approach the issue with Republicans: don’t appeal to shared humanity with folks who are a little down on their luck. That’s something Jesus would do. No, oh, no, Republicans have zero empathy for anyone in that position, except if they are in that position, and then it only lasts until they aren’t in that position again. Instead, appeal to those capitalized Republican and Roman values: Greed and Self-Interest.

    After all, Republicans will pay less in their own premiums if costs of emergency room visits aren’t cost-shifted onto them. They can be Wealthier just by signing more folks up for Medicaid.

    And then there’s medical benefits to Them, by which I mean the Perfect in Every Way Republicans. If expanded Medicaid means folks with communicable disease get adequate medical attention, there will likely be less disease spread to Them, by which I mean, of course, the Perfect in Every Way Republicans.

  4. mike from iowa 2015-12-24 18:59

    I know its been said many times many ways don’t get off topic,but I am to wish those who observe a merry Christmas and Happy Holidays or whatever to the rest. I’m off to hide from Santa.

  5. Rorschach 2015-12-24 21:16

    No worries Mike. You’re on the naughty list. Merry Christmas to all who believe in such things.

  6. MD 2015-12-24 22:26

    He forgets the sway that the health care lobby could bring. As South Dakota ages, health care is becoming the dominant industry. It is where youth go to get reliable jobs and the elderly go to seek top-notch care.
    It was by no mistake that Sanford hired Tim Rave to head their lobbying efforts. They wanted Medicaid expansion, and they knew they needed a rank-and-file republican to help them get there. Sanford, Avera, and Regional Health combined to write off over $115 million in charity care last year. While that $115 million is likely a gross overestimate, even at current Medicaid reimbursement rates, it represents a significant source of lost revenue. I expect the health care lobby to provide the final push to get this through Pierre.

    On a side note, why wouldn’t the federal government consider allowing reservations to decide whether or not they want to expand Medicaid? It seems odd that an entity that is technically separate from the state has to rely on the legislature to expand Medicaid.

  7. leslie 2015-12-25 09:41

    the indian health care aspect may develop extreme thorns for daugaard who may be counting on that so he can continue to deny care for 55,000 residents, imo.

    When the Republicans Really Were the Party of Lincoln
    July 2, 2014
    by John Nichols

    Unfortunately, the Republican Party that has spent much of its energy in recent years promoting restrictive Voter ID laws and that is currently entertaining a telling debate about Mississippi Senator Thad Cochran’s outreach to African-American voters in last month’s runoff election fight, often finds itself at odds with the legacies of Lincoln and the Republicans who championed civil rights in the mid-1960s.

    “There’s also a dark vein of intolerance in some parts of the party,” Powell said on NBC’s Meet the Press last year. “What do I mean by that? What I mean by that is they still sort of look down on minorities.”

    Powell recommended that his party “take a very hard look at itself.” In particular, the Republican Party should take a very hard look at its past – and it should embrace that past.

    ohn Nichols is Washington correspondent for The Nation and associate editor of The Capital Times in Madison, Wisconsin. His most recent book is The “S” Word: A Short History of an American Tradition.

  8. leslie 2015-12-25 11:25

    “expanding welfare rolls”

    well lee clearly sets out the two sides to the “debate”. has he no pride, no shame, as he lays out his biggest concern (and it isn’t people’s lives, either)?

    he said:

    I would really be surprised if it didn’t affect the enthusiasm of the people we ask to go out and organize and sell tickets to our large network of Lincoln Day Dinners [Rep. Lee Schoenbeck, blog comment, Dakota War College, 2015.12.23].

    lee-define “expand welfare rolls ” for us rather than trying to scare your/our base.

  9. larry kurtz 2015-12-25 11:30

    What prevents the governor from unilaterally expanding Medicaid?

  10. leslie 2015-12-25 11:39

    “i hate dependency. i hate it”–daugaard’s headstone (in hell… for killing 300+ residents for purely political reasons god does not share)

  11. grudznick 2015-12-25 12:32

    The legislatures, Mr. kurtz. They have to approve the budget to expand Medicaid. And those libbie bossturds probably will, too.

  12. Lynn 2015-12-25 12:57

    It’s Christmas Day at least for some of us who celebrate it and it seems the hatred, anger and demonization of all Republicans and those who are very hesitant to expand Medicaid or not agree with those here does not even take a break today.

    It might help to try and understand where those people are coming from. Many are good people and have the same compassion but are simply coming at it from a different angle. South Dakota is not exactly a wealthy state.

    Merry Christmas!

  13. jerry 2015-12-25 13:32

    What you talkin bout Lynn? You must have gotten into the eggnog.

  14. Donald Pay 2015-12-25 13:54

    Yes, it’s Christmas Day, Lynn, but I don’t think Jesus would say justice and empathy should ever take a break. There is anger, and there is justified anger. It would be nice to know what “different angle” some Republican are taking on the Medicaid issue, but all they say is NO! They have offered nothing else.

    If Mary needed to give birth to Jesus today, would Republicans really deny Medicaid and point to some cold shed to deliver? What “different angle” do you have for Mary and Jesus?

  15. mike from iowa 2015-12-25 14:24

    Medicaid would be good for uninsured people. Medicaid is good for South Dakota’s economy. It would make compassionless for the least among us wingnuts look human. It would also be a feather in Obama’s cap. OMFG! Can’t give Obama any credit. We’ll let people with curable illnesses die to prevent that damn Liberal,commie Muslim from getting any credit. Just like Korporate Jesus,right?

  16. jerry 2015-12-25 17:46

    If you have ever had a restaurant or any kind of food service you know the rules of employee sickness on the job. The requirements are that you must bring a note from your doctor to show you are no longer a treat to the foods they serve. If Daugaard or anyone else can explain how in the hell a person who has no coverage can go to a doctor and pay for that, I would love to hear it. The fact is that most low wage workers fall under the Medicaid Expansion that Daugaard and the rest of the dummies are forbidding. Of course if these workers cannot afford to see a doctor and cannot afford to take the day or two off for their sickness, then they stay on the job. These workers serve your burgers and fries each day, now doesn’t that make you feel safe?

  17. grudznick 2015-12-25 19:15

    Mr. Jerry, I may have missed something or you may have missed something. I thought Governor Daugaard is now proposing to expand Medicaid. Not forbid it, expand it to 50 thousand able bodied persons. That is going to be the argument, the Governor is now viewed by some as leaning libbie and there will be a small group who will holler lots in the legislatures.

  18. grudznick 2015-12-25 19:16

    We all get the TV, Lar. They have the weather on it.

  19. jerry 2015-12-25 20:00

    Mr. Grudznick, Daugaard is the alpha dog in this wizzing contest. He is the leader with a vast majority of the votes that made it so, and yet he is powerless to expand Medicaid? That tells me that he really is not being sincere. Why would you let a nobody like Lee Shoenbeck drink his milkshake while daring him to make a move? Daugaard was the sidekick of Rounds and as a duo, ran one of the most corrupt state governments in the nation. He could have stood up and said that Lincoln dinners were where he wanted to attend, demanding this to become law. No Mr. Grudznick, Daugaard is not for expanding Medicaid, he is slow dancing with Shoenbeck.

  20. grudznick 2015-12-25 20:09

    You could be right, Jerry, but I don’t know anything about this Mr. Shoenbeck fellow. He seems to be a newer comer to the dancing you discuss. I don’t think Governor Daugaard lets people eat his lunch in front of him but perhaps this Mr. Shoenbeck is a big fellow who drinks the milks of all the other people at his lunch table.

  21. jerry 2015-12-25 20:26

    They tell me that he is a barrister, so he knows how to do the ol’ two step while holding his partner close until he decides to dip. The two have to be in sync or someone will fall on their arse. MD notes that there does seem to be a lobbyist in waiting to cut in though, but who will be his partner? In the meantime, we have sick people in need of good medical assistance.

  22. grudznick 2015-12-25 20:38

    You are right, I too have been told Governor Daugaard is a barrister. The young fellow Mr. MD refers to might be in line but I bet you there are some prettier girls the Governor wants to dance with too. Think of a square dance where you cavort with many partners, but before you bring it on home it turns into one of those moshing vats that happen in front of the rock and roll stages at the state fair.

  23. jerry 2015-12-25 20:58

    Indeed, but you may have noticed with republicans in power, they don’t really want much to do with the pretty girls. For that matter, any women, take a listen to the front runner of the GOP and his words. Daugaard has always been playing to his base with this, and Shoenbeck wants to keep leading to that song. Lets hope that the one in waiting will have an offer that these two cannot refuse that will finally bring some relief to the working poor as well as the taxpayers who are in the mosh pit.

  24. grudznick 2015-12-25 21:05

    I don’t know, Mr. jerry. I, for one, like pretty girls. Plenty of fellows do. I don’t know much about Mr. Trump if that’s who you mean, but I will tell you he is insaner than most and more offensive even than Mr. Howie. I don’t think he or that has anything at all to do with South Dakota expanding Medicaid, however. Unless he comes here and blathers about it and that would probably push it over the edge. But I think that unlikely.

  25. jerry 2015-12-25 21:10

    Whatever the case may be, Medicaid Expansion makes sense for South Dakota, both morally and economically.

  26. MD 2015-12-26 06:01

    If pretty girls are what it takes, I’ve worked with plenty of pretty nurses, physicians, administrators, techs, mid-levels, etc. that would love to see Medicaid expanded. They staff our health care system from towns like Pierre and to Platte, are sick of the daily tragedy just like the rest of us.

    I had a quite tragic moment working on Christmas yesterday when I was caring for a patient that I realized would likely not see another Christmas because they delayed care due to lack of insurance.

    Unfortunately, these daily tragedies lend itself poorly to policy changes. The most compelling argument – fiscal sense – seems to be caught up in political rhetoric. Therefore, maybe pretty girls is what it will take.

  27. jerry 2015-12-26 12:12

    MD, Daugaard has just announced that the state will pay more in Medicaid costs to providers. I think that is a tell to Shoenbeck that he is gonna expand the Medicaid and kick him to the curb. When the state starts to do this, they are clearly gonna need more moolah. Hello Black dude in the White House, the time for taking care of citizens is here. Daugaard has his finger to the wind and knows full well that there will not be a Republican in the White House after January of 2017.

  28. 90 Schilling 2015-12-26 14:29

    “”””””powerless to expand Medicaid?”””””””””””” Could be a gun to his head. Or abdomen, Jerry. Hardly powerless in some situations.

  29. caheidelberger Post author | 2015-12-26 15:03

    MD, bring the pretty girls. Bring the fiscal argument. And bring that potent story of delayed care due to lack of insurance. Those things either persuade a majority of legislators to approve Medicaid expansion (and why wait for IHS reform? do it now!) or persuade a majority of South Dakotans to replace their callous, ideological legislators who think exciting the donors at Lincoln Day dinners is more important than moral, money-saving, life-saving policy.

  30. caheidelberger Post author | 2015-12-26 15:08

    A governor who won election by the largest margin in South Dakota history is far from powerless. A governor with Daugaard’s 2014 mandate can make or break legislators if he wants to. He could darn near get anything he wants from a legislator aspiring to succeed him who could use some gov love from the incumbent against a sitting attorney general and a sitting Congresswoman who outdo him in photogenicism and statewide recognition.

  31. Porter Lansing 2015-12-26 15:16

    It’s time to judge a political party harshly that chooses to save money instead of (as MD cites) save lives.

  32. leslie 2015-12-27 23:47

    WASHINGTON — John Thune of South Dakota, the No. 3 Republican in the Senate, voted earlier this month to repeal major provisions of the Affordable Care Act and to end its expansion of Medicaid, arguing that the health law was “unpopular and unaffordable.” nyt today


    Joan C. Alker, a senior researcher at the Health Policy Institute of Georgetown University, said the divide was “a reflection of the larger fight in the Republican Party between more pragmatic Republicans, including governors, and the ideological wing of the party that wants to stop Obamacare at all costs.”

    Gov. Bill Haslam of Tennessee, a Republican, wanted to use federal Medicaid money to extend coverage to 280,000 low-income people. His proposal failed in the spring in the legislature, under attack by conservative groups like the Koch brothers’ Americans for Prosperity, which urged voters to “stop Obamacare in Tennessee.”

Leave a Reply

Your email address will not be published.