Pat Powers rushes to tamp down the Robert Pear’s suggestion of a split between Pat’s sponsors Governor Dennis Daugaard and Senator John Thune on Medicaid expansion and the Affordable Care Act. I’ll actually concede Pat’s point and agree that Governor Daugaard and Senator Thune really aren’t that far apart on this issue. Neither one likes the Affordable Care Act. Neither one wants to see President Obama enjoy a legacy of reforming health care and helping millions of Americans enjoy greater health and financial security. But if they can’t grinch America and beat the ACA in Congress or in court, they at least don’t want to pay for the benefits of the ACA.
Pear’s article misses that latter point of miserly agreement, wherein lies the real gulf between South Dakota’s leading Republicans. Governor Daugaard wants the federal government to pick up South Dakota’s share (our small share, no more than 10% by FY2021) by increasing Indian Health Service spending. Instead of following Alaska’s lead and using the Medicaid expansion itself to provide Indians with more health care access, Governor Daugaard wants Uncle Sam to spend $67 million more a year via IHS on top of the $374 million in new ACA-Medicaid spending to actually reduce the amount that South Dakota spends out of its own pocket on both programs.
But to make that happen, Senator Thune will have to convince his colleagues to add $67 million to the Indian Health Service budget. In voting to repeal the Affordable Care Act (as recently as this month!), Thune and his colleagues have been voting to repeal the intertwined Indian Health Care Improvement Act, which repeal would result in cutting millions of dollars from the Indian Health Service. And the budget just passed (pp. 323–327) allocates $3.566 billion for IHS plus $523 million for IHS facilities for what appears to be a total of $4.089 billion, which is short of the $5.103 billion IHS requested for the services it anticipated providing in FY2016, never mind the additional services Governor Daugaard wants it to provide.
Governo Daugaard has been talking about the IHS-Medicaid trade-off since October. The Consolidated Appropriations Act of 2016 wasn’t nailed down until December 16. If Governor Daugaard really wanted the IHS-Medicaid switch to happen, Senator Thune could have made it happen by slipping $67 million into the budget. Instead, Senator Thune supported a budget that appears to do much less than what IHS asked for.
Senator Thune holds the IHS purse strings for the Medicaid expansion Governor Daugaard wants. Therein lies the real gap that must be bridged… an easy gap, if Daugaard and Thune are serious about providing health care to Indians and all South Dakotans.