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Tsitrian: We’ve Waited Long Enough—Expand Medicaid!

John Tsitrian brilliantly applies Rep. Kristin Conzet’s wait-and-see politics to Medicaid expansion. Tsitrian says we’ve waited, and we can see in Colorado and Ohio that Medicaid expansion works:

Applying Conzet’s wait-and-see principle, let’s take a look at Colorado’s results since Medicaid was expanded there in 2014.  The results are in and they’re good.  A study that was conducted by the Colorado Futures Center at Colorado State University found, among other gains: because of Medicaid expansion a full percentage point has been to the state’s GDP, household incomes have increased by more than 600 bucks/yr, and that the state’s general fund will incur no increased expenses associated with Medicaid expansion.  The authors of the CSU study conclude that “in addition to providing health insurance to nearly 400,000 Coloradons, expanding Medicaid has proven to be a fiscally sound decision.”  Looking farther afield, Ohio expanded Medicaid under Republican Governor John Kasich, also with positive results, including a $2.5 billion economic boost, vastly improved healthcare and a significant reduction in uninsured residents [John Tsitrian, “SD Rep Conzet Wants Us to Wait and See…,” The Constant Commoner, 2016.03.14].

Ohio—that’s the state that had the good sense to pick John Kasich over Donald Trump last night (though not by a majority, in Kasich’s home state… hmm…). How much longer must we wait, Rep. Conzet? How much more must we see before we accept that providing more South Dakotans with the financial security of reliable health insurance is good for all South Dakotans?


  1. mike from iowa 2016-03-16 07:51

    If Rep Conzet can’t speak,can we call her dumb waiter?

  2. Loren 2016-03-16 08:10

    I do believe the correct procedure for SD is to spend a few $100K on a losing Supreme Court challenge before we accept any kind of rational policy change!

  3. mike from iowa 2016-03-16 08:45

    South Dakota isn’t alone in losing Supreme Court challenges. It’s a wingnut,red state thing, but since Dakota’s wingnuts like to procrastinate and then lose like the others,it makes Dakota pols look that much more incompetent.

  4. happy camper 2016-03-16 15:51

    Though Tsitrian fairly added an addendum with a link to an Albuquerque Journal article pointing out numerous problems with the rapid expansion from 560,000 people to an expected 925,000 half of their population. Half on Medicaid! That’s unbelievable so they are having payment shortfalls and may have denial of services. Link below.

    What gets me is the continued pretty little song “we” were paying for the uninsured anyway so now let’s get them coverage so they can get preventative care. Who is we? In our state much of that burden has gone to the individual policy holder who has had monstrous increases to pay for those who could get an ACA policy so let’s get the “we” right out it cause most of you are over there on the side watching somebody else carry those big buckets of water. If not affecting you then it sure looks great!

    Get em on the dole Governor cause the individual policy holders in our state need help to pay for these beautiful liberal notions.

  5. mike from iowa 2016-03-16 16:25

    Taxpayers pick up a lot of the tab for “emergency room” care. In iowa,counties have a taxpayer funded fund that helps pay for indigent care. Several area hospitals have endowments that are used to help pay indigent care.

  6. leslie 2016-03-16 17:45

    happy: u still pedaling this bull sheit??–u said:

    “In our state much of that burden has gone to the individual policy holder who has had monstrous increases to pay for those who could get an ACA policy ….”

    45-55 thousand SD resident’s are not getting ACA and 30-90 are dying annually because of duagaard and your 3.5 year (and counting) criminal delay (thanks to your dead scalia).

  7. happy camper 2016-03-16 18:16

    Wellmark BCBS just doesn’t want to service the individual market (in SD & Iowa). As the dominant player they helped create the two least successful states for ACA enrollment by staying off the exchanges.
    “If one wanted to cleanse their risk pool, there is no better way to do it than to stay off the exchange where presumably lower-income, less healthy people would come on,” says Gold. “It keeps a lot of people out of the open market. All of the old plans have medically underwritten people in them, so they’re healthier than average risk pools.”
    That’s just what they did while raising rates much more than other insurers (only about 13%). I may have to dump Blue Cross and stop, well, minimize the complaining.

  8. John Tsitrian 2016-03-16 19:40

    RE: New Mexico–it’s unclear if the enrollment surge was created by Medicaid expansion (which was expected to bring in about 160k enrollees and was budgeted for) or a wave of conventional Medicaid enrollees not covered by the expansion proposal. NM’s real problem though is about $1 billion in lost oil and gas revenues caused by the collapsing market ( Either way, I don’t think SD is at risk as the number of potential expansion enrollees represents an income group that has been calculated by the gov and outside analysts. Our state’s revenue stream is way more predictable than a state like NM’s, which is subject to variance from the energy markets. I posted that url into the main body of my blog as a favor to one of my commenters, whose url couldn’t be linked in the comment section.

  9. happy camper 2016-03-16 20:58

    Taking the money is a no brainer and maybe is criminal not to, but still if a state could have 1/2 of it’s population on Medicaid that must give great pause. Even if they could afford it something is deeply wrong there. If our state added the roughly 50,000 to the existing 116k with a state population of 860k it’s about 20%. I couldn’t find a chart that broke that down by state only increases, like Kentucky up 94% at the extreme. If all the states take the money it seems like the best solution so those that pay can retain choice and keep a level of competition benefiting everyone single payer would eliminate. There’s no perfect answer. British doctors striking again no thanks.

  10. BOHICA 2016-03-16 23:17

    Am I understanding that the Feds agreement to cover all of IHS related medical expenses…thus freeing up many millions of $ of current Medicaid State expenditures within SD…is nation wide? Thus freeing up like State dollars in all of the other states as well and not just South Dakota?

    I cannot believe that the Federal agreement to fully fund IHS is exclusive to South Dakota.

    If so, this is a huge impact to Medicaid Expansion nationwide, not just to South Dakota.

    The commitment of the Feds to fulfill their initial agreement to fully cover IHS costs nation wide is a great accomplishment most likely initiated by South Dakota….or at least leveraged by our Governor.

  11. leslie 2016-03-17 00:21

    you might be right. however daugaard’s continued hand wringing delay doesn’t comport w/ that conclusion.

  12. leslie 2016-03-17 00:24

    thank you for the citations happy. good discussion.

  13. Shelly 2016-03-17 17:48

    My son was diagnosed with paranoid schizophrenia. He’s been hospitalized many times and is now unable to work. We’re working on disability. In the meantime, he has no insurance. He’s not uner 18 or pregnant, so he is ineligible for Medicaid. He’s too old to be on my insurance. He doesn’t qualify to purchase insurance through the exchange because he has no income. Ww can’t afford to purchase private coverage for him. His medications are currently “samples”; a monthly injection runs upwards of 3k monthly. This is also provided through samples, but we can’t count on it for the long term.

    I’ve written to Thune, Rounds, Noem, Daugaard & my representatives from my district.

    Now we wait.

    While the politicians in Pierre wasted time worrying about who used which bathroom, they ignored the real struggles of South Dakotans.

    My son

  14. caheidelberger Post author | 2016-03-17 22:15

    Awful situation, Shelly. I share your wish that our Legislature would focus on real problems like yours and your son’s rather than manufacturing new problems that better suit their ideological agenda.

  15. leslie 2016-04-12 23:17

    Medicaid eligibility. A member of the governor’s cabinet described the expansion preparation Monday as moving “full speed ahead.” mercer blog

    Rep. Conzet may not have the pulse of her district and her race this election should be a continuing conversation on why SD republicans resist insuring 45-55,000 residents, with the nearing 4 year delay killing 30-90 people a year.

  16. leslie 2016-04-13 00:29

    for example, The single greatest concern of the wealthy is budget deficits. They propose to reduce them not by paying higher taxes — far from it — but by cutting programs like Social Security and health care. This, of course, is directly opposed to the preferences and needs of the majority of Americans. And it is this disparity, in part, which is fracturing the Republican Party — dividing its donor class from its resentful blue-collar base.


  17. leslie 2016-04-13 00:52

    Conzet’s wealth?

    the top 1 percent of earners, who average $1.24 million per year, have the same effective tax rates as do Americans who earn $150,000.

    tonight tavis smiley’s guest reported a handful of billionaires own more world assets than half the world’s population–about 3.5 billion people.

    This is the central issue of our national life. We can debate what makes a society fair. But fairness is hard to find if rising income inequality is abetted by tax cuts for the wealthy empowered by our system of campaign finance, paid for by crippling deficits which shrivel opportunity for everyone else.

    This prospect is staring us in the face.

    Cruz’s tax plan — would add $3.7 trillion to the deficit over the next decade. Trump’s program would cost us a whopping $12 trillion in federal revenue in 10 years time.

    rich folks will keep trying to do what they have done since the beginning of time: buy influence.

    The more expensive the contest, and the more well-funded the opposition, the more candidates become entrapped in this morally toxic arms race.

    Start by making money in politics a litmus test. Supreme Court nominees who won’t change the law to suit the wealthy — e.g. Citizens United. Eliminate Super PACs and soft money, including dark money.

    economic and social policies which benefit a few while plundering our future. candidates who sell their policies to special interest funding. Give your favorite candidates whatever you can.

    Democrats devote more rhetoric than resolve to curbing special-interest money. Republicans hide their obscene use of Super- PACs behind free speech. Call both parties out, the issues you care about are up for sale.

    It is about a country where opportunity is there for the many, not just the privileged few.


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