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Baloney and Squish Prevail; Daugaard Chickens out on Special Session to Expand Medicaid

Once again, Governor Dennis Daugaard fails to lead. He has a creative plan that would bring the health and economic benefits of Medicaid expansion to South Dakota at no cost. This plan would have the remarkable side benefit of getting Uncle Sam to put more money into the Indian Health Service, which would fit with the professed agenda of our Congressional delegation to improve IHS care. This plan would win the Governor and our state merit points for innovation that could serve as a model for other states with large Indian populations.

But Governor Daugaard decides to let yahoossquishy maybes, and rich liars set the agenda and stand in the way of good policy. The Governor announced yesterday that he will leave Medicaid expansion on the shelf for another year:

Governor Dennis Daugaard says he won’t call a special session of the state legislature to vote on Medicaid expansion.

…Daugaard says several legislators requested more time to study his plan for Medicaid expansion. His plan would expand coverage to 50,000 South Dakotans between the ages of 18 and 65 [Lee Strubinger, “Daugaard Will Not Call Special Session of State Legislature for Medicaid Expansion,” SDPB Radio, 2016.06.22].

More time to study the plan? Come on—the plan has been out in the open for six months. Every responsible, open-minded legislator has had a chance to review the mechanics and the impacts of the plan. The people saying they need more time to study it aren’t planning to spend any time studying; they’re waiting for the Koch brothers to feed them more hogwash and donate to their campaigns.

Or they’re just stalling, hoping the Presidential election will make Medicaid expansion go away:

“I’m confident the numbers work,” Daugaard says, “Now it’s a matter of getting a majority of the senate and the house to agree. At this point, a number of legislators want to wait to consider this issue until after the Presidential election” [Mark Russo, “Special Session Nixed for Medicaid Expansion,” KELO-AM, 2016.06.22].

Waiting for external factors to make hard policy decisions for them—that’s how South Dakota Republicans lead. Aaarrrggghhh!

Republican Rep. Joshua Klumb, who is campaigning to switch from House to Senate for District 20, is one of these specious dilators (dilatators? dilatorifiers? dimwits?):

Klumb, an opponent of Medicaid expansion, said he was happy to hear of Daugaard’s decision.

“I’m glad he didn’t call a special session,” Klumb said. “I think to do so before a presidential election was just not a smart idea, because things could change radically in the next few months” [Evan Hendershot, “Daugaard Will Not Call for Special Session for Medicaid Expansion,” Mitchell Daily Republic, 2016.06.22].

When it suits their political purposes, Republicans seem to think a Presidential election justifies putting off decisions. Sure, the next President may wreak all sorts of changes in federal policy, and federal policy dictates a huge portion of South Dakota’s policies. But that impending change didn’t stop the Legislature from appropriating money for roads, special education, and existing Medicaid programs. Things can always change radically, for a host of reasons. The prospect of radical change should stand in the way of doing the right thing for South Dakota.

I’m going to say to Dennis what I said to Gordon yesterday: if you want to get stuff done, you need to vote for Democrats. Dennis, you know who the opponents of your plan are. You know which of those opponents have challengers in Legislative elections who would come to Pierre and vote for Medicaid expansion on Day 1 of Session. Quietly rally your friends to support those pro-expansion candidates, or at least decline to fund the anti-expansion candidates.


  1. Troy Jones 2016-06-23 08:58


    Logic fallacy of false equivalence between what they did do and not doing this. The Medicare Expansion directly depends on current health care insurance policies and Medicaid policies stay in place. The others aren’t so directly dependent. This logic fallacy renders the entire post goofy.

  2. caheidelberger Post author | 2016-06-23 09:23

    Goofy? I think not. The IHS/Medicaid swap depends on federal approval. We have federal approval. Let’s do it.

    But please elaborate, Troy. “What they did do and not doing this” is a bit fuzzy.

  3. Michael Larson 2016-06-23 09:33

    Here is what is illogical:

    Klumb, an opponent of Medicaid expansion, said he was happy to hear of Daugaard’s decision.

    “I’m glad he didn’t call a special session,” Klumb said. “I think to do so before a presidential election was just not a smart idea, because things could change radically in the next few months”

    Things could always change election or not. The election happens in a few months, but Clinton will not be installed as President until 2017 (after the next session will basically be over for South Dakota). It will then be a need to hold off because there will be elections in 2018 and we don’t want to start doing anything political until then.

    Are you saying that Mr. Daugaard doesn’t understand how the Medicare system works? I think maybe the problem is that too many Republicans can’t understand the paperwork, so they bury their heads in the sand and try to do nothing.

    Don’t hide behind vague and weak fallacy attacks. You are evading the real issue. Daugaard has a plan that he believes would benefit the citizens of South Dakota. He could choose to be “a decider” (a word used for pride with GW Bush) and call the special session and do the work to inform his party about those benefits, or he could sit on his hands because his party doesn’t want to talk about it. What should he do? I for one would like to see some action. I have always respected a person that stands on principle and allows for debate over those that hide.

  4. mike from iowa 2016-06-23 11:33

    Some decisions are just too important to let elected officials decide( especially if they are Libs), therefore we need to let the people decide with next election who gets to set policies( unless, of course, Libs win in November).

  5. Roger Cornelius 2016-06-23 12:32

    What is ‘goofy’ here is that republicans are playing political games with the healthcare of 50,000 South Dakotans.
    The only thing republicans need to study is their conscience, if they have one.

  6. W R Old Guy 2016-06-23 12:49

    I found this on the South Dakota website this morning. Try to ask your legislator to defend not expanding Medicare.

    Medicaid Expansion – State Savings Opportunities
    • One of the arguments for expansion is that there would be state general fund savings should states expand because existing programs currently funded with general funds would be funded with Medicaid for the expansion population.

    • Potential Savings Opportunities

    o Public Health Programs
     Breast and Cervical Cancer
     Family Planning
     HIV/AIDS
    o State funded high risk pools
    o Behavioral Health Services
    o Emergency medical/inpatient hospital care for indigent inmates
    o Uncompensated Care costs

    • Unlike other states, South Dakota does not have a large number of generally funded programs that could be covered by Medicaid for the expansion population.

    • Public Health Programs (Breast and Cervical Cancer, Family Planning, HIV/AIDS

    o No general funds used to support these programs provided through the Department of Health
    o Medicaid currently provides full coverage for women screened by DOH and found to have Breast and Cervical Cancer

    • State subsidized high risk pools
    o Currently no state funds used to support risk pool

    • Behavioral Health Services
    o Unlike many other states, South Dakota does not currently expend 100% general funds for behavioral health services except those required for Maintenance of Effort for Mental Health and Substance Abuse Block Grants
    o Criminal Justice Initiative is a potential opportunity.

    • Emergency inpatient Medical Care for Indigent Inmates
    o Inmates who meet all other Medicaid requirements are eligible for Medicaid while incarcerated. However, there is a prohibition on using federal funds for otherwise eligible inmates unless in a medical institution for 24 hours (hospitalized).
    o Currently pregnant women who are inmates and otherwise eligible are the most commonly covered.
    o Potential savings opportunity in this area
     $859,000 general funds

    • Uncompensated Care Costs
    o Savings potential at the county or provider level. No direct savings to the Medicaid program unless there is agreement to shift savings to the state.
    o County Poor Relief savings opportunities estimated at $3.3 million
     County Relief Medical Indigent expenses could decrease by $2,632,028.88.
     County Mandated Jail Medical expenses are reported at 90% outpatient and 10% inpatient for a total of $2,809,422.23. Therefore, the county jail medical expenses could decrease by 10% for the inpatient expense of $280,942.22.
     County Catastrophic Medical Pool could decrease by $395,459.00.
    o Hospital Charity/Uncompensated Care
     Additional information being collected from hospitals by SDAHO

  7. Dana P 2016-06-23 12:50

    Sad state of affairs, Gov D. You have the data, you have the documentation, you have the facts on your side, and you have the power. You are the governor of this state. You are refusing to use that power. Why? Like Roger said, this is nothing but political games. With people’s lives. “Need more time”? What?

    When it came to the potty police, the legislators needed no time at all and needed no evidence or facts when pushing a b.s. bill. Gov D had the nads to go against the political winds and do the right thing by using his veto pen. Medicaid expansion is a no-brainer. At least for some states.

    Fiscally responsible Gov D and the GOP legislators? Nope, not for a second. Pro-life? Nope, not for a second when it comes to this.

  8. Mark Winegar 2016-06-23 15:16

    Health needs won’t wait until after the election and neither should the Governor.

  9. leslie 2016-06-23 22:38

    like healthcare in SD, GOP rank obstructionism prevails. In DC similarly, “With a maddening 4-to-4 nondecision announced Thursday, the Supreme Court failed to decide the fate of President Obama’s 2014 executive actions on immigration. The program remains blocked — and there is no realistic way to resuscitate it before Mr. Obama leaves office.

    And so four million to five million people who might have been spared deportation remain stranded, vulnerable to arrest and unable to work legally. The impasse that made Mr. Obama’s program necessary — the absolute refusal by congressional Republicans to reform an unjust system — persists.”

    nyt today

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