Dentist and District 8 Republican Rep. Leslie Heinemann thinks expanding Medicaid is too risky. Dentist Leslie Heinemann has apparently never experienced the risk of living without affordable health insurance, a problem that expanding Medicaid would solve for 50,000 South Dakotans.
Proponents of Medicaid expansion say the federal government will pay for this new program, but can we trust the federal government to follow through? The federal government has broken promises before — Indian Health Services, the Veterans Choice and Accountability Act, and the Lewis and Clark Water Project are just three examples. And those broken promises were backed by treaties and legislation [Rep. Leslie Heinemann, “Medicaid Expansion Too Risky for S.D.,” that Sioux Falls paper, 2016.07.01].
Rep. Heinemann here repeats the lie peddled by the Koch Brothers that we need to reject any program funded by the federal government. I await Rep. Heinemann’s vote to reject federal highway dollars and to dissolve the Ellsworth Development Authority, because the federal government could default on its transportation and military budget at any moment.
Rep. Heinemann tries to be a little more logical by citing examples of Medicaid expansion enrolling more people than expected in other states:
Medicaid expansion is a fiscal disaster waiting to happen that endangers our state’s strong fiscal condition. In other states that have expanded Medicaid, enrollment has surpassed estimates, creating access issues as well as skyrocketing costs. In Washington state enrollment ballooned 104 percent over projections, in Nevada enrollment exceeded projections by 113 percent, and in Montana 20,000 enrollees signed up the first day although only 18,600 were projected to sign up during the first fiscal year. These numbers show that no projection, however well-intentioned or conservative, can accurately predict Obamacare Medicaid expansion enrollment [Heinemann, 2016.07.01].
Rep. Heinemann ignores an eleven-state study reported on Dakota Free Press on June 11 showing that Medicaid expansion is saving states and hospitals money. Even with the higher enrollment Rep. Heinemann cites, Washington state has saved over $100 million. As for Nevada, let’s look at the bigger fiscal picture:
The state paid about $522 million in general funds for newly enrolled and existing Medicaid recipients in fiscal year 2014, while it received a match of about $1.4 billion in federal funds that year. With more than 180,000 newly eligible recipients recently signed up, the state expects to pay $531 million in general funds for Medicaid this fiscal year, while receiving a federal match of $2.4 billion [Michelle Rindels, “Nevada Expects to Spend More on Medicaid Than Planned,” Reno Gazette-Journal, 2015.07.20].
Hmmm… spend $9 million more (1.7%) in state funds, get $1.0 billion (71%) more in federal health care dollars. That’s like the boss saying that if I deposit an extra $690 in my retirement account, they’ll match it with $36,000. I’m of the impression dentists take some math in college, but in case Les is still scratching his head, the answer to this story problem is yes!!!
And what about Rep. Heinemann’s third example, Montana? Oh, my goodness—it turns out that by March, their enrollment was up to 38,000, almost double that first-year projection. Everything’s going to heck, right?
The Department of Public Health and Human Services also announced this week that the State of Montana has already experienced $3 million in savings to the state general fund, and over $37 million in NEW federal dollars invested in communities across the state [Julia Cramer, “Montana Can Expect Continued Economic Benefits from Medicaid Expansion,” Montana Budget and Policy Center: Charted Territory, 2016.03.25].
Um, well, everything’s going to go to heck, right?
Even when the federal share scales down to a 90% matching rate, this is still a good deal for states, because these federal funds generate new economic activity that wouldn’t have happened otherwise. A simple comparison is when someone living outside of Montana visits and spends money in the state. Unlike a state resident choosing to spend a dollar in one area of the state economy versus another, our state economy reaps the benefits of that new out-of-state dollar. As the article points out, for every 90 cents in federal funds to pay for one dollar of new Medicaid spending, the state should expect $1.35 to $1.80 in state economic activity, supporting jobs and increasing tax revenues for state and local governments [Cramer, 2016.03.25].
Les, you’re the fiscal disaster.
Governor Dennis Daugaard chickened out last week on calling a special session to bring affordable health coverage plus $1.383 billion in economic stimulus and 29,500 jobs to South Dakota, so Rep. Heinemann’s op-ed reads more like a campaign pitch to District 8 voters who like voting against South Dakota’s best interest. District 8, figure it out and replace Rep. Heinemann.