Expanding Medicaid Extra-Helpful for Rural Hospitals

An area where Governor Dennis Daugaard and the Legislature have more damagingly dithered than grassy buffer strips is Medicaid expansion. Three years in, and we are still denying tens of thousands of South Dakotans access to affordable health insurance, just because a bunch of us don’t like Barack Obama.

Our Medicaid mud-sticking is also leaving our rural hospitals without a valuable financial kick. A new study indicates that South Dakota’s rural hospitals could benefit even more from Medicaid expansion than their big-city counterparts:

In states expanding Medicaid, rural hospitals saw a greater increase in Medicaid revenue than urban hospitals did. City-based facilities save a higher percentage than rural hospitals with the reduction in uncompensated care, though that change “did not translate into improved operating margins for urban hospitals,” the study notes.

…One likely factor: Rural hospitals serve more low-income people — who weren’t eligible for insurance before, but who got covered after the health law took effect. And rural hospitals are historically more likely to operate at a loss than are urban ones. So the chance to see increased revenue is greater than in a city-based hospital [Shefali Luthra, “Lack of Medicaid Expansion Hurts Rural Hospitals More Than Urban Facilities,” Kaiser Health News, 2016.09.07].

The study is Brystana Kaufman et al., “Medicaid Expansion Affects Rural and Urban Hospitals Differently,” Health Affairs, September 2016.

We’ve known expanding Medicaid would help our rural hospitals for years. Yet here South Dakota sits, waiting, as hospitals and sick people suffer.

12 Responses to Expanding Medicaid Extra-Helpful for Rural Hospitals

  1. bearcreekbat

    It gets worse. Yesterday, Thune’s op-ed in the RC Journal called for – wait for it . . . . wait for it . . . the repeal of Obamacare! If he can get that done, then all those states that actually expanded Medicaid under Obamacare will apparently have to scale back their programs and their low income citizens can just get sick without help just like in South Dakota. That Thune, what a policy wonk!

  2. mike from iowa

    To think I have been blasting wingnuts right along for not having any, let alone, original ideas. Marlboro Barbie must be in campaign as statesman role. Bet he can fool enough R voters to get another 6 years paid leave.

    C’mon South Dakota voters. Prove me wrong!

  3. Bear, I don’t think of Big John as a “wonk”, but rather a gent from Washington that gets the daily Republican talking points memo and ships it to the folks back home! Not a bad paying gig, eh? Work, work work,… No rest for the #3 dude in the U.S. Senate!

  4. I think there may be a little bit more to it than mere dislike of President Obama. Wouldn’t an expansion of Medicaid expansion require a greater investment from South Dakota? That’s what they’re trying to avoid.

    Some think that society would recoup the costs in lower future health care expenses, and maybe we would, but isn’t that somewhat speculative?

  5. He is more than a wonk a yes boy I thought they call him photo op.

  6. Darin Larson

    Timoteo asks: “Wouldn’t an expansion of Medicaid expansion require a greater investment from South Dakota? That’s what they’re trying to avoid.”

    Well, for the first three years of Obamacare, South Dakota and the rest of the states would pay 0% of Medicaid expansion. Starting next year and for each year thereafter, states will be responsible for a maximum of 10% of the costs and the federal government will be responsible for at least 90% of the costs.

    Now, if that wasn’t good enough, the Daugaard administration has cut a special deal with the feds so that it would not cost SD anything to do Medicaid expansion. In this deal, the feds agreed to pick up the costs for Native American healthcare services delivered outside the IHS system. Currently, SD is paying these costs. Thus, the 10% share that SD would be responsible for under Medicaid expansion is offset by the savings to SD for the increased federal IHS coverage.

    So, no Tim, Medicaid expansion would not require a greater investment by SD. In fact, the resulting $300 million federal investment each year in healthcare for 50,000 South Dakotans would ripple through our economy creating sales tax and property tax revenue for the state and local governments and economic growth.

  7. bearcreekbat

    Tim, there is even more to it – we in SD have paid federal income taxes that have been, and will be, used by the feds to help cover the cost of medicaid expansions in all states. By refusing to expand medicaid we are telling the feds to use our tax dollars we have already paid in, and will pay in the future, to fund medicaid expansions in states other than SD. Not exactly the brightest thing for our fearless leaders to do with South Dakotan’s federal tax dollars.

  8. Douglas Wiken

    Let us not pussy-foot around. Daugaard and Republicans refusal to expand Medicare and Medicaid is just plain stupid and shortsighted. There is nothing good that can be said for this. It is anti-health, anti-society, and anti-economy.

  9. amen

  10. mean while, daugaard insists that tribes and IHS cut him a special deal, while today IHS announces emergency room closure at Sioux San. Wow

  11. There has to be some other reason more important than hating Obama. These crooks are angling for some kind of way to line their pockets. Why would you say no to a pile of money that would take care of the hemorrhaging of hospitals unless you had something that could do both. Daugaard and his crew have already got the deals they wanted from the IHS, and now with this emergency room closure in Rapid City, this could really spell trouble for the Rapid City Regional Hospital. Maybe even to the point of being absorbed by a hospital organization like Avera. Who is the dude with the mustache we pay a hundred grand a year to, but never see? Ah yes, this dude http://dakotafreepress.com/2015/06/10/lawsuit-michels-strong-armed-avera-to-hire-bad-surgeon-sossan-for-profit/

  12. We’re tired of waiting in District 17 where over 800 would directly benefit from Medicaid expansion. Its time we showed our South Dakota values by helping our less fortunate neighbors.