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Moving Native Medicaid Costs to Indian Health Service Also Dead

I thought that, even if Governor Dennis Daugaard’s foot-dragging and Donald Trump’s victory mean South Dakota never cashes in on Medicaid expansion, we could still save some money with the Governor’s crafty plan to shift American Indian patients from the state’s Medicaid roll to Indian Health Service coverage.

Alas, no, Governor Daugaard says that plan is dead, too:

“Under present law, it would not,” Daugaard says. “It would not, because there’s no incentive for IHS, nor for these other providers, to jump through all the hoops that they must jump through for us to capture that money.”

Daugaard says health organizations need to create infrastructure to share medical records and patient details for IHS. He says Medicaid expansion would have offered health insurance to more people, so health systems would receive more payments. Without that money, Daugaard says they have no reason to change [Kealey Bultena, “IHS Deal to Save SD Million Not an Option,” SDPB Radio, 2016.12.06].

If I understand that explanation correctly, it’s not actually illegal for Indian Health Service to take on the cost of health care services provided to qualifying Indian patients at non-IHS facilities (care currently covered by state Medicaid dollars). It’s just too complicated and too costly for the health care providers without the offsetting benefits that would have accrued from expanding Medicaid.

The IHS swap could have saved the South Dakota budget $85 million, more than three times the revenue shortfall that has us all a-fluster. But who needs fiscal gains when we can have the joy of opposing the Obama Administration’s effort to ensure every American gets affordable health coverage?


  1. mike from iowa 2016-12-07 09:02

    He says Medicaid expansion would have offered health insurance to more people, so health systems would receive more payments.

    Do you suppose this dipstick ever reads his own words? Yes, Denny Dipstick more people would have had more insurance and yes more health systems would have received more payments and yes South Dakota could have hired more workers and yes the economy would have gotten a yuuuge boost and yer state would have had billions more dollars to play with if you weren’t such a dizzy, freakin’ dipstick.

  2. Porter Lansing 2016-12-07 09:32

    It’s common knowledge he’s after the ACA. What do we know about his overall opinion of IHS and Native American treaty obligations?
    ~WASHINGTON — If President-elect Donald J. Trump wanted a cabinet secretary who could help him dismantle and replace President Obama’s health care law, he could not have found anyone more prepared than Representative Tom Price, who has been studying how to accomplish that goal for more than six years.

  3. jerry 2016-12-07 10:00

    Porter, I will have to say that you are wrong on this. They are after Medicare, Social Security and Medicaid. Rounds publicly declared it statewide. The ACA has in its funding about 700 billion in savings to Medicare to keep it solvent and wonderful. The real prize are the three Rounds targets. Rounds is no different than any other Republican in office, this has always been there goal since inception.

  4. MD 2016-12-07 10:15

    It always struck me funny that our sovereign Native American tribes have to be stuck on the whims of state run Medicaid. If the US government truly thought these groups were sovereign, they would allow them to have their own equally funded Medicaid program to provide coverage as they see fit including allowing for Medicaid expansion. It has been shown that IHS is chronically underfunded and does not meet the needs of providing off reservation care, so that eliminates the IHS as an instrument of providing effective health care. Instead, they are stuck under the heavy hand of the political whims and institutional racism of the states that hold them hostage.

    Instead of protesting the DAPL, it would be nice to see that kind of outpouring of support for ending institutional racism in states with reservations.

  5. jerry 2016-12-07 10:32

    MD, you are correct on that. But you have to understand the minds of most folks. They really don’t care a whole lot about other folks and their issues when it comes to healthcare in particular. When you say working poor or Indians to someone in a red reservation state, they only see that person getting something they have to pay for. Jealousy is huge. When you say reservation, locals see that as a giveaway that they did not get their hands on. We only have solidarity when there is seen an equal screwing by forces that are after it all.

    Fact is, every person in the state of South Dakota, be it Indian, White or other, has either used Medicaid or has had a close family member use Medicaid. If you take a look at young mothers and their pregnancy, your gonna see the hand of Medicaid. When see an old folks or disabled folks in the nursing home, Medicaid again. Why do you think they want to get rid of this program? There is money to be squeezed, just like fracking.

  6. Porter Lansing 2016-12-07 12:02

    I see little doubt that Medicare, Medicaid and Social Security will be eliminated for new, young workers but see little chance it can be eliminated for we who’ve paid into it our entire lives. When I was a union boss that was the technique used to break us. Allow we older workers to keep what we’d won, if we voted to cut benefits for new hires.

  7. Rorschach 2016-12-07 12:10

    Imagine what we could accomplish if Republicans and Democrats worked together to implement solutions. I thought for a split second that Trump was serious in his victory speech about working with Democrats and bringing people together, but the people he’s picking to run his administration demonstrate that his election night words were just more Trump-talk (i.e. the opposite of what is meant, i.e. lies). If Trump and Republicans go straight to politics as usual and try to ram their hard-right agenda down the nation’s collective throat, then Democrats need to be just as ruthless about making him fail as Republicans were to President Obama. If Trump does tack to the middle, maybe Democrats can meet him there for the good of the country. There are solutions out there if anyone cares to put the country first ahead of their political party’s goal of winning the next election at any cost.

  8. jerry 2016-12-07 12:46

    Porter, you are sadly mistaken. That was the old days you speak of. When you let the nose of the camel in, you loose. This has to come now as there are millions of baby boomers coming on board. As long as you and others think you are immune, you invite the terror of loosing it all. The sooner we all heed these words of like, the better.

    “In Germany, they came first for the Communists, And I didn’t speak up because I wasn’t a Communist; And then they came for the trade unionists, And I didn’t speak up because I wasn’t a trade unionist; And then they came for the Jews, And I didn’t speak up because I wasn’t a Jew; And then . . . they came for me”

    This is coming now.

  9. Porter Lansing 2016-12-07 12:51

    Sorry, Jerry. Even Trump won’t screw the most powerful voting block in USA. We seniors. We have more time to write letters, more time to march in the streets and more money then we need when it comes to taking one in the posterior from the piss-ant Republican Party. But, they will turn the Social Security Trust Fund over to scalawags to invest, thus risking losing the whole damn pile.

  10. jerry 2016-12-07 12:53

    Porter, Mike Rounds says it very clearly what is coming. Old guys, young guys, it does not matter. Your being targeted, are ya gonna fight back or are you going to just take it on the chin?

    “Weekly Column: Getting our Country Back on Track
    As we look forward to the start of a new year, Congress and the new president will have a number of agenda items to start working on to get our country back on track. Along with executive overreach and regulatory reform, finding a solution to our nation’s fiscal crisis is one of the more important issues to address. With our debt spiraling out of control at more than $19 trillion, it’s clear that federal spending at current levels is unsustainable. According to a report from the nonpartisan Congressional Budget Office (CBO), in ten years, 99 percent of all revenue will go toward mandatory payments and interest on our debt. We need to begin managing our entire budget before it is too late.
    The long-term driver of our debt and deficit remains the rapid growth of mandatory payments. These include Medicare, Medicaid and Social Security. Already, spending on these mandatory payments, as well as interest on our debt, account for nearly three-quarters of all federal spending. Since the passage of the Congressional Budget Act of 1974, Congress has not exercised oversight over mandatory programs. There is no specific committee with oversight over the efficiency of these necessary expenditures. Instead, Congress has focused on defense and non-defense discretionary spending. This makes up only about 28 percent our entire budget today. I believe now we have the opportunity to change this outdated, failing budget process.
    Compare our lack of management of Social Security to South Dakota’s retirement system, in which both chambers of the legislature and the South Dakota Retirement System Board of Trustees actively manage one of the best retirement systems in the nation, every single year. Proactive management of all mandatory programs would be easier if they were voted on as part of the budget process every single year. Better management of these programs does not necessarily mean cutting them. It means making them as efficient as possible.
    When our Founders wrote the Constitution, they explicitly gave Congress the task of setting spending and tax policies for our country. James Madison called this power of the purse “the most complete and effectual weapon with which any constitution can arm the immediate representatives of the people.”
    Currently, I am working with a number of other senators to find ways to revive the budget process here in Congress, so we can address our budget crisis once and for all. What we have been working on would open up the entire budget to congressional management, including mandatory payments. Our plan would also require the federal budget to be approved and signed into law. Additionally, there would be consequences for Congress should we fail to pass a budget in a timely manner.
    As we move forward into a new year, I will continue to encourage my colleagues to work with us to make these important changes to the budget process in Washington. The fiscal crisis isn’t coming ten years from now. The crisis is here, and we need to face it head on.”

  11. Porter Lansing 2016-12-07 13:10

    There are laws preventing the absconding of all the money I’ve paid into SocSec since I was twelve. We who’ve paid in will not be cheated. However, should an offer be made to give me all the cash I’ve paid in, plus compounded compound interest for fifty years in a lump sum, I’ve no doubt I have the skills to turn that pile into a really nice inheritance for someone I love and still live the way I’m living now, with a brand new nursing home insurance policy. Even the “dark side” can’t just take away all the money millions of us old farts paid in. Easy on the anxiety (fear of something that only MIGHT happen, my friend) We’ve come too far to let a Trump ruin our days.

  12. jerry 2016-12-07 13:26

    There is no anxiety Porter, you prove the point. You say that you could be turned if they would pay you the money that you paid in, they would gladly do that as the money you have paid in, you probably already have received it. Depending on when you retired and how much you are receiving each month, they would be getting one helluva deal. Take a look at your best paycheck you can remember. Take a look at what was taken out. Then see what you receive each month. Rounds is telling you the road map Porter and he ain’t kiddin.

  13. jerry 2016-12-07 15:48

    Today, I spoke with a white woman of early 50’s. She has MS and is working to make a little over $10,350.00 each year. This woman pays her rent, her utilities and her food from her meager earnings. She does not qualify for the ACA now as she makes to little from what she made last year. She could qualify for Medicaid Expansion if the hypocrite in charge would allow it. But she now will have to suffer while she awaits the decision of Social Security that she recently applied for. What kind of country we running here? What kind of state? What happens if you get the MS and cannot work? How cavalier will you be knowing that you may soon be on the street with no place to turn?

  14. jerry 2016-12-07 15:59

    Governor Hypocrite thinks everyone in South Dakota is to stupid to figure out that Montana and North Dakota have Medicaid Expansion in place right now. These two states also have a significant number of Indians living within the borders of each state. All one has to do is look at the news and see quite a few of them in Cannonball, North Dakota. So his claim is really to let you know he thinks you are to stupid to figure our neighboring states are Indian free.

  15. MD 2016-12-07 16:16

    Medicare is the unsustainable behemoth it is today because we have yet to figure out a way to control the costs effectively. Every interest group figures out a way to put their stick in the fire and get as much as they can before they get exposed, and that is how we get the bloated mess that our health care system is today.
    Right now the screw you in this mess is pointed towards the consumer. Maybe we need to turn the other way and give a good screw you to the organizations that put us in this mess. Organize a system to uniformly charge for health care related goods so every health care organization can post online exactly how much their care will cost, how much is being placed on the government or insurance company, and how much is expected out of pocket. Let organizations compete on quality. Make this readily available and part of the informed consent process. Let the consumer help to decide how much their health related intervention will cost them and give them the opportunity to determine the cost and benefit.
    Taking an approach such as this is a solution to the problem in the conservative tradition (price transparency), this would help to ensure the sustainability of our health care system and universal health care programs in the long-term. This solution will be less of a screw you to the electorate than cutting Medicare, Social Security, or the ACA.

  16. Porter Lansing 2016-12-07 16:26

    MD – Would these standardized prices be set by the government or by the free market, which would have medical professionals competing on price?

  17. mike from iowa 2016-12-07 16:48

    They had a good plan for SS by raising the cap on all income for everyone they would have kept SS going for decades, but wingnuts wouldn’t consider taxing the wealthy’s incomes at the same rates they tax us peons.

  18. jerry 2016-12-07 17:01

    Medicare is the behemoth it is today because of where we have been in the last decade. Baby boomers are coming into the system in this last decade that has increased usage immensely. In 2003, we had a Medicare adjustment that added Medicare Part D and Medicare Advantage Plans. By adding these, it undercut traditional Medicare to make it completely profit driven. This was and still is, completely unfunded by offset tax or by anything. An unfunded mandate that raised prescription costs through the roof. Think Epi-pen on steroids. While the Advantage plans, shift more expense to policy holders when they need them the most.

    Here is where we are now and the republican thought is that well we forced this on you so we are now gonna take it back and then some. Medicare is the target and Social Security fits right into the scheme as well. The idea is laid out by Rounds on how they are gonna present it as well. In order to Make America Great Again, you are all going to have to suck it up and turn over your Medicare, Social Security and Medicaid.

  19. leslie 2016-12-07 18:23

    MD-Instead of protesting the DAPL, it would be nice to see that kind of outpouring of support for ending institutional racism in states with reservations.

    I think daugaard was never serious about Medicaid expansion given his republican tight collar. The IHS angle was just a clusterflock he created to avoid the ACA issue staring him in the face. the guy is as dangerous as any of these republican governors being considered to lead offices in a trump administration.

    jerry, thx for your constant pressure of the health care issue. this is as big as it gets, along with climate change and war.

  20. leslie 2016-12-07 18:27

    MD-explain why Standing Rock’s effort have not been remarkable and correcty? We dems lost a big battle. They won a battle.

    we, progressives, and Indians and democrats MUST work together. our values are good.

  21. leslie 2016-12-07 18:40

    this is why Standing Rock stopped the pipeline:

    “Fossil fuel giants Murray Energy and Southern Company paid for meetings with Republican attorneys general to discuss their opposition to the Clean Power Plan less than two weeks before the same GOP officials petitioned federal courts to block the Obama administration’s signature climate proposal, according to private emails (see below) from state attorneys general obtained by the Center for Media and Democracy. The meetings took place at an August 2015 summit hosted by the Republican Attorneys General Association (RAGA) in West Virginia, where attendees were offered the opportunity to meet with GOP attorneys general in exchange for financial donations to help reelect the Republican state prosecutors.”

    I’ve been telling you for the last year or two here that each AG office of the 50 states has 100 lawyers and that is a lot of horsepower republicans have harnesses for their 1% constituency. Republicans have how many of the 50 states, small and large –30 or 40 now. With or without conservative “owned ” political supreme court justices like scalia and Roberts, their pressure on the supreme court in such major litigation (Jackley and Daugaard often join in) is devastating.

    Democrats, progressives and tribes, and blacks, and Hispanics have got to stand together, like a rock. Sitting Bull’s people are showing us how to do this.

  22. jerry 2016-12-07 19:07

    leslie, “Democrats, progressives and tribes, and blacks, and Hispanics have got to stand together, like a rock. Sitting Bull’s people are showing us how to do this.” You leave some good folks out of the equation to stand and fight for healthcare, you leave out Independents along with Republicans. See, the ones who are gonna get hit very hard in this are folks that are in nursing homes. Most of these folks are hard scrabble white republicans who have worked their entire lives putting their children and grandchildren through school while going without. Now they are bodies are broken and as worn out as their net worth. They have spent down and suffered to be where they are and now Governor Hypocrite and the rest of the bandits are going to take that away from them as well.

  23. leslie 2016-12-07 19:10

    Yes, jerry, I knew my list was not inclusive enough. We always have to be looking at the biggest picture.

  24. jerry 2016-12-07 20:15

    Now then, what is the next move to get the word out to the good folks of South Dakota that their conservative cabal is about ready to sting them for all they are worth. Some think they are safe because of their age or because of their political party, bad news on both.

  25. Porter Lansing 2016-12-07 20:38

    @Jerry – I write the South Dakota Ex-Patriots Update on my Facebook page, now and then. Many who’ve moved away are uninformed of what the state they love has become. But, when I post it, probably more people still in SoDak read it. People are sometimes interested in what someone has to say but people are ALWAYS interested in what someone has to say about them. Keep up the good work, my friend.

  26. jerry 2016-12-07 20:46

    Here is what Governor Hypocrite and his legislature want to remove, all in the name of what his running partner Rounds calls, the fiscal crisis “Getting our country back on track”. Ask state legislators what their hand is in all of this. Nelson refused to answer so that kind of gives you the tell of what this whole thing is about. It is not about Indians, it is about the wholesale theft of all that people have worked their entire lives for, death with dignity.

     First and foremost, Medicaid or CHIP (Children’s Health Insurance Program) covers South Dakota’s children – 68% of those covered by Medicaid or CHIP are children. In fact, 50% of South Dakota’s children will rely on Medicaid or CHIP during the first year of life.

     More than 56% of our parents and grandparents in nursing homes are dependent upon Medicaid to pay for their care. 29.5% need Medicaid in order to live in an assisted living facility. And, many of our parents and grandparents rely on Medicaid to pay for much needed services so they can remain living in their own homes and communities in their later years of life.

     Nearly 3,500 South Dakota citizens with developmental disabilities are living in our communities through the support of Community Support Providers, relying on Medicaid to pay for their services.

     Approximately 10,000 South Dakotans with mental health and/or substance abuse challenges receive services in their community through community mental health centers or substance abuse treatment providers paid for by Medicaid.

     Children who have been abused and neglected are provided the services they need through Medicaid payments to providers, including psychiatric residential treatment programs.

     Medicare premiums are paid for low-income South Dakota seniors through the Medicaid program.

     Citizens with developmental disabilities served at the Developmental Center at Redfield are covered by Medicaid.

     Pregnant women who have low-incomes receive pregnancy-related services paid for by the Medicaid program to help ensure healthier birth outcomes.

    These South Dakotans are our children, parents, grandparents, neighbors and friends. You know these folks. They are not political parties, they are us. I think they are worth fighting for. What are we waiting for?

  27. mike from iowa 2016-12-08 07:38

    This right wing POS isn’t the least concerned with constituent’s lives or health. He is determined to wipe Obama’s legacy off the face of the earth. Priorities, doncha know?

  28. mike from iowa 2016-12-08 08:57

    Mitchie McCTurtle face says first priority for 2017 is to repeal Obamacare. Marlboro Barbie, McCTurtle’s shadow and stool pigeon, sez it will be replaced step by step. Let us remind Marlboro Barbie there are 13 steps up to the gallows and it is all down hill from there. Here’s hoping these un-kristian dirt bags- the ones that care less about their constituents health and well being and more about erasing all of Obama’s good works, choke on this rope they are playing with.

  29. jerry 2016-12-08 09:25

    NOem and Jackley have both committed to the theft of Medicare, Medicaid and Social Security for South Dakotan’s along with the rest of the country. While Republicans are thinking Democrats are looking at their belly buttons to pick someone to run against these two thieves, we should be getting the word out to folks of their intentions. How to do that? There is a way to do it for sure. The SDDP needs to contact Cory H on how to get that started, will they? We shall see. What defeats Democrats on issues is not that their voice is stale, it is because they cannot get their voices heard. The big money is behind the Republicans as shown by the bones tossed to Cory’s opponent in District 3. $25,000.00 is one big ole bone, but worth it to keep the agenda of skulduggery going. South Dakota needs to present the case that we have a way to win against the vampire machine that continues to suck the life out of everything it touches in South Dakota. NOem and Jackley are No jobs, No healthcare, No ideas, No economic development from a No nothing state government.

  30. jerry 2016-12-08 12:02

    People against one party rule in South Dakota. Here is how many South Dakotans would loose health coverage with the elimination of Obamacare ACA 74,000. SEVENTY FOUR THOUSAND VOTERS, damn, that is a few isn’t it. Republicans, Democrats, Independents all loose.

    How many South Dakotans would loose Medicare coverage that would be 156,127 ONE HUNDRED FITY SIX THOUSAND ONE HUNDRED TWENTY SEVEN voters, wow again. Republicans, Democrats, Independents all loose.

    Where is the Democratic party in South Dakota on how they are gonna pick a governor that will fight this? Clock is ticking. Clinton collected over a billion bucks in this election cycle, how about getting some of what was promised and start the fight for our state. Get this going before you even pick the standard bearer to go after the person in Washington that is working her arse off to take this from them, NOem. Go after the person here in South Dakota with a proven track record of doing all in his power to do the same here, Marty Jackley. The stakes are high. So how about a coalition between Democrats, Independents and moderate Republicans to do what is best for our state? Democrats cannot do all the heavy lifting, lets work together to solve this before it is to late. A quarter of a million people in the state of South Dakota will loose and that ain’t even counting those on Social Security and Medicaid, wake up.

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