Here in District 3, the Democratic candidates for House understand that expanding Medicaid would be good for South Dakota:
Both [Justin] Roemmick and [Leslie] McLaughlin said yes to expansion as it will provide affordable health care coverage for more people in South Dakota.
“I can’t tell you how many people are low income and don’t have access to affordable health care and they’re sick, but won’t go in because they can’t afford a visit,” McLaughlin said [Elisa Sand, “Differences in the Details for District 3 House Candidates,” Aberdeen American News, updated 2020.09.18].
Meanwhile, the Republican incumbents try to disguise their disdain for helping South Dakotans get affordable health care by mushmouthily portraying Medicaid expansion as an unaffordable policy with lots of unknowns:
[Rep. Drew] Dennert said he’s not opposed to expansion, but it comes at an estimated cost of $20 million to $30 million.
“So I’m not going to say yes or no,” he said. “I’d rather listen to the testimony.”
Expansion would also mean cuts somewhere else in the state budget or a tax increase to offset that expense, Dennert said.
[Rep. Carl] Perry said expansion would help those who can’t afford medical care, but added there are also disadvantages and issues with the current system. They include that there’s no guaranteed timeline for Medicaid payments, and not receiving those payments on time or adequately and could cause a doctor shortage. Payments can also be refused for services after a procedure is done, he said.
“There are a lot of loose ends on this. Am I in favor of doing more for people? I absolutely am. That’s why when I serve on the Health and Human Services committee I know it’s extremely important,” he said. “If we can’t get Medicaid changed, we should do all we can to change what we do have” [Sand, 2020.09.18].
Listen to the testimony, Drew and Carl: 35 states and the District of Columbia have expanded Medicaid under the Affordable Care Act; three are still working to implement voter-approved expansions. Not one state has expanded Medicaid, gone, “Whoops! Carl was right—too many loose ends!” and backed out of expansion. Utah’s legislature undid voter initiative to expand Medicaid and substituted a much smaller expansion that covers fewer people at higher cost than Medicaid expansion, in large part because the Trump Administration lied to Utah and denied a big chunk of funding for their plan.
The Kaiser Family Foundation has reviewed 404 studies on the effects of Medicaid expansion. The vast majority of those studies find positive effects; not one study has found negative effects on access and utilization of care, rates of insurance coverage, payer mix, self-reported health, or (Drew! Carl! pay attention!) health care affordability, financial security, or stare economy.
According to this June 2020 analysis from the Urban Institute, expanding Medicaid in South Dakota would insure 43,000 more people, reducing our rate of uninsured people from 12.1% to 8.6%. For $36 million in additional state spending, we would get $224 million in additional federal funding, plus savings on uncompensated care and economic stimulus that could Medicaid expansion budget-neutral. We could even see positive budget gains from Medicaid expansion, as has happened in Arkansas, Alaska, California, Colorado, the District of Columbia, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New Mexico, Oregon, Pennsylvania, Virginia, Washington State, and West Virginia.
We can sit around indulging Drew’s fake agnosticism and Carl’s pretense that it’s still 2009 and that we don’t know about this untried idea from this untried President Obama. Or we could elect Leslie, Justin, and other new legislators who recognize that Medicaid expansion has proven itself in every state that has adopted it. Save money, save lives—expand Medicaid!