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Knuckleheads: Hospital Lobby Delays Medicaid Petition Drive Three Months for New Fiscal Note That Will Not Come

It’s Sunday, and everyone’s relaxing after getting sunburned at the lake yesterday, so I’ll go easy and just say that the South Dakota Association of Healthcare Organizations are being led by knuckleheads.

That’s the most generous conclusion I can come to when I read this memo from SDAHO and its coalition partners behind the copycat initiative drive to expand Medicaid. Not only have they still not launched their petition drive to put this vital issue on the 2022 ballot, but they are tossing out the petition the Secretary of State approved for circulation five weeks ago (35 days, 200 signatures a day from ten dedicated volunteer circulators—you could have 7,000 signatures, over 20% of the minimum you need to put this initiated amendment on the ballot) and delaying their launch until July at the earliest.

And why is the hospital lobby delaying?

Are they submitting new initiative language to rectify some legal error or provide more medical coverage sooner to more South Dakotans? No, they are submitting exactly the same language that they have on their approved initiative petition, including the same severability clause that the Legislative Research Council told them last November and reminds them again now is entirely unnecessary.

Are they short on cash and resources to conduct a petition drive? Ha! These are the hospitals. They build sports arenas and host golf tournaments. For the money Avera spent to put its name on the NSU student union, the hospitals likely could have printed a few thousand petition sheets, put circulators at the front desk of every clinic, and collected all the signatures they needed by now.

Are they waiting for South Dakota’s vaccination rate to reach 80% so they can minimize the risk of spreading coronavirus with their petition activities? No, there’s no word of pandemic precautions in the announcement of this delay.

No, no, no, the hospital lobby is waiting because their polls (they have the money to conduct polls, which are absolutely superfluous to the practical hard work of collecting signatures and getting a measure on the ballot) say they should finagle a new fiscal note from the LRC:

The passage of American Rescue Plan Act last month was great news for our efforts to expand Medicaid in South Dakota. Thanks to a provision aimed at encouraging more states to expand Medicaid, South Dakota will receive more than $90 million right off the bat.

This matters to South Dakota voters—questions about the cost of a policy are often what keep undecided voters on the fence. Our polls of likely 2022 South Dakota voters tell us that having clear information about these huge savings is one of the most important aspects of this campaign.

Because in South Dakota a fiscal analysis of each initiative is printed on the ballot voters see on Election Day, we have refiled our ballot measure so that the Legislative Research Council will prepare a new fiscal analysis that includes the new Rescue Plan funds.

This means we won’t be collecting signatures for a few more weeks, but we will know that when we pick up clipboards and carry petitions our campaign will be advancing the very strongest language and fiscal note to get us to victory [South Dakotans Decide Healthcare, memo to interested parties, 2021.04.27].

I haven’t heard more fatuous bullcrap from a ballot question committee since the payday lenders tried to sabotage the 36% interest rate cap petition with their fake rate cap in 2015.

Yes, the fiscal note from the LRC appears on the ballot with each proposed initiative. Yes, the American Rescue Plan incentivizes holdout states to expand Medicaid by offering to increase the federal share of Medicaid funding for recipients eligible before expansion by five percentage points for two years after expansion. Yes, the identical fiscal notes the LRC prepared for both the hospital lobby’s initiative in January and for the actively circulating Dakotans for Health initiative petition last September fail to reflect this new, important, and lucrative policy reality. And yes, voters sure as heck ought to know about this new, important, and lucrative policy and how their vote in 2022 could make it come true.

But a new fiscal note from the LRC will not explain that reality to the voters.

Consider: By law (SDCL 2-9-30), the LRC must limit its fiscal note to 50 words. That’s an absurdly small number of words to explain the full fiscal impact of Medicaid expansion. But here’s the best the LRC could do with 50 words in fiscally noting both of the currently approved Medicaid expansion initiative petitions:

Based on eligibility requirements and income methodology set in federal law as of September 2020, the proposed expansion of Medicaid benefits could result in an additional 42,500 eligible individuals. The total annual estimated cost of Medicaid expansion is $301,800,000 with the state’s share of that cost being up to $20,800,000 [LRC, fiscal note to both Medicaid expansion initiatives, 2020.09.15 and 2021.01.28].

In its analysis of the fiscal impact the American Rescue Plan will have on South Dakota (an analysis I reported on when it came out a couple weeks ago), the LRC included 53 words explaining the ARP’s Medicaid expansion incentives:

Legislative Research Council, "American Rescue Plan Act (ARPA) Funding Overview," presentation to Executive Board, 2021.04.22.
Legislative Research Council, “American Rescue Plan Act (ARPA) Funding Overview,” presentation to Executive Board, 2021.04.22.

The LRC cannot cram those 53 words onto the ballot next to the 50 words it’s already penned for the Medicaid expansion initiatives. The LRC will not replace its previous 50 words with a somehow slimmed version of these new 53 on the ARP, because the ARP will not be on the ballot; Medicaid expansion will be. The ARP changes the net fiscal result for states that expand Medicaid for two years, but Medicaid expansion itself will still receive the same federal match rate that LRC used in its original fiscal note calculations. LRC and all the rest of us can reread the Medicaid expansion initiatives and say, objectively and honestly, that the state’s share of Medicaid expansion will be up to $20.8 million per year.

In other words, not one word of the LRC’s original fiscal note is incorrect. LRC can place those exact same 50 words on the ballot with a clean conscience.

Thus, SDAHO and its partners are throwing away three months of petition time on the knuckleheaded notion that LRC will write their campaign argument into a new fiscal note. That campaign argument is valid—for the first two years, every state dollar we spend on Medicaid expansion will bring us $2.20 in ARP incentives in addition to the $15 from Uncle Sam to support our new Medicaid enrollees—but LRC won’t make that argument in 50 words or less for us.


  1. jerry 2021-05-02 10:52

    All window dressing from a group that has as much interest in passing Medicaid Expansion as a chicken has to support Colonel Sanders.

  2. Donald Pay 2021-05-02 10:53

    We worked with some in the medical community on the mining initiatives we did in the 1980’s and 1990’s. They are great at fundraising and writing checks. Are they willing to collect one signature? No. Do they have a clue what it takes to put something on the ballot? No. This applies to the docs and the higher paid executives. You know who can get things done? Nurses. Patients. We had people who had heart conditions and cancer collecting more signatures than cardiologists and oncologists. You count on doctors to fix what’s wrong with you and to keep what’s not wrong from going wrong. That’s what they’re good at. They are not good at figuring out how to run an initiative campaign.

  3. grudznick 2021-05-02 11:05

    In a related development, it seems the arrival of the ARP has gotten Powertech all fired up to start in-situing again. Edgemont will see a boom.

  4. Cory Allen Heidelberger Post author | 2021-05-02 11:33

    Donald, I’d like to see SDAHO out on the streets collecting signatures. With their money and storefronts, they could collect enough signatures to put any measure on the ballot in a snap. But they are playing too cute by half thinking they can get LRC to rewrite a fiscal note in their favor and then further thinking that that fiscal note will somehow do more to secure votes for a ballot measure than the massive ad campaign that they can run explaining to people how much money and how many lives expanding Medicaid will save.

    Don’t overthink it: get the signatures, put it on the ballot, and then remind people why Medicaid expansion has been a great policy in the other states that have adopted it and that we’ve been dopes not to jump in for our fair share.

  5. Donald Pay 2021-05-02 12:08

    Cory, this is the game the special interests play. “Too cute by half” is another way to say they are trying to kill their initiative with complete stupidity. First, no one thinks fiscal notes are worth much. It’s just somebody’s opinion built on superficial analysis. If you’ve been around the Legislature for a session, you know that asking for a fiscal note is just another way to delay long enough to kill something. So, maybe they just want an easy out. Second, they are trying to game the system, something that only special interests do. I think it’s a dumb strategy that sets them completely above the average person. What they want to add would best be done in good TV spot, but if the LRC does it they can point to the LRC wording in their ad. It’s a chickesh*t way to get the government to run your campaign. It’s the same game the Mining Association played. They just want the LRC to do their job for them. Typical of the special interests. There shouldn’t even be fiscal notes involved in initiatives at all.

  6. bearcreekbat 2021-05-02 13:47

    I am having difficulty understanding how delaying or killing a Medicaid expansion iniative could benefit the “special interest” of hospitals, doctors, and medical personnel. What am I missing?

    Also, why is there no link to subscribe to email notice when there are subsequent DFP comments on this DFP story?

  7. 96Tears 2021-05-02 14:02

    COVID Kristi’s counting on Tim Rave (former GOP legislator/uber-rightwing blowhard) to make sure this issue is still-born for the 2022 election. Clearly, this is sabotage. In plain view. What other reasonable explanation is there?

    COVID Kristi doesn’t want to be on the campaign trail to explain why she’s been the Obstructionist in Chief on Medicaid expansion while the state burned up from the pandemic. Other than offering bounties for roadkill racoons and skunks, what else has the cold-blooded snow queen accomplished?

  8. Donald Pay 2021-05-02 15:24

    I tend to go along with 96Tears. It’s just too stupid, even for a former legislator, to be delaying signature collection over a goddamn fiscal note. All those groups listed under “Who Are We?” are being snookered by Rave or they are all dumber than hell, and not in control of their own sponsoring group. Time for those groups to dump Rave.

  9. bearcreekbat 2021-05-02 16:44

    If Rave is, in fact, making decisions to advance his own conflicting personal interest over the interest of SDAHO, then that seems to be additional evidence supporting the hypothesis that there is no apparent benefit to “the special interest of hospitals, doctors, and medical personnel” for “delaying or killing a Medicaid expansion initiative.” Thanks 96 & Donald.

  10. Mark Anderson 2021-05-02 16:47

    Come on, everyone knows the trumpies are still waiting for trumps great healthcare plan. That plan will save everyone and save lots of money too. Its still in the works, right? In the meantime, the poor should just die if they can’t afford healthcare. That last sentence will be in the new trumpie platform.

  11. grudznick 2021-05-02 18:36

    Mr. Tears, you are incorrect about young Mr. Rave. He is not an uber-rightwing blowhard. He is a blowhard but he is darn near a libbie in my book and the books of many. You will not find many working in his line of the insaner than most ilk. They are, by all accounts, money grubbers of a moderate slant.

  12. Cory Allen Heidelberger Post author | 2021-05-03 05:47

    [BCB, I have temporarily disabled the Subscribe to Comments function, since it was generating bum emails that may have been snarling the server a couple days ago. I need time to work through those plugins and determine which ones are safe to re-activate.]

  13. jake 2021-05-03 12:04

    It’s a SAD move y the right-wing to attempt to sabotage your site, Cory. Best of luck to you!

  14. John Kennedy Claussen, Sr., 2021-05-04 00:24

    Why is the SDFU involved in this? Shouldn’t they know better?

  15. bearcreekbat 2021-05-04 01:00

    [Thanks for the info Cory. Hope you can fix it soon.]

  16. Cory Allen Heidelberger Post author | 2021-05-04 06:48

    [Jake, I am not aware of any sabotage. Computers simply malfunction.]

  17. Cory Allen Heidelberger Post author | 2021-05-04 06:51

    That’s a head-scratcher, John KC. Farmers Union threw in with Dakotans for Health and the original petition drive last November, then jumped to SDAHO’s ship in December. We haven’t heard much from them since… and Farmers Union certainly isn’t out carrying petitions, since their coalition partners keep delaying for peanuts.

    The most generous read I can give is that Farmers Union is suffering from the same fear that many good South Dakotans have, that they must go along to get along and cozy up with the powers that be to get anything done.

  18. John Kennedy Claussen, Sr., 2021-05-04 10:01

    “….that they must go along to get along and cozy up with the powers that be to get anything done.”

    You just described a wing of the SDDP as well.

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