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SD Republicans Believe Medicaid Worse Than Marijuana

When I took my deep drag yesterday morning on the Legislature’s big marijuana bong, I noted in passing that Representative Will Mortenson’s Republican friends (and Republicans are the prime sponsors of all 26 marijuana bills in the hopper) appear to be ignoring his advice to leave marijuana policy alone until after voters get their say on the marijuana initiative that he is sure will make the November ballot.

Mortenson expressed this wish even though marijuana initiative organizers had not at the time of his writing over a month ago yet submitted their initiative petition for a repeat vote on legalizing marijuana. Those organizers still have not submitted their petition; South Dakotans for Better Marijuana Laws continue to collect signatures, as evidenced by their advertisement on this blog. Republicans could still halt their efforts the moment SDBML submits its petition to the Secretary of State—What? Steve got the petition, and it has 20K+ good signatures? Whoa, horse! Withdraw all of our bills! Let the people decide!—but I find that prospect highly unlikely. I’d suggest it’s more likely that marijuana advocates will pack the committee rooms and lobbies this winter to shape those 26 marijuana bills, and if they get what they want, they’ll call off the drive for another statewide vote.

Arguably, Mortenson’s Republican friends are deferring to the people by recognizing that all this petitioning signals that South Dakotans want legal marijuana and proposing Senate Bill 3 to codify that popular want. But I won’t make that argument, because if legislators really tuned their lawmaking to popular initiatives, they’d have Medicaid expansion right alongside marijuana legislation.

Consider that while one group is circulating a marijuana petition, two groups have been pushing Medicaid expansion initiatives. Rick Weiland’s Dakotans for Health has been engaging grassroots circulators around the state since November 2019 in circulating petitions to put Medicaid expansion on the ballot. The hospital lobby put together South Dakotans Decide Healthcare for the same purpose and placed a Medicaid expansion amendment (Amendment D!) on the November 2022 ballot.

The voters are sending at least as strong a signal with Amendment D (not to mention every poll I can find on the subject) that they want to expand Medicaid. Plus, the policy evidence from every state that has expanded Medicaid is paints a far more uniformly positive picture of the policy impacts of expanding Medicaid than we get from various states’ experience with legalizing marijuana. Expanding Medicaid saves lives, boosts state budgets, and stimulates the economy. Legalizing pot just means we stop putting people in jail and start taxing them for an already widespread activity of questionable value.

Helping 42,500 South Dakotans get affordable health insurance is a great social good. Adding another sin tax to South Dakota’s budget gimmicks is at best a shrug at behavior of little social value.

Medicaid is far more useful than marijuana. South Dakotans want both. Yet South Dakota Republicans will consider legalizing marijuana even as they resist Medicaid expansion. Will Mortenson belongs to topsy-turvy party that believes Medicaid is worse for people than marijuana.

14 Comments

  1. larry kurtz 2022-01-06

    How are 65 county seats and their bureaucracies either conservative or sustainable? They’re not; but, it’s the way Republican cronyism and patronage built barricades to democracy by providing benefits of the public dole to those who say they deplore big gubmint in a state that hates poor people.

    Homeless veterans are often refugees from combat and despite lies from the South Dakota Republican Party video lootery, payday loan sharks, domestic violence and homelessness are inextricably linked putting children at risk to more catastrophic consequences far more often than has happened in states that have legalized or lessened penalties for casual use of cannabis.

    Yes, socialized agriculture, socialized dairies, socialized cheese, socialized livestock production, a socialized timber industry, socialized air service, socialized freight rail, a socialized nursing home industry and now a socialized internet are all fine with Republicans in South Dakota but then they insist single-payer medical insurance is socialized medicine.

  2. larry kurtz 2022-01-06

    Hey Democrats. Most Native Americans don’t want Medicare for All; they want a fully funded Indian Health Service and military personnel want better TRICARE coverage.

    A member of a religionist cult in South Dakota incurred nearly $2 million in hospital bills so the plan she belonged to dumped her into Medicaid and the hospital lost the lawsuit. Imagine what’s going to happen with all the unvaccinated Republicans who run up medical bills.

    https://www.argusleader.com/story/news/2022/01/05/select-specialty-hospital-sioux-falls-loses-medicaid-dumping-lawsuit-hutterites/9092183002/

  3. Porter Lansing 2022-01-06

    Marijuana.
    Questionable social value with no use?
    South Dakota – Deriving enjoyment from denying yourself enjoyment.
    It’s so German it makes my kraut sour.

  4. Eve Fisher 2022-01-06

    GOP can’t make money from Medicaid expansion (besides, someone poor might benefit when all they “really” need to do is get a better job and work harder), but they can make money from recreational marijuana…

  5. 96Tears 2022-01-06

    How soon they forget:

    SIOUX FALLS, S.D. — Former Sanford Health CEO Kelby Krabbenhoft received a $49.5 million payout as part of his abrupt departure from the health system in late 2020, according to federal tax documents filed Monday and obtained by Forum News Service. Nov 16, 2021

    I don’t care what political beliefs you have, the current medical system does not deserve to be defended. Kelby was ridiculously handsomely paid as CEO. He didn’t need a golden parachute unless that’s what it took to boot him out of Sanford. But $50 million? Really? Who can spend a $50 million going away gift at his advanced age?

    We, the People, are getting robbed. It’s time to join the rest of the leading nations and switch to universal health care.

  6. Donald Pay 2022-01-06

    Eve Fisher explained it. Medicaid is for the poor, not the Republican donor class. Can’t have that around here.

  7. bearcreekbat 2022-01-06

    While Eve’s theory makes some sense on the surface it doesn’t really hold up under fundamental economic principles. Since the feds would bear 90% of the cost of a Medicaid expansion, that infuses a ton of money into the State. As that money flows through the multiplier effect, the end result seems likely that it would pretty much end up in the pockets of the weathiest individuals and companies in SD. If that is correct, then the idea that Republicans “can’t make money from Medicaid expansion” evaporates, at least for the moneyed class in the State which presumably holds the power.

    The more likely answer is that Republicans oppose the expansion because they really haven’t thought through the economic principles at work enough to overcome blind prejudice against helping people in need vs simple selfishness.

  8. O 2022-01-06

    bearcreekbat, you have a point on a macroeconomic level, but on an individual provider level, the medicaid reimbursement is lower than what a provider can pull privately (individually or from insurance) from a patient. Larry’s linked article speaks to this difference in compensation. In that way, Eve’s point is well-taken. Given that I would say our health care facilities are maximizing their profit potential, taking on more, low-paying services doesn’t really fill the coffers at the rate of return hospitals want.

  9. bearcreekbat 2022-01-06

    O, I wonder about the proposition that “the medicaid reimbursement is lower than what a provider can pull privately.” While it is true that that the medicaid reimbursement rate is lower than what a provider can and normally does charge for medical services, the problem is that without that the medicaid assistance that prospective or actual patients would otherwise have qualified for, these patients would have to either skip services altogether or simply end up owing a bill to the hospital that is uncollectible. To qualify for medicaid, by definition, a patient must lack sufficient income and resources to pay hospital charges.

    It is true that under SD poor relief law when an indigent receives care the county must reimburse the provider for that care. See SDCL ch 28-13, and in particular SDCL 28-13-27 et. seq. I simply don’t know whether a county will pay the prevailing charges of the provider or some lessor amount similar to or below the medicaid reimbursement amount. It looks like that is likely in non-emergency cases. See SDCL 28-13-27.2 (“Except for the costs of emergency hospital services, a county may adopt guidelines which define the amount, scope, and duration of medical and remedial services available to eligible persons and the basis for and extent of payments made to providers by counties on behalf of eligible persons.”)

    My best guess is that both a medical provider and the ultimate recipients (i.e. SD’s wealthy donors) of medicaid funds spent over and over again in the local economy would collect more lucre from folks that qualify for medicaid than nothing from uncollectible judgments, county reimbursements, or not treating folks that can’t afford the full price. I also note that the non-treatment option in emergency cases doesn’t really exist for hospitals that received 1946 federal Hill Burton funding in the past. Although a hospital recipient of HB funds may deny non-emergency services to indigents if over the years the hospital has provided sufficient free care non-emergency patients (i.e. free services valued in an amount equaling all or a percentage of the HB funds received), it is my understanding that the Act required hospital recipients to provide emergency care for the life of the hospital, regardless of the free non-emergency services provided in the past.

  10. ABC 2022-01-06

    96 Tears, I would fully support a system that gives EVERYONE a $49,500,000 payout when they retire. All day long.

    I believe it was in his contract and retirement plan he had paid into for years plus a severance package.

    Everyone can and should have this.

    $49 000 000 for everyone! (Good t shirt logo!)

  11. Mark Anderson 2022-01-06

    96 tears, of course Universal Healthcare is the way to go, but there are legions of people in the business opposed to it. Who besides Manchin was opposed to medicare expansion into hearing, dental, and vision? Dentists that’s who. Why reduce their way of living. Cavities are a way of life. You don’t have to go to a whorehouse to get screwed. Why my wife and I payed many thousands last year alone. For you younger folks who now have insurance through work, get your teeth checked every year.
    If Medicaid passes in South Dakota, how will Republicans differentiate themselves from the masses? You can’t play golf all the time.

  12. jerry 2022-01-06

    Take a look at the legislators and you can see why they oppose Medicaid. Medicaid would make them actually work and be competitive which is a word that republicans hate. If you want Dental care, take a dental vacation to Mexico and fill your prescriptions there too, or better yet, Dominican Republic. The ones in Mexico are clean as a whistle and you can save enough on those dental visits to actually have a vacation. It costs a little more to get to Dominican Republic but they have top notch dentists there and great dentistry schools.

    Chiropractors and lawyers hate Medicaid because it ruins their bottom line and the rest of the republicans there, are just moochers. Actually leave the country to see how healthcare is done in an affordable way. European healthcare does not include dentist visits, unless medically necessary. Same as they don’t do vision unless medically necessary. I had two crowns done there for a little less than half of what it would’ve cost here, so it paid for my ticket there and then some. Get used to the screwing or learn to say change, when you’ve had enough. Oh, and the dentists speak English and so do the assistants.

  13. Lottie 2022-01-07

    There are retired professors on medicaid and their grateful for the help. Cannibas has been around forever like cigarets. Inhaling all that can’t be good for the lungs but I think medical marijuana would be very helpful for some diseases.

  14. V 2022-01-07

    Medicaid has to be profitable in order for the medical profession to push for it. About one third of our residents could benefit because they don’t get employee or government health insurance. You think working 30 hours a week cleaning rooms at a hotel is going to help pay for the cost of even having a child in this state…and remember who pays…the mom. Women, children who don’t ask to be born, the elderly who did work hard all their lives, and now lots more people that are down and out because of covid need Medicaid.
    Those who receive IHS and Veterans benefits should have their own facilites AND be able to go to any clinic or hospital anywhere in this country.
    No one should be denied health care.
    We need that federal money now.

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