Expanding Medicaid can pass the South Dakota House, if we just don’t say “Medicaid expansion.”
Retired dentist Representative Paul Miskimins (R-20/Mitchell) offers House Bill 1103, which originally aimed to spend more Medicaid money on dental services. In House Health and Human Services last week, retired chiropractor Representative Fred Deutsch (R-4/Florence) moved to amend HB 1103 to give more Medicaid money to chiropractors and optometrists. But nowhere does the bill say increase or spend more or any other liberal fiscal terminology. Miskimins’s bill refers only to establishing, maintaining, publishing, and annually adjusting a reimbursement schedule for dental, chiropractic, and optometric services. The bill directs the Department of Social Services to determine reimbursement amounts based on a percentage of current normal and customary fees and seek the assistance of third parties (i.e., go ask dentists, chiropractors, and optometrists what their private customers and insurers are paying).
But getting more government money for services is exactly what HB 1103 intends. In his brief floor remarks yesterday, Rep. Miskimins lamented that current Medicaid reimbursement rates are 57% of commercial dental reimbursement rates for dentists and have not changed meaningfully in seven years. He said that the “regular review of rates”—and by “review” he means “increase”—will increase the number of dentists who can afford to treat Medicaid patients. While studiously avoiding any specific mention of cost (and amazingly, no one has asked for a fiscal note on this bill yet), Miskimins assured his colleagues that “reviewing” rates will save money in the long run by treating dental problems earlier, before they turn into more costly medical conditions.
Pause: Spending more on early preventative care for more people to save money on overall health care costs—that’s one of the basic arguments for Medicaid expansion. Senator Wayne Steinhauer, you’re paying attention, right?
And on Wednesday, nearly every member of the South Dakota House bought that argument from their resident dentist with not a word and only a handful of votes in opposition. Six hard-right-wing Nays were overwhelmed by 61 ayes from the conservative likes of Rep. Charlie Hoffman (R-23/Eureka), who invoked the lamentations of his dentist son-in-law in Brookings who is building a new office on the south side of town but can’t afford to treat Medicaid patients. Expanding Medicaid payments for dentists (and chiropractors and optometrists, who received no attention from Miskimins and Hoffman on the floor) got the nod from a whole bunch of folks who usually stand against socialism, like Rep. Jon Hansen (R-25/Dell Rapids), Rep. Phil Jensen (R-33/Rapid City), Rep. Trish Ladner (R-30/Hot Springs), and Rep. Kaleb Weis (R-2/Aberdeen).
Wow—if we can get all those right-wingers to vote for spending more on socialized medicine for teeth, joints, and eyes, Senator Wayne Steinhauer should have no trouble getting them to pass his Medicaid expansion measures. His Senate Bill 186 and Senate Bill 102 also cleverly avoid specifying that the state will spend more money, and he can use the same argument that covering more South Dakotans and helping them get care sooner means savings for patients, hospitals, and the state.
HB 1103 is another good step toward universal health coverage. Keep those socialist votes coming, South Dakota Legislature!