Remember how I said on Thursday that we can probably get the South Dakota Legislature to expand Medicaid if just don’t tell them they are expanding Medicaid? That appears to be part of the strategy Tim Rave is using ease legislators into finally, completely surrendering to Obamacare.
On Friday, Senate Health and Human Services took up Senate Bill 102, one half of Senator Wayne Steinhauer’s (R-9/Wall Lake) two-bill package to expand Medicaid in South Dakota. SB 102 would bankroll the early two years’ worth of extra Biden bucks we would get under the American Rescue Plan for expanding Medicaid into a new lockbox to cover future costs of Medicaid expansion.
Former legislator Tim Rave, whose South Dakota Association of Healthcare Organization is backing the public vote on Medicaid Expansion through Amendment D this fall, spoke in favor of SB 102’s lockbox. Even though SB 102 has Medicaid expansion in its title, calls its lockbox the “Medicaid expansion fund,” and creates a statutory definition of Medicaid expansion, Rave said, “This has nothing to do with Medicaid expansion—separate those topics. This is creating a fund if in the future it would be necessary to have those funds to help stabilize the state’s budget.”
Rave’s flatly counterfactual statement doesn’t help me trust him on Medicaid expansion.
Senator Steinhauer’s explanation of SB 102 to his committee seemed far more straightforward and trustworthy. Steinhauer spoke of Medicaid expansion as an inevitability. He noted that every state that has brought Medicaid expansion to the ballot has expanded Medicaid. (Montanans rejected a Medicaid expansion initiative that included a tobacco tax, but the Montana Legislature then expanded Medicaid.)
Senator Steinhauer expertly rattled off details on the mechanics of Medicaid expansion, noting that South Dakota will receive $52 million extra from the federal government in the first two years courtesy of the extra incentive in the American Rescue Plan Act (he did not say “Biden bucks”) plus over $11M each year in ongoing savings in IHS services, behavioral, and incarcerated treated in hospitals. Steinhauer said it makes sense to bank the extra early windfall and use it to cover ongoing costs, and since ARPA doesn’t earmark the incentive dollars for specific uses, sticking the cash in the SB 102 lockbox for later use is legal.
Senator Jim Bolin (R-16/Canton) was the only member of the committee unwilling to take Steinhauer’s sensible fiscal action. The committee voted 5–1 to advance Steinhauer’s Medicaid expansion lockbox to the Senate floor.
SB 102 is on Tuesday’s Senate calendar. It will be fun to watch how many Senators adopt Senator Steinhauer’s apparent fiscal fatalism in the face of successful liberal policy and how many like Rave will still find it hard to admit that they are advocating the expansion of Medicaid under the venerable and robust Affordable Care Act.