Senate Commandant—er, President Pro-Tem—Lee Schoenbeck (R-5/Lake Kampeska) was on the phone with Lori Walsh on SDPB this noon making stuff up about Medicaid expansion, which South Dakotans can finally by voting Yes on Amendment D this fall. Unable to deny that expanding Medicaid saves lives and saves money or explain why not one of the 38 states that have expanded Medicaid has reversed that decision (including Virginia, where Medicaid expansion has paid for itself twice over), Senator Schoenbeck yelled Slippery Slope! (or, in this case, Sticky Escalator?) and said passing Amendment D will inevitably lead to further expansion of state health care benefits.
Referring to the standard Medicaid expansion threshold of expanding benefits to folks making 138% of the poverty line, Schoenbeck said, “You know what’s going to happen when this one is done? Two years from now they’re going to say we need to be at 150% and you don’t care about people if you don’t vote to raise it another 20%.” Schoenbeck told Walsh that she should look beyond the fiscal note for Amendment D and run the numbers for expanding Medicaid to folks making 150% of the poverty line, because “there’s no policy reason why the people that keep pushing more welfare will stop” at the 138% level Amendment D will enact.
Translation: An imaginary Amendment E would be a terrible idea, so vote against the real Amendment D.
Senator Schoenbeck, first, read Amendment D. It says “provide Medicaid benefits ro any person over age 18 and under 65 whose income is at or below 133% of the federal poverty level, plus 5% of the federal poverty level for the applicable family size, as provided in federal law.” Amendment D says nothing about 150%. There is no secret clause in Amendment D triggering an increase to 150%. Amendment D’s multitudinous supporters have said nothing about 150%. 150% is not on the ballot.
Second, Lee, there is a very clear and well-known policy reason that the supporters of Medicaid expansion will stop at Amendment D’s threshold of 138%. That policy reason is the Affordable Care Act—ObamaCare! Folks making more than that in states that expand Medicaid get enough in ACA premium subsidies that they can get affordable health coverage without Medicaid. If South Dakota cranked Medicaid eligibility up to 150% or wherever else Lee’s slippery slope-alator leads, President Biden would say, “Good on you!” but we wouldn’t get any federal money for it. Absent such federal dollars, Senator Schoenbeck’s Republican friends at the hospitals know there’s no reason to push, not to mention no way to get cheap South Dakotans to vote, for further Medicaid expansion.
I’d be fine if Amendment D were really just the first stop on America’s trip to join Canada, Norway, and other nice countries at the pinnacle of civilization with universal single-payer health insurance. But Amendment D ain’t that. Amendment D seeks to resolve the ACA coverage gap that Chief Justice Roberts—a good Catholic just like Lee—created when he saved the ACA in 2012 by making Medicaid expansion optional, which boggled the ACA math that assumed all states would expand Medicaid. Amendment D fully solves this problem all by itself, going as far as necessary and logical under the ACA. There will be no Amendment D+.
Bonus Republican Quote: Lori Walsh asked Senator Lee Schoenbeck if his opposition to expanding Medicaid comes from fiscal worries or from a moral concern about who deserves access to health care. Senator Schoenbeck replied, “People decide whether they deserve health care. They decide it by the choices they make every day about whether they get up and go get a job or not.”