Speaking of ballot measures, the expansion of Medicaid that South Dakota voters smartly approved last November may not be costing the state nearly as much as Republicans fretted it would.
In July 2022, Governor Kristi Noem tried to scare voters away from Medicaid expansion by claiming that it would cost South Dakota $80 million a year, not the $33.2 million a year the Legislative Research Council calculated in 2021. Once voters approved Amendment D, Governor Noem revised her budget guess for the first year of Medicaid expansion down to $65.3 million in state general funds.
On Tuesday, along with her budget outline for Fiscal Year 2025, Noem proposed budget adjustments for FY2024. The largest adjustment is a $48.9 million reduction in funds allocated for Medicaid expansion utilization. It represents a 75% reduction in the amount the Governor and the Legislature thought we’d spend on Medicaid expansion in year one. The resulting $16.4 million expenditure is half of what the LRC said Amendment D would cost us each year.
This major downward adjustment in the expected first-year expenditures on Medicaid expansion likely reflect the slow uptake of enrollment. Back in October, the Department of Social Services said only a fifth of the predicted enrollees had signed up. DSS Secretary Matt Althoff told Legislative appropriators last month that it will take two years for the 57,000 expected enrollees to get on expanded Medicaid.
Remember that every dollar we spend on Medicaid expansion this year is matched by $19 from the federal government, so every state dollar we spend on Medicaid expansion is an investment not only in more health coverage to make healthier South Dakotans but also in more federal stimulus to make a healthier economy. Alongside the $48.9 million reduction in state spending, Noem requests $337.8 million less in federal spending on Medicaid expansion. That’s $337.8 million less that will be pumped into the state economy through purchases of health care resources. $337.8 million equals 0.67% of South Dakota’s gross state product in 2023.
The federal match for South Dakota’s Medicaid expansion will drop from 95% to 90% in Fiscal Year 2026. Governor Noem mentioned that fact in her budget address Tuesday to explain why she was asking the Legislature to sock away $18.3 million to help cover that increased cost in the future. But she did not mention this year’s 75% lower cost, and she did not mention that the “full need” of “about $64 million” that she’s predicting for FY 2026 is still lower than the cost she predicted the state would incur this year when more federal aid was coming.
Enrollment is slow because people won’t enroll until they are sick enough that they finally struggle in to see a Doctor. I’m not being critical, I was the same bullheaded way when I was young. I had to be very, very sick before I went in and sometimes it had three years between appointments. I didn’t change my ways until I was over 50.
Is enrollment also slow in other states when they initially adopted Medicare expansion? Or is slow enrollment due to a lackadaisical effort by the state?
MEDICAID costs the State nearly $4,000 per participate, Kristi Noem was not wrong in her assessment, even I did the math, adding 40,000 new customers to our Medicaid Rolls costs us $300,000,000 a year, to which the first 9 years, the FEDRAL GOVT pays for 90% of the cost. Either NO ONE is applying for, nor using the Medicaid Program, or the Democrats lied, and said we would throw everyone on the program. PEOPLE do NOT want to be on Medicaid, and most South Dakotans prefer private health insurance over government welfare programs. SO if no one is applying for Medicaid Plans, then well, NO ONE is costing the “State” any such money at all. The program simply ceases to exist.
MLZ, Americans have a right to life. No expense is too much for the government to pay to fulfill that obligation. Stop treating health care like a commodity — a commodity to coerce people into subservient existence to an employer.
The state constitution instructs the State Officials, Officers, Agents to preseve, protect, and defend Life, Liberty, Property, Prosperity. IT does not instruct the government to fund them. In fact, it restricts the government from interfering in the private lives of its citizens. Therefore, it simply licenses the prescribed businesses as directed by the people and their representatives to license only those types of businesses to whom provides for healthcare services, and to ensuring that the rights to life, liberty, and prosperity shall always be preserved, protected, and defended.
Therefore, S.D Law does NOT entirely ban Abortion, but merely sets up the process of which the Healthcare Providers are to follow, in order to legally, and lawfully precure an abortion, without punishing, or penalizing the woman for consenting to have an abortion. If the process is unjustly followed, then the Healthcare companies are then penalized for not faithfully, religously following the law of which we, the people have created.
Furthermore, the Mediaid Program is a Federally Created Program, adoped by the Citizens of the State, asking the citizens themselves to self fund the Medicare and Medicaid Trust Funds by electing to contribute 2.9% of their Net Income to the Fedral Trust Fund(s). The State Government by means of the Federal Law is then entrusted to best manage the South Dakota Citizens Portion of the Trust, ensuring that ALL Qualified S.D Citizens are fully capable of utilizing the funds where they elect to participate in the Federal Program. The S.D Citizens at this point, have NOT instructed the State Government to fund the program(s) with state or local tax dollars beyond the federal monies. But, we have adopted state laws to restrict the funds by qualifying only specific people to whom can utilize the funds, to purchase healthcare insurance, or obtain help in paying for their healthcare. We have adopted a rule, that the program cannot bankrupt the state.
Nuts.