Tuesday, August 20, 2013

SD Task Force Is Ready to Report. Seems To Support Expansion

A task force that made up of 29 members has been studying if they should expand Medicaid to over 48,000 South Dakotans.  It seems that the task force is leaning to yes on the expansion.
The task force recommended that if Daugaard and the Legislature approve an expansion, they should include a provision that ends the expansion if the federal government fails to pay its full 90 percent share of the costs after 2020.
I think that this is a fair tradeoff.  The idea is that if the federal government fails to follow through with its contract, South Dakota can alter the contract.  To me, the issue of expanding Medicaid has always been about long term thinking and not instant gratification.

One of the concerns brought up by Daugaard's appointed task force chair is a healthcare shortage of doctors, because people would seek primary care instead of emergency care.  It seems that one of the biggest problems facing mental health availability is a lack of funding for different services like Community Health Centers.  A 2009 report from NAMI (National Alliance on Mental Illness) pointed out that one of the biggest obstacles to mental health services was a lack of resources.
South Dakota's community mental health services "are basically starving" due to lack of resources, leading to increased demand for care at its state psychiatric hospital.
South Dakota spends the lowest amount in the nation on Mental Health Care (45.1 million).  That amount was the same in 2009 as it was in 2012.  North Dakota increased spending on Mental Health Care by 48.1% to 73.9 million, Minnesota increased by 6.8% to 204.4 million, and Iowa increased it by 3.2% to 208.2.  Expanding Obamacare might place a burden in the short term, but an increase in costumers will lead to an increase in people willing to meet those customers.  If the Governor's appointed task leader is so worried about access to mental healthcare, maybe she should recommend spending a few million dollars more on the service instead of propping up business ventures like NBP.

I hope that the government will look toward the example of Iowa which is expanding Medicaid.
Expanding Medicaid to an estimated 115,000 Iowa adults under the Patient Protection and Affordable Care Act would add nearly $2.2 billion and more than 2,300 jobs to the state’s economy over the next seven years while saving more than $1.6 billion, according to a report released today by the Iowa Hospital Association and funded by the AHA. The federal government would pay 100% of the cost of the Medicaid expansion through 2016, phasing down to 90% in 2020. “Medicaid expansion is a win for everyone in Iowa,” said IHA President and CEO Kirk Norris. “It’s a win for uninsured Iowans who will be covered. It’s a win for Iowa businesses that will benefit from these new dollars and a healthier workforce and it’s a win for the state with more than a billion and a half dollars in net savings.”
In the end, expanding Medicaid could increase the economy by $200 million at a cost of $2 million for the first three years and then up to $20 million in 2020.  It is also key to protecting rural services as the Winner Advocate summed up:
Medicaid expansion is especially important in rural areas, in order to help keep our hospitals financially functional. If Medicaid were expanded, it would drastically cut back on uncompensated care and the high cost of emergency room visits from the uninsured would be reduced as well.
  I think that the issue is fairly clear.  The benefits of expansion outweigh the potential costs.  Simple cost/benefit analysis thinking on the policy matter.  If the Governor needs a "Circuit-breaker" clause in it to allow for reassessment in future years, then I say include it.  I hope South Dakota will soon stop trying to be the state that leads from the rear and begins to think long-term.

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