Sunday, September 22, 2013

Help Daugaard Make the Right Choice

Daugaard seems a bit confused about what to do with expansion of Medicaid, but he is leaning to his right against the expansion and making tens of thousands of South Dakota citizens eligible for insurance coverage under Medicaid.  I would like to offer him some advice to Mr. Daugaard on why he should lean towards the citizens and away from party politics.

Reason #1:  The expansion would have a large benefits to many young, working citizens (voters) in South Dakota.  According to South Dakota Medicaid Opportunities and Challenges Task Force
61% of the uninsured population up to 138% FPL is between the ages of 18 and 34.
54% of people up to 138% FPL are working, and 57% of working individuals are employed full time. 
These members of our society are the ones trying to raise a family, trying to establish themselves for further growth and become the future leaders, trying fulfill the American dream by having a better life than their parents.  These are also able-bodied adults (many of them) that despite working full-time still can not afford health care.  This is a point that Cory Heidelberger made and showed that it would be very cost beneficial 

Reason #2:  The expansion will help keep taxes in check by helping the counties (many struggling already due to a lack of state support) with millions of dollars a year.

South Dakota counties operate what is known as the Catastrophic County Poor Relief Program (CCPR). CCPR assists counties with the payment of catastrophic medical expenses incurred on behalf of individuals who are medically indigent and who have no ability or only limited ability to pay the costs of hospitalization. Eligibility criteria and funding sources are determined at the county level. Counties also incur costs for county jail medical expenses and a Catastrophic Medical Pool. If the State decides to expand the Medicaid program, much of the cost for these programs – $3.3 million annually – will be shifted to Medicaid, thus saving costs at the county level. There will be no direct savings to the Medicaid program, however, unless there is agreement to shift savings to the state. 
 Right now many homeowners are feeling the threat of increased or already high property taxes (one of the main methods that counties use to fund and maintain roads, increase police security, etc.).  This would provide some relief to counties and allow them to use those fund on much needed services without having to worry about raising property taxes.

Reason #3: The majority of the reasons provided by the task force are political and not about South Dakota citizens or are hypothetical issues that can be dealt with.  They can be summarized as

1. We don't like Obamacare
Con: Expansion of Government and Implementation of Obamacare
Con: Effect of Expansion on the National Debt
Con: Risk of a “Bait and Switch” by the Federal Government

2. We don't like Medicaid
Con: Lack of Flexibility in Medicaid Program Design and Administration
Con: Concern that Nationally Medicaid is an Ineffective Program and Should be Reformed, Not Expanded
Con: Replacement of Private Insurance Coverage

There are a few legitimate worries like the cost, but we have rainy day funds grow by those amounts and could possibly be offset by increased economic gains:
Proponents of expansion argued that states that expand Medicaid will likely see revenue from the broader economic effects of the Medicaid expansion such as increased jobs, income and state tax revenues at the state level within the health care sector and beyond due to the “multiplier effect” of spending. Research has shown that federal Medicaid dollars spur economic activity beyond the initial investment.20 
A number of individuals who provided public testimony also argued that the State’s failure to expand Medicaid would have an adverse effect on the business community in South Dakota. Specifically, they argued that if lawmakers turn away federal money to pay for expanding Medicaid coverage, companies will restrict growth, businesses will move to states with more competitive health insurance markets, and that companies that pay for health insurance for their employees will see their premiums rise as hospitals and doctors shift their losses from the uninsured to them. Others argued that the availability of Medicaid in neighboring states will attract low-income workers to these states, placing South Dakota businesses that do not offer health insurance at a competitive disadvantage.    
The other major concern is a lack access to doctors for those that are added, but those people already can't access because of a lack of insurance.  The real issue is working to offset the lack of access and not say let's ignore the problem by not giving people access to affordable insurance.

The reasons for expanding are numerous and involve real human beings that could use this opportunity for real potential.  Maybe it is time for you Mr. Daugaard to stop leaning right toward political constituents and lean a little left toward the good of South Dakota.


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  2. What about the small start-up companies, tomorrow's big boys and major players, who will write-off any consideration of establishing their business into a non-expansion state considering they will then incur additional requirements and pressures to provide insurance to one extent or the other for their lower wage workers. Not expanding Medicaid is both unconscionable and bad business. Yes - bad business! It IS happening either way, regardless of ideologies, and states that do not expand are going to be on the losing end of a fight that was already decided.

    Then of course there are the lower wage workers. Why on earth would anyone who makes lower wages, who has any choice in the matter at all, live and work in a state that does not expand Medicaid? I can see a flood of lower wage workers into neighboring states where they can have some healthcare security. Now the economic conservative says good riddance and I will just say be careful what you wish for when the pool of low cost labor dries up and businesses in non-expansion states are left paying traditionally minimum wage workers double or triple what the neighboring state's similar businesses are as the supply of cheap is too small to meet the demand. Economics 101 - conservatives should be able to relate to that.