Lawmakers to take up Medicaid debate

2013-02-19T05:00:00Z Lawmakers to take up Medicaid debateKevin Woster Journal staff Rapid City Journal
February 19, 2013 5:00 am  • 

The plan to expand Medicaid coverage in South Dakota will make a key public appearance Wednesday in the Legislature, where it is given a slim chance of approval this year.

But the future could be brighter for the expansion plan if questions troubling many in the Republican majority about the long-term state costs of expansion can be answered.

That process starts with a 10 a.m. Wednesday joint hearing of the Senate and House Health and Human Services committees. Rep. Scott Munsterman, R-Brookings, who chairs the House committee, said the hearing will begin a public dialogue that will last well beyond this legislative session.

"This year, I would agree that there's a slim chance of it passing," Munsterman said of Medicaid expansion. "But this joint hearing is really the start of us trying to vet this out in the public."

Some of that vetting has already occurred as legislators returned to their home districts for weekends away from the session. Munsterman said many of his constituents share his interest in expanding medical coverage for low-income people but also worry about the long-term budget impacts to the state.

"The feedback I'm getting from people back in Brookings is that they like the idea of helping more people, but at the same time they ask what it means, and where the money would come from," Munsterman said. "And at this point, I can't answer that with any degree of certainty."

There are two key money questions at work: How much of the expansion's costs will the federal government carry long term? Where will the state get its share?

Short term, the federal government would cover everything but $1 million or $2 million in administrative costs, starting in 2014. But that is a gift with a short shelf life. In three years, the state would begin taking on more of the actual expansion costs, up to 10 percent by 2020.

If the bulk of the 48,000 South Dakotans thought to be eligible for the expansion take part, that 10-percent share could mean $40 million to $45 million.

That's financial issue enough. But Munsterman and others fear a bigger bill if federal support shrinks in coming years.

"What I tell people is that once we understand all the financial unknowns, that's when we can have a discussion about our moral obligation and how much it would cost," he said.

Munsterman, a former Brookings mayor and 2010 GOP gubernatorial candidate, said he would welcome that discussion. So would a number of other Republican legislators who are partial to the expansion but fear the cost.

Rep. David Lust of Rapid City, the Republican leader in the House, said support would grow in his caucus if the federal government's commitment to cover 90 percent seemed secure.

"There are some who don't like the expansion of Medicaid, period," Lust said. "I don't think they are the majority. I think the majority believes this has potential but worry about the federal government not being able to uphold its obligation, and what that would mean to us."

Gov. Dennis Daugaard has said he opposes the Medicaid expansion in South Dakota this year but does not necessarily reject it in the future. Lust said many Republican lawmakers feels the same way.

States have the option of expanding Medicaid coverage under the Patient Protection and Affordable Care Act, often called Obamacare.

Lust said not taking that option this session doesn't mean lawmakers won't decide it is worthwhile in the future. And it is not too early to begin a serious discussion about expansion, he said.

Lust worked with House Democratic Leader Bernie Hunhoff of Yankton, a key proponent of the expansion, in forming a group to study the issue. The group decided the expansion would be most appropriately heard before the Health and Humane Service committees.

The joint committees won't vote on the proposal. Its role is to hear from the public in two 40-minute sessions, one each for proponents and opponents. Then committee members will ask questions and discuss the issue.

Munsterman encouraged public comments. He said phone-in accommodations for comments could be made in advance by calling the Legislative Research Council at 605-773-3251.

"We really hope to hear from the people of South Dakota on this," he said. "We don't necessarily need to hear from the lobbyists. We're not discounting what they say. But we hear from them every day."

If lawmakers listen, they'll hear real stories of need and a broad base of public support for the expansion, Hunhoff said.

"We've got 48,000 uninsured. We've got hospital and many rural clinics in dire need of funding," Hunhoff said. "I'm confident that we'll extend Medicaid at some point. The question is when we do it. I don't see any reason to wait."

Any expansion proposal will actually come through the Legislature's Joint Appropriations Committee, where it would be proposed as an amendment to the general appropriations bill. It would then need approval by both the committee and the full House and Senate.

It's an unlikely possibility this year, although Hunhoff isn't giving up on 2013 yet. He believes many of the Republican members who fear the cost in their heads admire the expansion in their hearts.

"Some of them have to play the party line against Obamacare," Hunhoff said. "But I don't think anybody is arguing that a 90-to-10 match from the federal government wouldn't be a great thing for South Dakota. Their real concern is whether we can trust the federal government five or six years down the road to stay with that."

Contact Kevin Woster at 394-8413 or

Copyright 2015 Rapid City Journal. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

(9) Comments

  1. Deklan
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    Deklan - February 19, 2013 10:05 pm
    Due to a structural deficit, South Dakota was forced to implement cuts in Medicaid and education spending.

    Eventually, the federal government, like South Dakota, will be forced to make cuts.

    It’s been noted, the Obama Administration has been willing to cut Medicaid to lower the federal deficit, and shift costs to the states.

    The Obama Administration, during the super committee reduction talks, proposed reducing federal funding for the Medicaid expansion, with the states picking up the difference.

    Mr. Obama’s ’13 budget plan proposed a funding system which would shift more of the cost of Medicaid to the states.

    A Report of the State Budget Crisis Task Force noted Medicaid programs are growing rapidly because of increasing enrollments, escalating health care costs and difficulty in implementing cost reduction proposals. At recent rates of growth, state Medicaid costs will outstrip revenue growth by a wide margin, and the gap will continue to expand.
  2. Deklan
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    Deklan - February 19, 2013 6:59 pm
    An excellent take on the issue.
  3. Deklan
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    Deklan - February 19, 2013 6:42 pm
    The people who receive Medicaid do not incur any cost in premiums, deductibles, or co-pays.

    With the expanding $16 trillion deficit, the idea of co-pays being applied to Medicaid recipients is quite acceptable.

    I would add co-pays should be applied to prescriptions and for unnecessary trips to emergency rooms.

    Vision examinations, eyeglasses, and dentistry should be covered by Medicaid only when related to an illness or injury like most private health insurance.
  4. 6k9t8n
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    6k9t8n - February 19, 2013 2:04 pm
    The federal government should put a restriction on the household size for all public assistance assistance programs, not just the Medicaid program.
  5. Wayne Gilbert
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    Wayne Gilbert - February 19, 2013 1:18 pm
    The studying that is now going on should have been completed months ago, but for the Governor's magical thinking about how the general election would turn out.
  6. Rowdy
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    Rowdy - February 19, 2013 12:59 pm
    Obamacare's Medicaid expansion is a trap that more states seem to be falling into for short term political and financial gain. It's like a credit card company or cable provider's "teaser rate" to get you to sign up before the true long term costs become apparent, at which point you're stuck. How could any governor refuse? The feds pick up almost all of the costs! It's a great deal! People like free stuff and it makes you look like you care. But the federal government (which is TRILLIONS of dollars in debt in case anybody forgot - Obama and the Democrats sure aren't about to remind anyone of that fact) can always print more money to defer those tough financial decisions, unlike state governments that have to try and live with their means. Medicaid costs will simply devour the state budget in a few short years, when the fed's promises prove to be illusionary.
  7. Dakotalady46
    Report Abuse
    Dakotalady46 - February 19, 2013 12:45 pm
    Being "penny-wise and pound foolish" doesn't make much sense to me. We, the taxpayers are going to pay for the medical coverage one way or the other. People who do not have insurance are less likely to get medical help, become sicker and cost more to treat, costing all of us more in the long run. Let's get real and make medical care available to everyone. Healthy people work harder and improve life for all.
  8. Proud
    Report Abuse
    Proud - February 19, 2013 9:19 am
    Medicaid should be a temporary help, not a permanent family insurance plan. It would shock you how abused the program is! If the parents need some help to get back on their feet, I'm all for it. When they have no plans of finding a job, I have a problem with it. You have medicaid patients coming in for a cough that started that morning and then on the other hand you have someone that pays for their insurance that waits it out and try and get better on their own. Everyone one medicaid should have a small copay even if its $5.00 for a child and $10.00 for an adult. It would stop alot of these visits that are unneeded. It makes me angry to see the system abused and seeing that more money is going to it.
  9. tipimakr
    Report Abuse
    tipimakr - February 19, 2013 8:36 am
    What's the problem? Take up the Presdent's offer and then help him create the jobs he is also proposing...that in itself would help cover the costs. Seems the Legislature is afraid of their own abilities for any Long Range Planning? Or are they planning to do the same as Washington? Nix anything Obama???
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