Fearing a long-term rise in private insurance premiums, South Dakota physicians are renewing pressure on the governor to expand Medicaid eligibility under President Obama's 2010 health care overhaul.
Dr. Daniel Heinemann, president of the South Dakota State Medical Association, addressed a group of 50 physicians in Rapid City on Thursday and reiterated that failure to expand would have implication for all South Dakotans.
"The citizens of South Dakota are going to continue to get care, but it's going to be more expensive and it's not going to have the same kind of outcomes," Heinemann said in an interview before his address.
Under the Affordable Care Act, popularly called Obamacare, states are given strong financial incentives to expand Medicaid eligibility to more low-income residents. Twenty-two states, almost all of which have Republican governors, are choosing not to expand or are leaning against it.
If South Dakota expands Medicaid eligibility, it would provide coverage to 48,000 uninsured residents. Under the Affordable Care Act, the federal government covers about 100 percent of the cost of those new patients until 2016. From 2020 onwards, the federal government covers 90 percent of the cost and the state 10 percent.
Daugaard's primary concern is that the federal government will renege on its promise in the long-term, leaving the state to cover more than 10 percent of that bill.
But Heinemann said that argument was flawed because all South Dakotans would pay more in the long-term if the state choses not to expand Medicaid.
Heinemann said without health care coverage, those uninsured people avoid doctor visits until their condition is so severe they end up in an emergency room. Not only is emergency care significantly more expensive, but hospitals shift the cost of unpaid bills onto private insurers.
"We are all paying for the cost of those services," he said.
By expanding Medicaid eligibility, Heinemann said, the state can provide preventive care for those patients and reduce emergency room visits.
"It's like anything else," he said. "If you delay taking care of your automobile and wait until a major breakdown, it's more expensive."
Ultimately, Heinemann said that would mean a reduction in the growth of private insurance premiums — saving money for all South Dakota residents.
Beyond that, he added, he believed South Dakota had a moral obligation to help its most vulnerable citizens.
"We know that people who are insured are more likely to live longer and have healthier lives," he said.
According to a report by a task force set up by Gov. Daugaard, 54 percent of the 48,000 residents who would be covered by the expansion are employed but their employer doesn't offer health coverage.