Rejecting Medicaid could cost all South Dakotans, physician says

2013-10-19T05:30:00Z Rejecting Medicaid could cost all South Dakotans, physician saysDaniel Simmons-Ritchie Journal staff Rapid City Journal
October 19, 2013 5:30 am  • 

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.

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 This material may not be published, broadcast, rewritten or redistributed.

(24) Comments

  1. Deklan
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    Deklan - October 21, 2013 10:46 am
    Why can't it be understood that at recent rates of growth, state Medicaid costs will outstrip states revenue growth by a wide margin, and the gap will continue to expand?
  2. Obtuseangler
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    Obtuseangler - October 21, 2013 5:46 am
    Roger, I'm saying charity is not a legitimate government function, that government dollars for healthcare should be limited to extreme cases. The "death panel" is a reference to government rationing of healthcare as a means to hold down costs. I agree with you that getting government out of healthcare is probably wishful thinking, for the exact reasons you listed. However, government involvement in healthcare is the main reason costs keep skyrocketing above what people can pay. The government is paying the gap between what the market can bear and what the consumer can pay.
  3. ZAR
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    ZAR - October 21, 2013 12:42 am
    Those doctors need to get out of the health care industry!
  4. ZAR
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    ZAR - October 21, 2013 12:40 am
    Why did you continue onto the receptionist to check in?
    If the Doctors office wouldn't accept reasonable FEES from Medicaid, fees that are negotiated by physicians for physicians, not unlike insurance fees are. Then it would be simple greed and or stupidity not to accept Medicaid!
  5. Farwalker
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    Farwalker - October 20, 2013 4:46 pm
    the cost of insurance premiums is going up to cover the cost of the obamacare mandates
  6. morningstar
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    morningstar - October 20, 2013 7:50 am
    In a grudge against Barack Obama getting elected the first time, past Senator Jim DeMint (now with the Heritage Foundation) issued the conservative rallying cry for health care reform to be "Obama's Waterloo." But the issue fell short and Obama was elected a second time.

    As with the SD Physicians and the Chamber of Commerce, factual information and common sense will prevail over the long haul.

    The only justification against accepting Medicaid under the Affordable Care Act is that to do so is "Anti-Obama."Sooner or later the Governor will have to eat crow and accept the facts of life; We are already paying for those people, only at a higher rate because it is done through hospital emergency rooms.Why is that so hard to understand?
  7. Algebra
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    Algebra - October 20, 2013 6:10 am
    I saw the writing on the wall 20 years ago, in an orthopedic surgeon's office: a big sign in the waiting room that said "This office does not accept Medicaid. If you are a Medicaid patient, please see the receptionist to arrange an alternative method of payment." In other words, if you're on Medicaid, get out of my office. Providers who do see Medicaid patients shift the cost of uncompensated care to their private pay patients, meaning that those of us who are on private pay have to pay for Medicaid patients twice: with our taxes, and with our own inflated medical bills. Expanding Medicaid will not solve this problem.
  8. Rhudedog
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    Rhudedog - October 20, 2013 5:22 am
    Don't be gullible Shorty. Obamacare will force many more millions into Medicaid which is why the doctors want this. Liberalism ALWAYS makes problems worse. 30-50 M uninsured will grow to > 100 million easily
  9. MBBob
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    MBBob - October 20, 2013 12:13 am
    The US is the only industrialized country that allows its people to die and go bankrupt for lack of affordable health care. We spend twice as much per person for health care as the average of the other countries and have poorer outcomes. How do they do it? Health care is mandatory and government regulated like a utility. We have an example of this in Medicare. Ask seniors how many wish they had never been required to contribute.
  10. Farwalker
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    Farwalker - October 19, 2013 5:52 pm
    who is gonna benefit from the trainwreck known as Obamacare?
    this is another mandatory Dem social program that the Obama administration is already stealing money from.
    do the math.
    the Boomers are the largest age group in the US.
    they paid into Socialist Security and Medicare.
    The Boomers want the benefits they were promised.
    the programs have both been fleeced to cover the deficits of every administration since LBJ.
    the government cannot make good on its public debt
  11. Scharfschutze
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    Scharfschutze - October 19, 2013 3:51 pm
    Now wait a second...aren't the working individuals who do not currently have health insurance one of the primary demographics that obamacare was originally targeted toward to begin with? Isn't obamacare supposed to be providing them with affordable health insurance that they can pay for themselves (albeit with generous federal subsidies)? Could this big Medicaid push be because that was obama's plan all along?

    Or in the infamous words of Rep Nancy Pelosi, "We have to pass this bill to see what's in it".
  12. Deklan
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    Deklan - October 19, 2013 1:53 pm
    The reason 0’Care increases insurance premiums is because the law relies on the money paid into the system to offset the cost of caring for older individuals, to offset preexisting conditions, and to pay for extra coverage in what the Obama administration deems as essential benefits.
  13. Deklan
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    Deklan - October 19, 2013 1:46 pm
    The Journal on 02/04/13: Under the proposed expansion, the federal government would cover costs — at a rate of about $200 million a year to South Dakota — for the first three years.

    After that, reimbursement from the federal government would drop each year to an eventual 90 percent of costs in 2020.

    The drop in federal funding could end up costing the state as much as $45 million a year if all 48,564 additional people take advantage of the expansion, said Deb Bowman, a senior adviser to Daugaard.

    Last year’s, “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 states revenue growth by a wide margin, and the gap will continue to expand.

    Last year, the Centers for Medicare and Medicaid Services released their annual report on health care spending in America. It was projected that healthcare spending will rise 8.3%, due in large part to Obamacare’s expansion of Medicaid and the new subsidies in purchasing health insurance in the exchanges.

    By 2020, they estimated that the Federal government will account for one-half of the health care expenditures in the nation.

    Additionally, the O’ administration, during the Super Committee reduction talks, backed reductions to Medicaid, shifting the growing cost onto the states. The administration’s proposals included blending Medicaid reimbursement rates and to limit states’ use of provider taxes.

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

  14. Freedome
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    Freedome - October 19, 2013 1:29 pm
    Being on medicare is no fun when your doctor drug tests you because your on pain meds that I need even though I don't do drugs. Now with the new drug rules our leaders have put on everyone I have to go to the doctors office every month to pickup a hard copy for my meds than wait sometimes hours to get them filled. I can't travel for the winter because I am treated like a crook because I am on pain meds, Its like being on work release without doing the crime.

    I tried to get a new doctor but after about a dozen calls I only found one that would see me but he said I can't give you pain meds because you could sell them. Again treating me like a crook.

    Was at a doctor one time that said to me I don't care if you want surgery or not since I only get about 20 cents on the dollar from medicare. Now would you let this doctor operate on you. I am on disability but under 65 so finding a doctor is very hard they say we only have to treat a % of people under 65 & we have meant those numbers this goes the same for the medicare supplement insurance also. I worked to become disabled but am treated like I never worked before & like I am a crook being drug tested & can't leave the state for over 30 days because I cannot get my meds refilled anyplace but here in person.

    So if you think people are going to get good medical care for the low income or no income people you have to be joking there is no suck thing. They treat you like a crook on a work release program. Any good federal lawyers out there want to sue our country for me, for not being able to travel in the winter & being treated like a crook. I have one parking ticket on my records so guess I deserve to be treated like a felon. Now you know why so many people have depression problems in the winter time here, because they can't leave for the winter like they use to do.

  15. Roger Cornelius
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    Roger Cornelius - October 19, 2013 12:21 pm
    barry freed,

    Once the Republican leadership in this state find that it politically expedient and financially rewarding for them they will except Medicaid expansion.

    The problem seems to be that they have not figured out to make a government and personal profit off the program. Don't worry, they'll find a way to line their pockets eventually.

    I can hardly wait to hear their excuse when they do.
  16. Roger Cornelius
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    Roger Cornelius - October 19, 2013 12:16 pm
    A simple answer to a simple question.

    Why are insurance going up?
    Under the pretext that ACA is bad for them, insurance companies are raising premiums for one simple reason. It is call corporate greed.
  17. Roger Cornelius
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    Roger Cornelius - October 19, 2013 12:13 pm

    Are you suggesting the government set up a "charity panel"? And, what would the criteria be to be eligible for government charity

    And wouldn't that be similar to Sarah Palin's "death panel"?

    It is wishful thinking that the solution is to get the government out of healthcare, the doctors, corporate hospitals, lawyers, lobbyist, et al, need that government welfare to live in luxury.
  18. Common Man
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    Common Man - October 19, 2013 11:57 am
    You do understand that this same paper did an article some time back about doctors who were going to quit taking any additional Medicare and Medicaid patients. So an expansion of Medicaid still won't amount to anything since not 90% of the doctors in SD will even accept it. Pretty soon it will be only accepted at Hospital ERs with the doctor on staff being the one to tend to these people. Would you want to go to school for 12 years and rack up hundreds of thousands in loans just to have the government tell you what you can charge folks? So where does the expansion of this program get but more crowded ERs and lesser quality doctors to tend to these folks.
  19. bluestem
    Report Abuse
    bluestem - October 19, 2013 10:48 am
    I hope that 90% of SD physicians unite to support expanded Medicaid. I know too many individuals who cannot go without it, and individuals who are likely to die without it; our physicians certainly know the seriousness of the problem. I know they will see patients for free, but many patients won't run the gamut of the front office to get to the doctor.
  20. Obtuseangler
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    Obtuseangler - October 19, 2013 9:13 am
    In a free market system, doctors would have to adjust prices to what the market would bear. This would radically decrease healthcare costs. It is understandable that doctors would prefer to increase the dollars available for healthcare rather than decrease prices. Unfortunately, these dollars will ultimately come from consumers of healthcare, taxpayers, and further decrease their ability to pay for their own healthcare. Those eligible for Medicaid are undoubtedly eligible for free or low cost health insurance through the ACA. By having them insured in that way, the state is not directly vulnerable for increased costs. Of course, the taxpayer will be picking up the tab in either case. Ultimately, providing taxpayer subsidized medical care to a large segment of the population decreases the incentive of that segment of the population to pay its own way, and decreases the assets available to those who truly are unable to provide for themselves.

    The solution? Get government out of the charity business except in the most extreme cases. Allow healthcare prices to fall to a sustainable level by eliminating most subsidies. Increase the incentives for people to be productive by decreasing public assistance, which will both lower government expenditures and increase tax revenue.

    If government would subsidize my vehicle purchases I would drive a new Cadillac and stay home. Since I have to pay for my vehicle myself, I drive a five year old truck and work to pay for it. That's how the market works for all things, including healthcare.
  21. trustno1
    Report Abuse
    trustno1 - October 19, 2013 7:28 am
    The argument that the fed might renege on it's obligations is the same kind of logic that the T-Party used to justify the government shut-down, which is to say flawed. The allegiance to some phantom constituency, probably a few monied interests, is starting to negatively impact a majority of Americans.
  22. Shorty
    Report Abuse
    Shorty - October 19, 2013 7:10 am
    Proving once again, republican leaders can't see the forest because of the trees.
  23. Rhudedog
    Report Abuse
    Rhudedog - October 19, 2013 7:02 am
    Aren't there any journalists around questioning WHY insurance premiums are going up and WHY doctors would want this? Thanks again to Obamacare regulations premiums will be going up (not down as promised). When will journalists get tired of Obama's lies?
  24. barry freed
    Report Abuse
    barry freed - October 19, 2013 6:10 am
    The Governor is is happy to take ALL of the other Federal money offered with the expectation that the Federal Gov. will continue the funding, but he doesn't trust them with only one program: the ACA.
    If that is truly his primary concern as presented by the writer, why does the Governor imply that the 48,000 uninsured are deadbeats by referriing to them as: "Able bodied"?

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