PIERRE | South Dakota Democrats will push to have the Legislature quickly expand Medicaid to cover thousands of additional low-income residents, but Republican Gov. Dennis Daugaard and GOP lawmakers say they need more time to study the potential costs.
Senate Democratic leader Jason Frerichs said the Medicaid expansion, which is part of the federal health care law, would cover an estimated 48,000 South Dakotans.
"It needs to be done, and we hope it will happen," said Frerichs, of Wilmot. "In most cases, these folks are not covered right now by some type of health insurance."
But House Republican Leader David Lust, of Rapid City, said lawmakers must first find out who would be covered by an expansion and, most importantly, whether the federal government can afford to pay its share. Much of the next legislative session, which opens Tuesday, will be spent seeking that information, he said.
"Until there's more information, more clarity, I think it would be irresponsible for anyone to reach a conclusion as to whether or not to expand Medicaid," Lust said.
The Republican governor had hoped President Barack Obama's health care overhaul would be stopped, but the Supreme Court upheld the law in June and Obama was re-elected in November. As a result, states have the option to expand Medicaid, with the federal government picking up most of the extra cost.
South Dakota's Medicaid program now covers about 116,000 children, adults and disabled people, or more than 14 percent of the state's population, at a cost of $300 million a year to the state. The expanded eligibility would add an estimated 48,000 people, mostly adults without children.
Daugaard — who believes health insurance decisions should be left up to each state — has said he does not favor expanding Medicaid when much of the federal law goes into effect in 2014, partly because he's uncertain of the federal government's ability to pay for it. But he said an expansion might be possible in 2015 or later, depending on how much the state would need to chip in and how much flexibility federal officials will allow.
The aim of the health care law is to help uninsured people get health insurance through online markets called exchanges, with many people getting federal aid to help pay premiums.
People with lower incomes — up to 138 percent of the federal poverty line under the law — would be covered by a Medicaid expansion, the cost of which the federal government would fully cover through 2016. The state's contribution would rise in stages to 10 percent, but South Dakota would face substantial extra costs in administrating a larger program.
Some governors have asked if they can do a partial expansion, and Daugaard had hoped to get some flexibility in determining eligible income levels and covered services. But the Obama administration in December said if states expand Medicaid only part way, they wouldn't get the three years of full federal funding provided under the law.
Doctors, hospitals and other health care businesses are urging the state to expand Medicaid, saying uninsured South Dakotans often delay getting medical care until they get very sick and go to hospital emergency rooms. Since they can't afford expensive emergency care, hospitals and clinics have to charge insured patients more to offset losses in charity care.
About 105,000 South Dakotans didn't have health insurance in 2010, according to the U.S. Census Bureau, but state officials have said their own survey shows 71,000 are uninsured.
House Democratic Leader Bernie Hunhoff of Yankton said the health care overhaul clearly will remain law, so South Dakota should do all it can under the law to provide health insurance. Because South Dakotans pay federal income taxes to support the expansion of Medicaid across the nation, the state should take the federal expansion money, he said.
"I do think when all the facts are on the table, it's going to look like a pretty fair and responsible deal. The fair and responsible decision would be to participate," Hunhoff said.
Rep. Brian Gosch, R-Rapid City, said it's a matter of studying the issue.
"I'm not saying we should or shouldn't. I don't have the information," Gosch said.