PIERRE | Some lawmakers and health care groups plan to ask the South Dakota Legislature next month to expand the state's Medicaid program to cover the medical costs of 48,000 more poor people, despite resistance from Gov. Dennis Daugaard.
Daugaard last week told state lawmakers that he is not recommending the Medicaid expansion, available to states as an option under the federal health care overhaul, as part of next year's state budget. He said the federal government is having trouble putting the entire overhaul into effect. He also wonders whether the federal government can meet its pledge to pay most of the cost of the expansion.
"I have continuing doubts about the federal government's ability to deliver on its promises," the Republican governor said.
But supporters said an expansion is needed to improve health care for poor people who now wait until they are seriously ill before seeking medical care. They said hospitals are not paid for that emergency care and cover the loss by boosting charges to patients with private insurance.
Cathy Brechtelsbauer of Sioux Falls, an advocate for low-income people, said she talks to many who don't qualify for Medicaid but can't afford to buy even the subsidized insurance available under the new health care law.
"I don't think we can sleep well at night until we get these people covered. These are our neighbors. These are our fellow citizens," Brechtelsbauer said.
Rep. Bernie Hunhoff of Yankton, leader of the House Democratic minority, said measures seeking to expand Medicaid will be introduced in the legislative session that opens Jan. 14, but lawmakers won't make a final decision until late in the session when they pass next year's state budget.
"That's a moral imperative. It should not be put off for another year," Hunhoff said. "Most of them are people who are working two or three part-time jobs with low wages. They are working hard trying to provide for themselves, but they cannot begin to buy health insurance in the marketplace."
President Barack Obama's health care law seeks to provide more people with insurance through subsidized private insurance offered through online marketplaces called exchanges. States also have the option of expanding Medicaid to cover people considered too poor to get the subsidized insurance.
South Dakota's Medicaid program now covers about 116,000 children, adults and disabled people. The expanded eligibility would add an estimated 48,000 people, mostly adults without children.
People earning up to 138 percent of the federal poverty level — $15,451 for a single person or $31,809 for a family of four — would be covered by an expansion. The federal government would fully cover those added to Medicaid's rolls through 2016, and the state's contribution would rise in stages to 10 percent of the medical costs by 2020.
Federal officials earlier rejected Daugaard's request that South Dakota be allowed to expand Medicaid eligibility only up to 100 percent of the poverty level because those over that mark can qualify for subsidized private insurance. He has said he likely will renew that request.
Senate Republican Leader Tim Rave of Baltic said he doubts the 2014 Legislature will agree to an expansion covering all the 48,000, but lawmakers would be open to accept a federal waiver that would expand Medicaid to cover some of those people.
"Certainly, everyone wants to do the right thing for the people who need assistance," Rave said. "We also are reluctant to jump at first into something that we may not be able to pay for going forward."
Brechtelsbauer, the advocate for low-income people, said many disabled people of modest incomes are not getting help with their medical bills. That's because they can't get coverage from Medicare, the program mostly for retired people, until two years after they start receiving Social Security disability benefits, she said.
Jessie Currie, 57, of Sioux Falls, wants to see Medicaid expanded because her medical bills have piled up since she hurt her back in 2009 and became unable to work. She won't start getting Medicare disability coverage until next November.
"Now I'm just trying to make it," Currie said.
The South Dakota State Medical Association and the South Dakota Association of Healthcare Organization support expanding Medicaid.
Dave Hewett, president of the Association of Healthcare Organizations, said hospitals and nursing homes will continue to urge the Legislature to expand Medicaid. An expansion would hold down private insurance costs because hospitals would not have to charge other patients as much to cover losses for free care given to low-income people, he said.
Hospitals nationwide have already taken a cut in Medicare reimbursements to help the federal government pay for the health care overhaul, he said.
Hewett said supporters of expanding Medicaid know they face an uphill battle in the upcoming legislative session.
"We may not be successful this year, but the important thing is to keep the issue in front of our elected officials and bring to light any new information that might change some minds," Hewett said.