South Dakota legislators have mixed feelings about Medicaid expansion

Dec. 20--Gov. Dennis Daugaard's plan to expand Medicaid services in South Dakota will likely monopolize much of the 2016 legislative session, as not all legislators are behind his proposal.

Previously, Daugaard had been opposed to expansion because of the cost and the tie to the federal health care program. But he believes he's found a way to offset the expense if he can reach an agreement with the federal government about fully covering health care costs for American Indians.

Expansion of Medicaid is part of the Affordable Care Act's intention of providing health insurance for everyone. As it sits now, low-income adults are not covered by Medicaid, but their income also isn't high enough to get private insurance on the open market.

District 1 Rep. Dennis Feickert, D-Aberdeen, said it's time South Dakota expanded coverage. He recalled one of Daugaard's first budget addresses where he talked about, "kicking the can down the road.

"That's what we've done with this expansion,"Feickert said. "We've kicked the can down the road long enough."

Feickert said he's not opposed to seeing if the federal government can pay its fair share with American Indian medical costs.

"On the other side, I wonder how many have died because they haven't had the medical care they would have gotten," he said.

District 3 Rep. Al Novstrup, R-Aberdeen, said the state has been trying to get the federal government to fully cover American Indian health care costs for decades.

"His presentation gets us to break-even and doesn't cost us money," Novstrup said. "How I've received that is a wait-and-see attitude."

Novstrup said there are two sides to the issue, and he'd like to hear both sides before making up his mind.

The expansion of Medicaid coverage hinges on the federal government accepting responsibility for roughly $67 million in new annual expenses from South Dakota. While South Dakota is the primary beneficiary from the plan, Novstrup said, other states with American Indian populations benefit as well.

Novstrup said the request also asks the federal government to shoulder a new expense that adds to the nation's nearly $18.8 trillion deficit.

District 3 Sen. David Novstrup, R-Aberdeen, said he's also hesitant to fully support Medicaid expansion. He is Al Novstrup's son.

"I don't know all the details, and there's a lot of pieces that need to come together," he said.

David Novstrup said the plan will need to work for everyone, but he is sympathetic to those who don't currently have the medical coverage they need.

"It's crazy that the federal law left the most unfortunate people out," he said.

David Novstrup said the Affordable Care Act originally required states to expand Medicaid, but a Supreme Court ruling made expansion optional.

"It's impacting everybody to some degree now," he said. "So, how do we want to do it? Write it off as charity care or expand Medicaid and insure the 50,000 to 55,000 people?"

District 1 Rep. Steven McCleery, D-Sisseton, said he's pleased the governor has pitched the plan. As a member of the board of directors for the Coteau Des Prairies Hospital in Sisseton, McCleery said he sees the effect of the current system because 55 percent of the hospital's patients are American Indians.

"When the reimbursement doesn't come in 100 percent, that's on our back," he said.

Sisseton used to have an Indian Health Services hospital, but it's now closed, so the only American Indian-specific choice is a clinic outside of town. He said the result is that there's a higher prevalence for emergency room calls.

"We run 9,000 to 10,000 calls in a year," he said. "A lot of the ER calls are people who don't take advantage of going to the clinic during work hours."

While he sees the need for change, McCleery said convincing the Legislature that change is needed might be a challenge.

"I think it's going to be more of an uphill battle for the administration and the governor," he said. "There's a segment (in the Legislature) that doesn't want to go that route because of the cost. If we'd done that already, we would have already saved. To me, this is a windfall for the state and for those 55,000 people we'll bring back."

The fiscally conservative governor's proposal is unusual in that Daugaard is getting support from many Democrats while right-leaning lawmakers aren't convinced.

District 2 Sen. Brock Greenfield, R-Clark, said Daugaard's plan is going to require further discussion.

"This certainly is something that sounds favorable," he said. "Sometimes things that appear too good to be are."

Greenfield said he sympathizes with those who don't presently qualify for coverage, but said Daugaard's plan hinges on the federal government's continued coverage of 90 percent of the cost for additional enrollees.

"The federal government has a track record of offering their manna from heaven, then saying they can't afford that anymore and asking states to pick up a greater share," Greenfield said. "We know the federal government is spending us into oblivion. Where do we go in five years when they say it's not working any more?"

District 2 Rep. Lana Greenfield, R-Doland, also spoke cautiously about the governor's proposal. She is Brock Greenfield's mother.

While she admits the current America Indian health care system is flawed, she said the state needs to look beyond 2021. It needs to know what its financial obligation would be for Medicaid coverage and have a firm grasp on how many potential enrollments there will be.

Lana Greenfield said she's reviewed what's happened in other states that have expanded Medicaid and found instances where actual Medicaid enrollment is double or triple the projections.

"When you're dealing with projections, you have no idea where it's going from there. At this time, I'm not in favor of Medicaid expansion. There's too many gray areas," she said.

She also pointed out the federal government's history of withdrawing promised funding or shifting more of the burden on the states.

"That would be scary," she said. "This would bankrupt us. We don't want to take more on and have it blow up in our faces."

Follow @ElisaSand_aanon Twitter.

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