Is Medicaid expansion going to be a far more difficult sell than people think?

Pat Powers

There was an interesting comment in another post from State Representative Lee Schoenbeck, which could be a preview of one of the big legislative battles coming up next month in the State Legislative Session:

Lee Schoenbeck – December 23, 2015 at 3:53 pm

good discussion – I am concerned about what this Medicaid/Obamacare expansion will mean for both our state, and our party. If expanding the welfare rolls by adding 10% of our state’s population passes in an overwhelmingly GOP dominated legislature, there will be a lot of us asking: what’s the difference? And that will be a future challenge for the GOP in organizing and recruiting. 

I would really be surprised if it didn’t affect the enthusiasm of the people we ask to go out and organize and sell tickets to our large network of Lincoln Day Dinners.

Read that here.

Lee seems to think the Medicaid expansion represents a line in the sand for the soul of the GOP.  And let’s not forget about possible tax increases for education and county wants. 

Could the 2016 session be a battle royale on the GOP side of the aisle?

70 thoughts on “Is Medicaid expansion going to be a far more difficult sell than people think?”

  1. I think the answer is “yes.” Early scuttlebutt I’m hearing indicates much GOP legislative opposition to (or at least skepticism about) the concept.

    The challenge for opponents is that Medicaid expansion is designed to be written into the general appropriations bill (as additional state spending authority for federal money should HHS approve the proposed Medicaid expansion waiver). If the Appropriations Committee puts the expenditure authority in the general appropriations bill, the rest of Legislature would be faced with opposing the will of the Appropriations Committee *and* likely prolonging the session – or forcing a special session – wrangling over the always-last-to-pass bill.

  2. Gee, that sounds exactly like the DC government operates. Are we really becoming them???!! I believe Lee Schoenbeck is exactly right as to the ramifications if Medicaid is expanded. And sooner or later SD will be stuck with the bill, regardless of what those in power now or in the future say.

  3. The strategy of those who want the government to be the solution to everything utilizes the same tactics:

    1) Tempt States with programs with the statement: “It is federal money and not State money. Use it or lose it.” Now the program is an entitlement and has a new powerful co-advocate for the spending, a Governor and Legislature. The inertia to ever cut the program has become almost unsurmountable.

    2) Demonize opponents as being uncaring about whatever is the primary beneficiaries (poor, students, elderly, veterans, woman, children, etc.). Now the program and spending is immune from a debate about whether it is an effective program or in the common good.

    That said, I’m not going to let fear of liberal tactics stop me from supporting the right thing. If this is the right thing to do, it is the right thing to do and we should do it. However, the case has not been made to convince me. Because of the inertia against rolling back a program, the legislature needs to be extremely cautious and the Legislature needs to be thoroughly convinced. Even though it is not State money, federal money is my money too and I expect everyone spending my money to be diligent with it, even if it was initially entrusted to someone else.

  4. How about a complete overhaul of how Medicaid works. I know of people who are getting these benefits who truly do not deserve it. I know people who are milking the system for as long as they can get away with it. And I know of people who are encouraged to get on the government dole for Medicaid and all the other assorted handouts in lieu of working, even if those people are fully capable of and willing to work. Their social workers are encouraged to get them on the government dole vs personal responsibility. Maybe if a person is to receive Medicaid, that person should have to have a job and be drug tested (unless he/she has a TRUE disability, not the new Obama disability qualifications), and it should be a time limited thing. Maybe if these changes were instituted in Medicaid, I would be willing to accept Medicaid expansion, but until then, NO!

  5. Cheats, loafers, etc. are irrelevant to the discussion. Even if every one of them disappeared tomorrow, the numbers wouldn’t move enough to make a difference. The demographic bomb of the baby boom generation landing on all social programs dwarfs any other possible discussion we might have on benefits, taxes, eligibility, fraud etc.

    Caring for the elderly will be the number one function of government for the next 20 – 30 years and will break whatever system we have, whether Obama’s or a GOP alternative. There is no avoiding the problem. We as Republicans have to offer practical alternatives to the liberals “everything free for everybody”. I doubt DD’s plan is more than a short-term band-aid to bail out local governments for a few years and kick the can along some more.

  6. If Westra advocates for medicaid expansion he is handing the House majority leader position to Schoenbeck on a silver platter. This will be one of the most fascinating sessions in years. I’m glad we have people in the GOP and legislature that aren’t just rubber stamps for the Governor’s office.

    It’s about time. Schoenbeck is 1,000,000 times more tactful and wise than the nuts that throw stones at Daugaard most of the time so this will be a test that pushes the untested Governor’s office – he will be wishing he hired a more experienced team at the top for this fight.

    Schoenbeck would be the best Majority Leader in the GOP caucus in many years. Perhaps since Matt Michels.

    1. Matt Michels was never Majority Leader.
      Don’t think Gosch won’t do everything possible to stop expansion.

  8. I should have added one other tactic:

    Allowing Republicans to argue about “waste, fraud, abuse” for these reasons:

    1) As MHS points out, the cost to the system of cheaters isn’t as big as the cost of expansion. And related, it is impossible to design a system to keep out all cheaters.

    2) Expanding who is eligible just makes it easier for those who game the system (those referenced by Springer) while the proponents argue they will help pay for it by eliminating waste, fraud and abuse. Program eligibility has to be objective (vs. subjectively determining who “deserves” it). If the criteria is income, there is no practical way to keep out those willing to manage their income to maintain eligibility (not get married but just live with a significant other, not work overtime or a second job, etc.)

    3) Liberals can just say “I’m against waste fraud and abuse too.”

    One critical thing I want to get answered is this: At a time when increasing numbers of doctors are refusing to limit the number of Medicaid patients, by making another 10% of our population eligible for Medicaid, are we going to actually adversely impact the health care of those most vulnerable among us?

    1. Should read: At a time when increasing numbers of doctors limiting the number of Medicaid patients, by making another 10% of our population eligible for Medicaid, are we going to actually adversely impact the health care of those most vulnerable among us?

  9. The GOP has a soul? Funny. Especially when people like springer think they know people who should not be on welfare. You don’t know their situations because the reasons why they are on welfare are NONE of your business. You might think it’s your business but you are wrong.

    There are plenty of elderly folks who have to live in nursing homes who can’t afford it and rely on Medicaid to get the help they need. Would you rather they live by themselves and suffer? And there are plenty of elderly who can afford to pay their own monthly nursing home bill but depending on how long they live and how much money they have, the money could be wiped out. And then they rely on Medicaid to make up the difference for the amount they can’t pay.

    But have no fear, the SD DSS Estate Recoveries department is at the ready to claim the small remaining funds the person had left at the time of their death.

    1. In two cases I DO know people who should not be on welfare. One is the referenced person who was willing to work but was told not to by the social worker because she could get more living on the public dole than by working. Another is a person who has stayed in college for over 10 years, worked parttime sporadically, has a wife who could work but instead fancies herself an artist but has yet to make any money on it, and has 3 kids who have lived their entire lives on the public dole. I have another relative who did receive welfare for about 5 years, during which time she divorced a worthless husband, went to college (and on to get an MBA later after getting off welfare), and used the system like it is supposed to be — use it for only as long as necessary and then give back by working and paying into the system.

      And pardon me, it IS my business when I am the one paying their expenses!

  10. Medicaid is a distraction from the major liberal proposal for a one cent sales tax increase. Daugaard has succeeded in getting Schoenbeck to focus on the shiny object when the most serious threat to taxpayers is deliberately cloaked.

  11. One thing that has really annoyed me is that the cabinet secretaries are not conservative people in far too many cases. They are bureaucrats.

    1. I don’t know about cabinet secretaries but I do know that at least one DSS Estate Recoveries employee is a very conservative Republican who is anti-public assistance. Their opinions are on full display on Facebook. And note that if one does not want the world to see everything one posts, maintain the privacy settings. Otherwise, it’s fair game to be documented.

  13. TANSTAAFL (There Ain’t Not Such Thing As A Free Lunch)

    At best, exanding Medicaid is based on the “promise” of robbing Peter to pay Paul” for a short period of time, as Federal funding under ACA progressively declines to 90 percent after 2020. Assuming the federal government can even keep its promise to fund 90 percent of the cost of the expansion after 2020, the state would have to foot at least 10 percent of the cost, plus administrative costs (which can be hefty).

    We must also consider that, among the new enrollees in Medicaid, there will be those previously eligible but never enrolled. For these people, less generious the pre-ACA Federal Medical Assistance Percentage (FMAP) formula will apply.

    Medicaid is now the single largest and fastest-growing program in most state budgets.

    This is already blowing holes in state budgets, in states that have expanded enrollment. Even Ohio, whose Governor John Kasich is running for President as a “fiscal conservative,” has seen state spending on the program grow by $5.8 billion since 2011. The Ohio Department of Medicaid projects that by 2017 spending will increase 59% during his term in office.

    As Troy mentioned above, another important consideration should be that an increasing number of physicians are refusing to accept patients on Medicaid, as the reimbursement rates frequently fail to cover their expenses.

    The result is that enrollees skip routine doctor visits, illnesses and chronic conditions worsen, and patients end up seeking care the only place they can get it — in an emergency room.

    Simply increasing the number of people “covered” by Medicaid, is no guarantee of improving either access or quality of care, but it will become an ever increasing obligation once its embedded into the budget as an entitlement.

    1. I wonder if you would still feel the same way if you end up in a nursing home some day and you live long enough and all your money is expended on your care. And then you need Medicaid to make up the difference between your monthly pension and the bill from the nursing home.

          1. If there’s an iron rule in economics, it is Stein’s Law (named after Herb Stein, former chairman of the Council of Economic Advisers): “If something cannot go on forever, it will stop.”

            1. Congratulations on proving my point. You have to quote someone else to pretend you know everything about everything. So, when will Medicaid come to an end? Month, date, year and time?

      2. How would you like to be stuck in a nursing home where the ratio of private pay to Title XIX clients shifted from 3:1 to 1:3 over the course of a few years, causing the facility to cut staff so drastically there was nobody left to take care of you, and you lie in your own waste for 8 hours every night? And if you fall out of bed at night, the staff puts a pillow under your head, covers you with a blanket and leaves you there until day shift arrives with the manpower to pick you up? Where the adult diapers are rationed and you only get two per day? Where the meals are so bad, supper menus consist of things like naked elbow macaroni with no cheese, peanut butter and no jelly sandwiches, and Easter Dinner is one piece of deli sliced ham wrapped around a pickle and fastened with a toothpick? Do you want to be an elderly person living in a place like that? What do you think happens in nursing homes when the money runs out??

        1. He’ll have a definite answer for you when he’s tooling around a Madison nursing home trying to remember where his room is.

  17. Such compassion from the “white privileged” is pitiful.
    “In whom do you have a difficult time recognizing the face of Christ?” – Pope Francis

    1. Compassion cannot provided by proxy.

      There is nothing charitable about taxes. No matter how they’re used.

      There is nothing compassionate about Government social programs.

      1. Mr. Beal;

        Please forgive Mr. Porter. He comes from an area where only the Government can show compassion, and the art of giving is consider a crime. He has yet to embrace the idea of freedom.

    2. Comrade Lansing, Socialism utterly failed in the Soviet Union, North Korea, Cuba and their proxies. Government is not a charity!

      Next thing is you socialist will want your Devils Weed and other drugs provided free by ObamaCare!

  18. Creating a permanent entitlement class is not concern for the poor. It’s what liberals do so they can claim to care about the poor

    2. ‘Liberals’ have to care about them because malevolent Republicans only care about themselves. Like you.

  20. Not one soul on this blog is farther away from welfare than fate would dictate. Bless you all.

  21. It’s Christmas Eve. It’s fitting to recall Ebenezer Scrooge, when he was asked to give a bit to the poor. “Are there no workhouses? Are there no prisons? I just want to be left alone.”

  22. Exactly! He was asked to give to the poor.
    The IRS did not seize his assets
    His home was not raided by ATF agents
    His business dealing were not part of a FBI investigation

    The act of giving is a gift within itself. yet, still you want to take.

  23. I’ll be curious to see if this is dead on arrival.

    When Dems are praising Daugaard and the GOP is booing you know the governor is on the wrong side of his base.

  24. William,

    Good points.

    Compassion and proxy are by definition mutually exclusive. Compassion can’t be delegated.

    Charity and taxes are by definition mutually exclusive. Charity must be freely given and taxes point a gun at our heads.

    And, just as a heroine dealer isn’t being compassionate when he says “this will make all your problems go away”, the liberals promises of “caring” is really just a perverted need to have others dependent on them so they can feel superior.

    Thanks for the Christmas present William. Merry Christmas as I AM has come to live with us.

    1. Another malevolent, narcissistic Republican who believes he knows the answers to everything just to make himself feel superior. Happy Holidays!

  26. If anyone here truly wants to see kindness and love and caring and free will giving and compassion and Christian prevalence go spend a day at any Shriners Hospital. You will leave feeling more blessed by just being there seeing what goes on than any other place you will ever go to.

    Merry Christmas all.

  27. Anon 11:37 of course “we who are entering the old fart age want others to care about us all who were born perfect and lived long wonderful lives” but those children born with abnormalities into families with little or nothing need someone to care about their future too.

  28. There is a real simple solution for you Republicans on this issue, or this political dichotomy I should say. If only your “fat cat” Republican contributors in this state would pay their deserving employees a higher wage, then not so many South Dakotans would qualify for Medicaid to begin with….. and thus your dichotomy would then be solved or dissolved as you adventure into 2016 and beyond…..

  29. Anonymous December 25, 11:12 am:

    Presume all those are true about me, your comments are still irrelevant and a logic fallacy to the points William makes or my additions to them.

    1. Okay, I’ll bite. ‘Compassion’ and ‘proxy’ as words are no more mutually exclusive ‘by definition’ than are the words ‘intelligence’ and ‘lawyer’.

      Your perspective seems to invalidate two key tenents of civilization, Troy: ‘social contract’ and ‘representative government; substituting instead some vaugue (ans seemingly selfish) notion that society in general is incapable of having a collective conscience. Sorry, but that’s the aspect of libertarian thought that I reject conceptually.

      To conflate the idea of personal responsibility to the point where it negates the notion of social responsibility runs counter to the humanitarian potential of both ‘church’ and ‘state’ and invites tyranny and or anarchy in their wake. The result is bad faith, bad government and ultimately no faith in either ‘we the people’ or their government.

      That said, I won’t impugn you or William personally. You both are better thinkers than to have written and truly believe what you wrote above. I’m thinking you might just need better dictionaries? Happy new year fellas.

      2. A non-response that claims definitions include or exclude is simply a vain effort to avoid addressing the issues. And then to pile on statements about irrelevance and fallacies is to completely misunderstand & misapply those words to again avoid the issues as if such a debate is beneath the vanity of the writer.

        At least Bill tries to tackle the issues straight on.

        keep it going bill.

      3. To rephrase your statement above: (and unsure of your meaning with the word conflate, I changed it to a more sensible word)

        ‘To inflate the idea of SOCIAL responsibility to the point where it negates the notion of PERSONAL responsibility….’

        This is where this nation seems to be at this point, the idea that the government can solve all our problems and we don’t have to be personally responsible for any of our choices or outcomes. Fact is that the government cannot solve all our problems and was never meant to.

        1. Not surprised you had to change the word so you could understand. Simple minds are challenging. If you are ever involved in a natural or man made catastrophy, then please rely on yourself for help. And not the local, state or federal governments.

          1. I did look up the word conflate just to make sure; that IS how I expand my vocabulary. You stated, “To conflate (fuse or confuse, take your pick) the idea of personal responsibility to the point where it negates the notion of social responsibility…” And I just thought that inflate would be more appropriate here since the government is INFLATING the idea of social responsibility to the detriment of personal responsibility. No one is arguing that social responsibility is necessary to a certain degree, but so is personal responsibility, and that is being lost in today’s discussion of the government owes me free or subsidized housing, higher education, health care, a job, etc etc.

    2. According to you, your Lordship. The ‘points’ you two make are based on fallacies and conjecture. And personal opinion which makes them irrelevant. But you’re entitled to your feel-good moments.

  30. Compassion is a personal act. Proxy is to do itself or for another. By definition mutually exclusive if the definition of words mean anything.

    Charity must be a voluntary act and taxes are a forced act. Mutually exclusive by definition if the definition of words mean anything.

    Bill, to your point, societal responsibilies are not matters of compassion nor charity but responsibilities grounded in the social contract which may justify (root word is just which goes to justice which is giving another their due) many societal acts but that is another matter.

    1. Are you sayingthen Troy That it would be impossible by definition for you to appoint a compassionate proxy? Knowing you, I would be suprised to learn that you would settle for anything less. You’re trying too hard to make a semantic distincton where none is warranted, my friend. Not sure why, but you should stop it. There are better ways to present your argument. Corruption and bad faith in governmrnt for example. Choosing the wrong proxy, etc.
      Reread my critique above and think it through. Your reply to me was just more of the same argle-bargle. 🙂

      1. To put a little finer point on it, Troy, both The Catholic Church, and The United Way are proxy organizations with (hopefully) compassion intentions.

        1. BF, of course both of those organizations are supported by those choosing to provide voluntary contributions and service 😉

          1. Paying taxes is also voluntary, William. At least that’s what they tell me. 😉 Point being, ‘proxy’ and ‘compassion’ are not mutually exclusive, but rather more like apples and cooked apples.

    2. One could be forced to make a charitable contribution and one could voluntarily pay a tax. Your superfluous arguments are old.

  31. Bill,

    Compassion: “sympathetic consciousness of others’ distress together with a desire to alleviate.” If you can be conscious by proxy, please give me an example.

    Charity: “benevolent goodwill toward or love of humanity.” Goodwill must be given voluntarily or it isn’t goodwill.

    Tax: “a charge usually of money imposed by authority on persons or property for public purposes.” If something is imposed, how can it truly be voluntary?

    Voluntary: “proceeding from the will or from one’s own choice or consent.”

    Bill, I don’t disagree one can use proxies to accomplish results or outcomes and are natural outgrowths of compassion and charity but not the thing itself. For instance, I can give to United Way for reasons other than compassion. Or, I can give to a panhandler out of compassion (expectation $ will be used for food) or I can withhold a gift out of compassion (expectation it will be used for booze) depending on how we evaluate the condition and needs of the person.

    1. The example most relevant to the topic at hand is the Bill of Rights of the US Constitution, and the Preamble, Troy, aka your Federal Government. 🙂

      1. If the Bill of Rights isn’t about compassion and empathy of the Founders for the citizens of their newly formed country, it’s not about anything. Another example is the sermon on the mount.

Comments are closed.