Governor Daugaard has been taking the lead in formulating a way to allow Medicaid Expansion in South Dakota to happen. He’s been working with the federal government to come up with a plan for expansion if there is no additional cost to the state. The idea is that the change in treatment of Indian Health Service related costs would save the state more money than it costs to expand.
However, not everyone agrees, and some argue that while it might look good on paper, we need to consider the effect on society an expansion of this nature represents. Watertown State Representative Lee Schoenbeck has been one of the legislature’s strongest voices in opposition to the expansion on that basis.
This week he’s authored a column on the topic which appeared in the Watertown Public Opinion, is on the Argus Leader’s web site, and has been provided to the SDWC for your reading:
Welfare Expansion Will Make South Dakota Sick
Medicaid is a federally designed welfare program, which Obamacare encourages states to expand. In the 17 states with statistics available on Medicaid expansion, on average 63% more individuals applied for this component of Obamacare than the states had projected. In November we were told this expansion would add 44,000 South Dakotans to the welfare rolls. By December that number had increased to 55,000. Based upon the experience of the other states, South Dakota would likely see almost 90,000 citizens added to the welfare rolls if we do this expansion. Over 10% more of our state’s population that would be looking to the remaining taxpayers for free health care. At least 75% of those new welfare recipients are able-bodied and without dependents.
State officials met with then-Obama HHS Secretary Sebelius and said South Dakota would consider expanding this welfare program if we could require the recipients to work. Seems like a reasonable request, the South Dakotans paying for the program have to work. Secretary Sebelius dismissed the request as a non-starter! The Obama administration’s refusal to consider this reasonable requirement is enlightening. It means they don’t care about health care coverage so much as they care about creating unrestricted government dependency. Encouraging pride and some level of self-reliance for welfare recipients through earning the benefits is unacceptable to the Obama administration.
Opposing more welfare is not foreclosing health care coverage, and our family has experience with this situation. When dad was home disabled, mom took a job as a kitchen aid at the local nursing home. I remember mom telling us she did it for the health insurance. For our family, it just seemed like a natural continuation of the teachings of commitment, hard-work, and responsibility that had always been our parents’ lives. Today the politicians would – by their policy positions – preach against those qualities and those actions. They would encourage welfare, instead of work. They would send a message to young people of the value of looking to the government, and not the values our parents taught us.
States that have bought into the Obamacare deal have largely underestimated the number of eligible welfare recipients, many by up to 100%. It’s easy to see why. Free concentrates and creates demand. Run an ad offering free anything, and see how much demand you will create. Now tell people that you have an option for free health care that only requires them to either not work or reduce their work – its not rocket science to understand the consequences. People will adjust their lives and income so that they can qualify for free.
Understand, this is a government welfare program, not a health program. If the goal was health, the federal government would require (or at least let state’s require) that the welfare recipient not smoke, and be on a program to manage obesity – two huge health care cost drivers. But, the Obama administration will not allow these conditions either.
These 90,000 new welfare recipients will have to pay no deductible and no copayment. The financial skin in the game that makes the taxpaying South Dakotan’s think twice about overusing expensive health care resources, doesn’t exist for the Medicaid recipient.
There are some big players in South Dakota exerting pressure on the Governor because they want access to these federal funds, but their gain comes at too great a cost to the citizens of this state. Today the Obamacare advocates describe their new arbitrary mark – taxpayer funded health care for all who keep their earnings below 138% of the poverty level – as the mark where we really are caring and loving. Given their way, in five years that number will be 175%, and if given enough time they will get to where they set out for at the beginning of this Obamacare march – government owned and operated health care.
There is no such thing as free federal money. The brunt of the higher cost of this new welfare program will fall on those current programs that rely on our current Medicaid appropriations – the impoverished elderly in our nursing homes and the severely disabled in our community based facilities – people that really need and deserve our welfare tax dollars. Unlike the Obama Administration, South Dakota lacks the ability to print money or go into debt. The South Dakota legislature needs to bring sanity to this debate.
Great article!
The only thing better than Schoenbeck prose is Schoenbeck poetry.
There once was a pheasant from Ft Pierre….
…that took 6 shot in the rear.
Anybody note the number of times Rep. Schoenbeck used the word, “welfare?” I lost count.
Heartless, blind tripe
Lee! nice job!
Our farmer’s get federal subsidies. Many (if not most) could be fairly described as millionaires. But somehow it’s wrong for the poor who need healthcare coverage to receive federal assistance through Medicaid expansion? Assistance that other States are already getting?
Even though it will cost the State more over time, I’m not sure you’re right about this, Lee. If I were poor, I’d be certain.
What will cost the state over time is Obamacare expansion—looks good up front; a lot of money for the state; then each year the state’s obligation grows and where does that money come from in the state budget?
Jimmy James you might have a roundabout point there. Ending subsidies to farmers and forcing them all to join the Federal Food Producer Union would allow them to set their own price level needed for maintaining profit; as most manufacturers do now, which would quadruple retail food prices. This would then force a lowering of overall overweight Americans and much lower overall healthcare costs. You are a genius.
Lee your Dad must have known, as mine did and said often; “There’s no such thing as a free cup of coffee!”
Ten or twelve years ago the states in our region were poised to build great long term solutions to making high risk health insurance coverage doable. Then things came to a halt and a few years later we find states had instead poised themselves to seamlessly enact so-called Obamacare, and Medicaid expansion instead. What an odious tradeoff; this “boon” has killed what chance we all had of seeing truly innovative care solutions in our lifetimes. Schoenbeck is correct, by the numbers this is like quenching a fire by dousing it with a bowl of fire.
http://m.content.healthaffairs.org/content/35/1/111.abstract
Lee,
I think this is good but I think you don’t highlight with appropriate emphasis two things:
1) The capacity of doctors/clinics willing to take more Medicaid patients is exhausted or nearly so. There is NO way you can add this much demand into the system and expect it not impact the care of all Medicaid patients. In reality, give a doctor the choice to take the people (working poor) who will become eligible under this program or those (often with challenges more than poverty) already straining the system and hard to care for? This proposal is bad for those most vulnerable among us.
2) We have the lowest workforce participation rate in 30 or 40 years. This low workforce participation rate is putting most of our entitlement or welfare programs on actuarial sand. Does anyone think expanding this program will increase workforce participation? The Schoenbeck family example demonstrates otherwise. If his mother would have had a free option vs. going back to work, she might have.
3) At the same time we have low labor participation in the economy, starter and low rung jobs go unfilled while the low-level dead-end jobs are all filled. Do we make our nation stronger by making dead-end jobs “good enough?”
What do our hospitals think of the Medicaid expansion proposal? Same question for the social services organizations and insurance companies. Who is lobbying on which side of this issue? I would like thoughts on that because I really am curious.
Jimmy James,
I’m sure the hospitals are for it. This will decrease their “charitable care*” expenses because they will have less uncollectible billings.
*The reason hospitals are non-profits (allows tax-deductible donations) and exempt from federal, state, local taxes is in exchange for providing “charitable care.” If we keep doing things to eliminate “charitable care,” at what point do we eliminate their preferential tax status?
Side-note on tax-deductible donations: I get to deduct the donation from my taxes and the hospital doesn’t have to pay taxes on the “revenue.”
So much of this piece is baseless conjecture. Let’s begin here. Obamacare hasn’t enticed the working poor to work less .
https://www.washingtonpost.com/news/wonk/wp/2016/01/06/one-of-the-biggest-fears-about-obamacare-never-happened/
You are correct Mr. Lansing the entire ACA a.k.a Obamacare debate is conjecture. However, Mr. Schoenbeck is correct in questioning the impact on the taxpaying citizen of South Dakota. Unlike you Mr. Lansing, South Dakotans will be left with the bill for a failed Washington policy that has not reached its’ goals anyplace. Tell me how it has reduced the cost of care, improved access, or made America more competitive? I for one believe education is our #1 priority and we should not consider any more programs that would impact it’s funding.
Mr. Lansing is physically in Colorado though mentally as he has repeatedly shown who knows! Regardless he is physically not a resident of South Dakota and will have to deal with the bill. We being actual South Dakota residents & taxpayers will be stuck with this as the Feds stick it to us at an increasing burdon! It is a very flawed program!
Amen!
I like this Schoenbeck fellow. He’d make a great majority leader next session.
He has a brain and thinks for himself.
I agree a very sharp fellow!
he’s over-rated — ask my wife 🙂
He’s a good solid guy, for a lawyer. 🙂