South Dakota lawmakers debate Medicaid expansion - KTIV News 4 Sioux City IA: News, Weather and Sports

South Dakota lawmakers debate Medicaid expansion


A battle is brewing in the South Dakota legislature over the future of health care.

Thousands of South Dakotans could be covered under a new federal provision on Medicaid.  Some lawmakers say the reward isn't worth the risk of taking the federal government up on its offer to pay for the expansion.

"We need Medicaid," said Democratic Senator Tom Jones, of Viborg.

Health care is always a hot topic in Pierre, but this year it's taken center stage.

"Whether we should expand Medicaid and insure these 48,000 South Dakotans who have no health care, that's the biggest public policy decision we face out here," said House Minority Leader Bernie Hunhoff, of Yankton.

A provision in the Affordable Care Act that went into effect January 1st, allows states to expand Medicaid on the federal government's dime.

"We have issues where the federal government has pulled the rug out from underneath us," said Majority Whip in the Senate, Dan Lederman.

Lederman points to the Lewis and Clark Rural Water project, where federal funding has dried up, leaving communities on the hook.

"Why would we want to put people in a position where they're going to be dependent upon a system that isn't going to provide the results that it promises," added Lederman.

"If we don't trust the federal government, then I guess we should just go on into the budget and look for places where we've got partnerships with the federal government," Rep. Hunhoff said.

The plan pays for 100% of the costs to expand Medicaid in every state, phasing down to 90% by the year 2020. But, right now the state isn't getting any of those federal funds.

"I admit, I am concerned about the amount of dollars that our state is forfeiting in a sense, by not being a part of it," said Representative Mike Stevens, a Republican from Yankton.

However, Stevens and other Republicans are worried about the long term effect on the state's finances.

"I feel strongly that everyone should have good health care, but we also are working with a budget," said Representative Nancy Rasmussen, a Republican from Hurley.

"You've got to get accountability by those receiving the services,” added Senator Jean Hunhoff, (R) Yankton.

Senator Hunhoff who works in health care says the state should set the criteria, more accountability, ownership for providers, and a trigger to pull out if the federal government doesn't hold up its end of the bargain.

"You cover those three things, I think we could do something with Medicaid expansion," Sen. Hunhoff said.

Governor Dennis Daugaard has asked for a waiver to allow for a partial expansion. The federal standard covers people who fall up to 138% of the poverty level. His administration is pushing for just 100%. Expanded Medicaid would be offered to those who are employed or the recently unemployed.

"Really help those who can't help themselves, but are trying," Lederman

Some lawmakers say they want to put on the brakes and let other states be the guinea pig.

"Even with waivers, once you're in it you're in it, and you're not going to get out of it," Rep. Stevens said.

However, that's exactly where some in legislators think South Dakota should be.

"I think we should go for a full expansion," said Rep. Ray Ring, (D) Vermillion.

"Democrats need to accept that it's not perfect. That it needs reform. Republicans need to understand that it's the law of the land," Rep. Bernie Hunhoff.

Next week, members of the state house will debate a bill to put the issue to a vote on the next election.  A state senate committee killed a similar bill this week.

A survey by the American Cancer Society's Cancer Action Network found 63% of South Dakota residents support Medicaid expansion.

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