It’s no surprise that Republican Gov. Dennis Daugaard couldn’t find enough support for Medicaid expansion to cover the working poor that was necessary to call a special legislative session.
He received a message in the Republican primary elections for several Senate seats earlier this month, with the victories by former Rep. Stace Nelson of Fulton, Rep. Lance Russell of Hot Springs and Sen. Phil Jensen of Rapid City.
But just as significantly, many Republican legislators elected in 2014 had emphasized in the past year they didn’t run for election promising Medicaid expansion.
Some were willing to consider Medicaid expansion on one condition: That state government wouldn’t have to pay anything for Indian Health Service patients’ care delivered outside the standard IHS system.
But when President Obama’s administration decided to stop requiring states to pay for part of IHS care when it occurs outside the IHS system, Daugaard lost that leverage.
Largely unacknowledged is the significance of Daugaard’s victory on the IHS funding question.
It promises to save millions of dollars annually for South Dakota’s state government. Now those dollars can be spent in other ways as the savings accumulate in the coming budget years.
Daugaard didn’t start as a supporter of the Medicaid expansion that is subsidized through the Affordable Care Act aka Obamacare. He, like many Republican legislators, didn’t know whether the federal government could be trusted and disagreed with spending money the federal government clearly doesn’t have
But in pursuing the IHS subsidy/Medicaid expansion trade-off, Daugaard sparked a revolution among South Dakota’s all-Republican delegation in Congress.
Suddenly senators John Thune and Mike Rounds and our one U.S. House member, Kristi Noem, took urgent interest in the Indian Health Service’s operations in South Dakota and nationally. Their records weren’t strong on the matter until 2016.
The poor service at IHS facilities that has been documented by them has only fed further suspicion of the IHS.
Four years ago South Dakota voters rejected a sales-tax increase, from 4 percent to 5 percent, that was intended to fund Medicaid expansion and teacher salaries. This year, Daugaard led the Legislature to raise the sales tax to 4.5 percent for teacher pay and property tax relief.
There was discontent but there wasn’t a backlash in the Republican legislative primaries earlier this month over the sales-tax increase approved by state lawmakers.
The inference became this: Voters wanted to support their schools but didn’t want to pay more for Medicaid services.
Raising the white flag on Medicaid expansion seemed inevitable once Daugaard received the IHS letter and won the sales-tax increase fight this year.
Medicaid expansion likely is dead for the 30 months remaining on Daugaard’s second and final term as governor. And for what it’s worth, he didn’t run for re-election on Medicaid expansion, either.