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SD doctor: Expand Medicaid

Dr. Daniel Heinemann says the failure to expand Medicaid under the Patient Protection and Affordable Care Act will leave thousands of South Dakotans without insurance. Heinemann, of Canton, is the president of the South Dakota State Medical Association, an organization of more than 2,000 physicians, residents and medical students dedicated to protecting health care interests of patients and enhancing effectiveness of physicians throughout the state.

Heinemann was in Mitchell recently to meet with local doctors who make up the Mitchell District Medical Society and discuss issues in health care for next month’s legislative session. The organization he represents is in favor of expanding Medicaid, or health care for the needy, funded by the state and federal government.

Under the Medicaid expansion, all people earning up to 138 percent of the poverty level would be eligible. That includes single people earning up to $15,451 and families of four earning up to $31,809. South Dakota’s Medicaid program now covers about 116,000 children, adults and disabled people. The expanded eligibility would add an estimated 48,000 people, mostly adults without children.

“Unless there’s an expansion of Medicaid and the state government helps to pay for that, those people are not going to be able to get insurance,” Heinemann said.

  South Dakota Gov. Dennis Daugaard told state lawmakers during his budget address earlier this month that he is not recommending the Medicaid expansion.

Daugaard said the federal government is having trouble putting the Affordable Care Act into effect, as evidenced most noticeably by the rampant problems with the website for the new health insurance exchanges. He also wonders whether the federal government can meet its pledge to pay most of the cost of expansion, given federal budget deficits.

Heinemann said the expansion of Medicaid would help give more people access to insurance and in turn help with preventative care, rather than reactive care.

“In this country, we’ve determined insurance is the way you access the system,” he said. “If you don’t have insurance, you tend to access the system later and in an emergency. We know that people who have insurance live longer and live healthier. We would argue that if insurance is the access ticket, we should do whatever we can to increase the number of people who have insurance. And if they can’t afford to pay for it, that’s where we say we should be expanding Medicaid.”

Heinemann met with about 30 to 35 doctors at Chef Louie’s and talked about Medicaid and Medicare reforms, improving public health, expanding access to health care and medical liability reforms, among other topics. The stop was one of 12 that Heinemann will make on his tour of the 12 medical districts in the state.

Originally, the Affordable Care Act required Medicaid’s expansion, and states that did not comply risked losing all of their federal Medicaid funding. But the U.S. Supreme Court in June 2012 ruled that the federal government could not withhold those funds if states did not expand Medicaid. As a result, states have been given the choice to expand or decline expansion annually.

The federal government would cover the costs added to Medicaid’s rolls from 2014 through 2016, and the state’s contribution would rise in stages to 10 percent of the costs by 2020.

The South Dakota Association of Healthcare Organizations has also publicly supported Medicaid expansion in South Dakota.

Dave Hewett, president of the Association of Healthcare Organizations, said hospitals and nursing homes will continue to urge the Legislature to expand Medicaid. An expansion would hold down private insurance costs because hospitals would not have to charge other patients as much to cover losses for free care given to low-income people, he said.

Hospitals nationwide have already taken a cut in Medicare reimbursements to help the federal government pay for the health care overhaul, he said. Hewett said supporters of expanding Medicaid know they face an uphill battle in the upcoming legislative session.

“We may not be successful this year, but the important thing is to keep the issue in front of our elected officials and bring to light any new information that might change some minds,” Hewett told The Associated Press.