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Sen. Johnson to Gov. Daugaard: Unfair not to expand Medicaid

Refusing to expand Medicaid under Obamacare is much more than a political issue, it's a matter of life and death for thousands of South Dakotans, Sen. Tim Johnson, D-S.D., told Gov. Dennis Daugaard in a letter last week.

"Denying health care for 48,000 South Dakotans and millions of Americans is simply wrong," Johnson said in a news release. "Expanding Medicaid would provide our most vulnerable citizens with access to important preventive services and basic health care."

Johnson was one of 20 senators who signed a letter to 18 governors in states where Medicaid, the federal health insurance program for the poor, was not expanded under the Patient Protection and Affordable Care Act.

"By refusing to (expand Medicaid), these governors are denying millions of individuals access to life-saving health care and preventive health services," reads the news release announcing the letter.

During the 2014 legislative session in January, February and March, Daugaard and lawmakers tried to reach a compromise for a limited Medicaid expansion. The Obamacare legislation calls for states to expand Medicaid to all people whose income is up to 138 percent of the federal poverty level -- $15,700 for an individual or just under $31,721 for a family of four in South Dakota.

Daugaard had sought to expand coverage to 100 percent of poverty -- $11,670 for an individual or $23,850 for a family of four. The Obama administration rejected Daugaard's proposal.

Daugaard's communications director Tony VenHuizen said Johnson should work to get Daugaard's proposal accepted.

"The governor would certainly welcome any help Sen. Johnson and his colleagues can offer in asking the administration to reconsider the waiver request he made earlier this year," VenHuizen said.

If Daugaard were to change his position and seek an expansion of Medicaid to 138 percent of poverty, it's unclear how that might happen.

VenHuizen said because the Legislature must approve the state budget each year, lawmakers would need to approve Medicaid expansion via a vote on the state budget.

"The governor would not expand Medicaid without agreement from the Legislature," VenHuizen said. "The Legislature has to approve the state budget. If there was room in the budget, expansion could be done through a state plan amendment."

At the same time, the letter sent by the senators points out that the cost of Medicaid expansion would be fully covered by the federal government for the first three years, and would be funded at no less than 90 percent in following years -- "the highest federal match your state has ever received."

Without an expansion of Medicaid, about 6 million Americans and 48,000 South Dakotans are likely to still go without health insurance because they make too much to get Medicaid and too little to qualify for a tax credit through Obamacare's health insurance marketplace.

The senators also argue that Medicaid expansion is good for a state's economy, from helping small businesses with low-wage employees to boosting the bottom lines for hospitals and clinics.

"One recent study found that community health centers in states that are electing to not expand Medicaid will lose nearly $570 million in extra federal funding while centers in states that have expanded will gain up to $2.1 billion in new revenue," reads the letter. "Hospitals in states like yours across the country are collectively losing out on $130 billion in additional revenue."

A decision not to expand Medicaid is inherently unfair, the senators argue.

"Your state's decision not to expand health coverage is creating two Americas: one where millions are benefiting from preventive care and covered treatments while local economies get stronger and healthier by the day; and another where patients continue to show up to emergency rooms without a way to pay and the local economies are falling further and further behind," they write. "Again, we urge that you put politics aside and do the right thing in helping to expand Medicaid coverage to the millions of Americans who desperately need it."

In addition to Daugaard, letters were sent to Govs. Robert Bentley (R-Ala.), Sean Parnell (R-Alaska), Rick Scott (R-Fla.), Nathan Deal (R-Ga.), Butch Otter (R-Idaho), Sam Brownback (R-Kan.), Bobby Jindal (R-La.), Paul LePage (R-Maine), Phil Bryant (R-Mississippi), Dave Heineman (R-Neb.), Pat McCroy (R-N.C.), Mary Fallin (R-Okla.), Nikki Haley (R-S.C.), Bill Haslam (R-Tenn.), Rick Perry (R-Texas), Scott Walker (R-Wis.) and Matt Mead (R-Wyo.).

In addition to Johnson, the letter was signed by Sens. Chris Murphy (D-Conn.), Mark Begich (D-Alaska), Jay Rockefeller (D-W.Va.), Mary Landrieu (D-La.), Brian Schatz (D-Hawaii), Sheldon Whitehouse (D-R.I.), Barbara Boxer (D-Calif.), Kay Hagan (D-N.C.), Claire McCaskill (D-Mo.), Ben Cardin (D-Md.), Bernie Sanders (I-Vt.), Richard Blumenthal (D-Conn.), Tammy Baldwin (D-Wis.), Charles Schumer (D-N.Y.), Kirsten Gillibrand (D-N.Y.), Patty Murray (D-Wash.), Debbie Stabenow (D-Mich.), Martin Heinrich (D-N.M.) and Tom Harkin (D-Iowa).