TV salvo aimed at Daugaard Medicaid plan

A conservative group that opposes Medicaid expansion is upping the ante in its campaign against Gov. Dennis Daugaard’s plan to expand the program.

Americans for Prosperity plans to run a television ad critical of the governor’s proposal during Thursday’s Republican presidential debate, which takes place in Houston and airing on CNN. The ad’s timing aims at having maximum effect by mobilizing Republicans who will likely be watching.

Medicaid expansion was part of the Affordable Care Act, or Obamacare. States were originally required to expand the program to more of the working poor, but a Supreme Court decision that upheld the constitutionality of Obamacare struck down the requirement that states expand Medicaid, making it voluntary.

South Dakota is one of about two dozen states that haven’t expanded Medicaid, a government health program financed by the federal and state governments. Under the terms of the Affordable Care Act, the federal government would initially pick up 100 percent of the cost of the additional population that would qualify for the program. That amount would eventually ratchet down to 90 percent over three years, leaving states to pick up the remaining 10 percent.

Until this year, Daugaard resisted calls for expansion, saying South Dakota can’t afford the additional 10 percent. But his administration has been trying to work out a deal in which the federal government would pay for 100 percent of all Indian health care. Currently, the state Medicaid program pays tens of millions a year for Native health care that occurs outside of Indian Health Services facilities. If the federal government were to pick up all of those costs, it would free up state money to expand Medicaid to working adults with incomes at 133 percent of the federal poverty limit.

The administration has not advanced a detailed plan to lawmakers because it hasn’t received solid numbers from the federal government yet, a development that could scuttle plans to expand the program in this legislative session.

Americans for Prosperity has already attacked the governor’s plan in radio ads played on conservative shows. The first round of ads criticized expansion because it would add an additional $400 million a year in federal spending at a time when the federal government is running massive deficits. Daugaard downplayed that concern, calling $400 million a “rounding error” in the federal deficit.

The newest ad that GOP debate watchers will see questions whether the federal government can be trusted to uphold its end of the bargain on Medicaid expansion. The ad quickly scrolls through a list of federal scandals to downplay the federal government’s credibility.

“If the Legislature passes Obamacare’s Medicaid expansion, it puts South Dakota on the hook with Washington,” the narrator says. “And when the federal money dries up, South Dakota can expect budget shortfalls, leading to cuts to schools, roads and even tax increases.”

It concludes with a phone number to call lawmakers.

“While free money always sounds nice, the federal government doesn’t have a great track record with following through on its promises,” said Ben Lee, Americans for Prosperity’s state director. “South Dakota will have to come up with hundreds of millions of dollars when the federal government steps back its ‘promised’ contributions.”