Daugaard touts Medicaid expansion plan

Gov. Dennis Daugaard said he knows he'll have a tough sell in convincing a majority Republican Legislature to approve Medicaid expansion.

The Republican governor took his plan on the road Monday, meeting with legislators and business leaders in Sioux Falls.

In an interview with Argus Leader Media, Daugaard said he's crafted a plan designed to defend it against those who don't think it's "conservative enough."

"There may be some who are ideologically opposed, but most of them are fiscally conservative and this has the potential not just to cover expansion but to do better than that," Daugaard said.

Daugaard announced last week he'll try to expand Medicaid in South Dakota as part of his $4.8 billion budget plan, but only if a majority in the state Legislature approves it. The plan is linked to a separate proposal to shift 100 percent of costs for providing Medicaid-eligible Native Americans' health care services to the Indian Health Service (IHS) or tribes.

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Currently, Medicaid-eligible American Indians can choose to receive covered services from any provider that participates in a state's Medicaid program. Where those patients seek services can affect the rates the state and federal government have to pay.

Daugaard said expanding the program could extend eligibility to 55,000 additional South Dakota residents. South Dakota's Health Care Solutions Coalition continues to meet to discuss logistics of expanding the jointly funded federal and state health insurance program for needy people.

Many conservative lawmakers have said they don't plan to support Medicaid expansion, even if it is cost-neutral, and that they're unlikely to be swayed by the governor's presentation.

Daugaard said he'd talked to one legislator who walked out of the governor's budget address last week opposed to the plan. The governor said after he explained the specifics that lawmaker walked away with a different perspective.

"I moved a 'hell no' to a 'maybe,' and that's who this is for," Daugaard said. "I designed this to show to legislators who say, "We don't think this is right.'"

Daugaard introduced his proposal to a bipartisan group of about 20 legislators Monday and to the Downtown Sioux Falls Rotary Club.

Rep. Jim Bolin, R-Canton, who was at the meeting with legislators, said he entered skeptical of the proposal and walked out "leaning strongly against it."

"The presentation was very effectively done, but the fundamental issue remains that if we go down this road we will be even more dependent on federal funding," Bolin said.

State Rep. Elizabeth May, R-Kyle, said the proposal doesn't do enough to ensure that IHS provides effective health care for the state's Native Americans.

“I’m so afraid that we’re letting IHS off the hook," May said. “What infuriates me about the whole thing is we’re still going to have the incompetence."

May said she was unlikely to believe the feds would cover 100 percent of the cost for Native American health care. She said she has seen residents in her district sink into debt when IHS refused to refund the costs they incur for care.

“The treaty that the federal government entered in with the tribes said that they would cover their medical needs and that has been completely obliviated,” May said. “They’re not doing it.”

“Medicaid expansion isn’t going to fix any of that," she continued.

South Dakota previously balked at expanding Medicaid, citing potential costs to the state. In 2014, federal officials quashed a proposal that would have partially expanded coverage in South Dakota, covering residents earning up to 100 percent of poverty. That came out to about $11,670 for an individual or $23,850 for a family of four.

Though Daugaard said he would have a challenge in getting a majority in the Legislature, he was optimistic about the outcome.

“I don’t see it as frustrating. I see it as exciting because we have a chance to really help some folks who don’t have really good health care opportunities," Daugaard said.

Follow Dana Ferguson on Twitter @bydanaferguson