MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Another good example of the use of Rule #8 from Alinsky’s Rules for Radicals.

 
 

 
 

Clipped from: https://www.northcarolinahealthnews.org/2023/01/11/this-state-could-be-the-last-one-for-a-while-anyway-to-expand-medicaid/

Stateline/ Pew Trusts

For years, state Sen. Phil Berger says, there was nobody in North Carolina who opposed Medicaid expansion under the Affordable Care Act more vehemently than he did.

“If there was somebody in the state of North Carolina that had spoken out publicly in opposition to Medicaid expansion more than me, I’d like to talk to that person,” Berger said in an interview last month. From the time the ACA passed in 2010 until last spring, “my attitude was Medicaid expansion was wrong for North Carolina,” he said.

Berger, a Republican, is president pro tempore of the North Carolina Senate, the most powerful position in the chamber, so his opposition virtually guaranteed that the legislature would not expand the joint federal/state program to include an additional 600,000 adults with low incomes.

That’s why Berger’s recent conversion from opponent to proponent has shot North Carolina to the top of the list of the states that are most likely to break ranks with the other 10 that have refused to expand Medicaid.

But it’s hard to imagine the other states doing the same anytime soon, which means that an estimated 6 million Americans will continue to be denied coverage.

In November, South Dakota became the 39^th state to approve expansion under the ACA, but it did so by a citizen-initiated ballot measure over the opposition of the state’s GOP governor and legislative leaders. Six other states also have expanded Medicaid that way. But among the holdouts, only Florida allows that option, and the pathway is so arduous there that proponents recently postponed their campaign for two years.

“We’re pretty close to the end” of expansion by way of citizen initiatives, said Kelly Hall, executive director of The Fairness Project, a national organization created to promote Medicaid expansion and other progressive goals through ballot initiatives.

Of course, it’s possible that GOP leaders in the remaining states, the largest of which is Texas, could have a change of heart like Berger did.

The North Carolinian said he had three objections to expansion: He feared that extending Medicaid coverage might discourage people from seeking work; he worried that the federal government could one day renege on its pledge to cover 90% of the cost of expansion, leaving states holding the bag; and he was concerned about adding to the unpredictability of North Carolina’s wildly fluctuating Medicaid expenses.

That last issue was resolved in 2021 with North Carolina’s transition to a Medicaid managed care system, which Berger says has made expenditures much more predictable. He abandoned his first objection, he said, after coming to realize that most of the younger, nondisabled adults who would be covered under expansion have jobs, are caregivers or are students.

As to the federal government backing out of its commitment on the federal match, Berger noted that it hasn’t done so under Democratic or Republican presidents, or with either party in control of Congress. “It ain’t going to happen,” he said.

Inducements for expansion

When former President Barack Obama signed the Affordable Care Act in 2010, it included a requirement that states expand Medicaid to enable all adults with low incomes to enroll in the program. In 2012, however, the U.S. Supreme Court ruled that Medicaid expansion was optional for states. Nearly half the states and Washington, D.C., expanded in 2014, as soon as the new law allowed, and more followed.

States that rejected expansion turned down substantial inducements. In the original Medicaid program, the federal government pays anywhere from 50% to nearly 78% in matching funds depending on a state’s per capita income. (Congress temporarily raised that federal match rate during the COVID-19 public health emergency.) But under the ACA, the federal match to cover the Medicaid expansion population is 90% for every state.

States that expanded Medicaid experienced job growth, particularly in the health care sector, as a result of the federal largesse. Expansion also reduced the amount hospitals needed to pay for uncompensated care, which was particularly helpful for financially strapped rural hospitals, many of which have closed in the past two decades.

In 2021, in response to the pandemic, the Biden administration added another inducement for the holdout states: a 5 percentage point bump in their federal match under traditional Medicaid for two years. That amounts to hundreds of millions of dollars in extra funding for those remaining states. Florida, for example, would pocket nearly $4 billion of extra federal money if it expanded, according to an analysis by Manatt Health, a research, legal and consulting organization. Mississippi would get $739 million.

“We’re losing money [in Mississippi] every minute we don’t expand, not to mention the human cost,” said Brandon Jones, campaign manager for the Southern Poverty Law Center, which supports Medicaid expansion.

Among the holdouts, only Florida allows for a ballot initiative process that could be used to expand Medicaid. (Wyoming’s law does not allow initiatives involving revenue or appropriations, as a Medicaid expansion would.) But even in Florida, the legislature has made qualifying for a ballot initiative so difficult that backers of Medicaid expansion recently decided to try to get on the ballot in 2026 rather than 2024 as they initially had intended.

“Given the complexities we have here in Florida that you don’t see in other states, even though the will of the people of Florida is there for expansion, but we need time to gather the funds to run a successful campaign,” said Jake Flaherty, campaign director of Florida Decides Healthcare, which is leading the expansion effort.

Flaherty acknowledged that hostility toward expansion from Republican Gov. Ron DeSantis and GOP leaders in the legislature make it virtually unthinkable that an expansion bill could pass. The same is true in many of the other holdout states, including Texas, where recently reelected Republican Gov. Greg Abbott and Lt. Gov. Dan Patrick remain staunchly opposed. Even if privately sympathetic to expansion, GOP lawmakers in Texas are unlikely to cross their party’s state leaders.

Ballot foreclosed in Mississippi

Until recently, Mississippi seemed to be fertile ground for a successful ballot campaign. In fact, several years ago, proponents of expansion launched an initiative campaign with an eye toward getting on the ballot in 2022. But in 2021, the state Supreme Court threw out the state’s ballot initiative process. The ruling pertained to an initiative concerning medical marijuana, but it scuttled the Medicaid expansion ballot campaign.

There have been proposals in the Mississippi legislature to devise a new initiative process that can withstand legal challenge. But for now, proponents of expansion say they don’t see a pathway, and passage in the legislature would have to overcome the steadfast opposition of Republican Gov. Tate Reeves and state House Speaker Philip Gunn.

The state’s GOP leaders remain opposed despite the fact that a majority of Mississippians want to see Medicaid expanded, according to polls. Jones, of the Southern Poverty Law Center, who is a former Mississippi House member, says his private conversations with Republican lawmakers have convinced him that they largely feel the same way. But, he said, they are fearful of crossing their leaders on the issue.

With Gunn’s announcement that he will not run again for his seat, Jones said he believes the legislature will eventually pass expansion.

“Do we do it this year? Probably not. It’s an election year, and we still have a speaker and a governor who are opposed,” Jones said. “But anything big we’ve ever done in Mississippi seems to happen real quickly … that’s what happened with changing the state flag. So, this could be the year it happens with Medicaid expansion.”

Reeves’ office didn’t respond to a request for comment, and Gunn’s office said he wasn’t available for an interview.

In Wyoming, proponents drew encouragement from state House passage of a Medicaid expansion bill for the first time in 2021, but the measure ran aground in the Senate that year.

Proponents in Kansas also have been heartened by newly reelected Democratic Gov. Laura Kelly’s plan to make another run at expansion next year. Polls there too indicate strong support for passage, with more than 70% in favor. Kansas is surrounded by states that have expanded. (Kansas does not have a citizen ballot initiative process. Last August’s referendum in which Kansas voters chose to keep abortion protections in the state constitution was placed on the ballot by the legislature.)

Nevertheless, April Holman, executive director of Alliance for a Healthy Kansas, a coalition of 128 Kansas organizations working toward expansion, said the Republican legislature and its leaders have proved impervious to popular opinion — though pressure is rising.

“For me, I’m always hopeful or I wouldn’t be able to do this work,” Holman said. “But it requires building a movement that is too large and too loud to ignore and that’s what we’ve been trying to do.”

Neither the new Republican House speaker in Kansas, Daniel Hawkins, nor Republican Senate President Ty Masterson responded to Stateline requests for comment.

That leaves North Carolina as the most likely domino to fall next. And if it does, Berger will be one of the key players toppling it.

Berger single-handedly changed the political landscape for expansion by announcing his support last year, putting himself alongside Democratic Gov. Roy Cooper, who has long advocated for expansion. The Senate passed expansion overwhelmingly in its 2022 session, but the bill failed to pass in the House, not because of objections to expansion itself but because of a provision that would have made it easier to create new health facilities or services in the state, which the hospital industry opposed.

Last year’s legislative session was the shorter one in its two-year cycle. As a result, Berger said, the House and Senate didn’t have time to negotiate their differences on the bill. This year, lawmakers will have more time, and Berger said he is optimistic about reaching a different result.

“I have told folks that I felt like by the time the two-year session is over, North Carolina will have expanded Medicaid,” he said. “There’s a deal in there somewhere.”

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This state could be the last one (for a while, anyway) to expand Medicaid

by Pew Trusts, North Carolina Health News
January 11, 2023

1

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: SD officials grudgingly begin to implement the expansion approved by the 3rd estate.

 
 

Clipped from: https://www.mitchellrepublic.com/news/south-dakota/gov-kristi-noem-state-departments-begin-process-to-implement-will-of-the-voters-in-medicaid-expansion

After passing with 56% of the vote, offering Medicaid benefits to an expanded population is now a part of the state constitution. Here’s what state officials have to do to meet the July 1 deadline.

 
 

House Speaker Hugh Bartels stands to applaud during Gov. Kristi Noem’s budget address on Dec. 6. Part of the new spending in Noem’s budget was $13 million this year to begin implementing the Medicaid expansion passed by the voters on Nov. 8, 2022.

Jason Harward / Forum News Service

SIOUX FALLS, S.D. — With language now etched into the South Dakota State Constitution requiring the state to provide Medicaid benefits to an expanded eligibility group, Gov. Kristi Noem and the state legislature are indicating they will implement the amendment as written.

“The legislature’s hands are tied,” said Rep. Kevin Jensen, who will chair the House Health and Human Services Committee this coming session. “Because of the constitutional amendment, we can’t do anything to change or restrict it other than pass another amendment. So the legislature, as far as I can see, our only role will be to either vote for the funding bill at the end of the year or vote against it.”

Timeline requires enrollments by July

The language of Initiated Amendment D, which passed with 56% of the vote on Nov. 8, makes clear the general process ahead of the Department of Social Services, which will oversee the expansion of Medicaid to adults between the ages of 18 and 64 with incomes below 138.5% of the federal poverty line.

By March 1, 2023, the department must submit an amended state plan to the federal divisions that oversee Medicaid. In a statement to Forum News Service, Laurie Gil, the secretary of the state Department of Social Services (DSS), said these amendments “will establish eligibility, benefits, and the delivery system for the expansion population.”

The amendment then requires that the program begin accepting applications and conferring these benefits on July 1, 2023.

“DSS currently anticipates accepting applications in July 2023, and we plan to communicate a more specific date for accepting applications in late spring 2023,” Gil wrote in the statement.

As currently constructed, the federal government covers 90% of health care costs incurred by those in the expansion population — according to the Bureau of Finance and Management,
52,000 South Dakotans are expected to be eligible for the program.

During the first two years of expansion, the federal government offers states a boost in funding as an incentive; these incentives are estimated to total $53 million in the first year.

On top of these incentives meant to offset parts of the initial cost, Noem during her budget address on Dec. 6 proposed an appropriation of just under $13 million in the first year of expansion.

South Dakota

Gov. Kristi Noem delivers South Dakota budget address, headlined by grocery tax cut, strong revenues

The budget, which features a topline dollar figure of $7.2 billion, makes investments in state employees, providers and the state’s correctional infrastructure. Noem will look to push her proposals through the legislature, which has final say on all spending matters.

December 06, 2022 03:55 PM

 · 

By  Jason Harward

The Bureau of Finance and Management says this will cover an additional 68 full-time DSS employees to administer expansion and “includes additional contingency funding on both healthcare cost and projected enrollment.”

Opposition could inform legislative actions

Even in appropriating those dollars, Noem continued to make clear her opposition to the program itself.

“Make no mistake, the expansion of Medicaid — as passed on the November ballot by the people of this state — is an expansion of a government program that will give free healthcare to a population of the state that the majority are able-bodied, single males,” Noem said.

While this statement is generally true when looking at state-level data (in Maine, for example, more than 86% of enrollees as of Oct. 1 are childless adults, 54% of whom are male), some legislators think that the economics of the program still make sense for the state.

“From a practical standpoint, these folks are the working poor,” said Sen. Sydney Davis, who will serve as the vice chair of the Senate Health and Human Services committee this session. “They have no resources for preventative health care, so they end up in the emergency room, with conditions that could have easily been prevented, and that is likely to now be more costly.”

Noem disagrees, saying during her speech that “costs exceeded their expectations” in every other state that has expanded Medicaid, a point that several legislators concur with. Noem estimated that, in the fifth year of implementation, the state would bear a cost of $80 million.

“A lot of people fear it could lead to a state income tax because at some point it’s going to cost us $100 million per year,” Rep. Kevin Jensen said.

Although enrollment does often exceed expectations, several states report savings in other areas of the general fund that make up for part of these overruns. In Montana, for example, direct savings from Medicaid expansion in 2021 totaled $27 million, largely from new federal dollars covering other state expenses

South Dakota’s Legislative Research Council estimated these savings at around $11 million per year, with the offsets mainly coming from “correctional healthcare, behavioral healthcare, and Indian Health services.”

Another concern for legislators is the potential for the federal government to change its end of the 90-10 cost share, which would not change South Dakota’s constitutional mandate and would simply increase the cost borne by the state.

Sen. Jean Hunhoff, the chair of the appropriations committee in the Senate, told Forum News Service in November that it might be wise for the state to save some of the federal dollar incentives coming into the state during the first two years to cover this potential risk.

“We would have to pick up all that extra that [federal dollars] were no longer picking up,” Hunhoff said. “I think we have to see how we can manage those dollars that are coming in and make sure those dollars go into a fund that is to cover a Medicaid expansion group.”

An additional ancillary appropriation that could increase enrollment would be some amount of one-time funding for outreach and education. While Shelly Ten Napel, the executive director of the Community HealthCare Association of the Dakotas, said efforts like these have had “really significant impacts” on enrollment rates in other states, the stomach for this sort of appropriation might be lacking.

“I really don’t see an appetite for it in the state legislature,” Davis said. “I think my colleagues will see that as a cost in addition to something that is already costing money.”

Though related appropriations are still speculative, Rep. Greg Jamison, a Republican who was a vocal proponent of expanding Medicaid, is certain that the legislature will at the very least appropriate the $13 million requested by the governor.

“There are a lot of my Republican friends who are not happy with it, and they may think that they could stop it or defund it or something, but they’ll realize that that’s not possible,” Jamison said. “The governor seemed a little bit begrudging but she played it pretty safe and did say it’s the will of the voters, so she definitely understands that.”

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: SD got expansion approved by voters 56% to 44%, but it may be the last state to push expansion through the ballot box.

 
 

Clipped from: https://www.politico.com/news/2022/11/09/south-dakota-expand-medicaid-health-care-coverage-midterms-00065911

The Republican-controlled state, where lawmakers have long resisted Medicaid expansion, is the seventh in the last five years to do so at the ballot box — and likely the last to do so for some time.

 
 

“We are thrilled by this victory, which took years of work, coalition building, and organizing to achieve,” said Kelly Hall, executive director of the Fairness Project, which helped pass the ballot measure. “Citizens took matters into their own hands to pass Medicaid expansion via ballot measure — showing us once again that if politicians won’t do their job, their constituents will step up and do it for them.”

Opponents of Medicaid expansion tried to make passage of the ballot measure more difficult through a June initiative, Amendment C, that would have raised the voter approval threshold to 60 percent. That measure was overwhelmingly defeated.

Under the American Rescue Plan, the federal government encouraged states to expand Medicaid by covering an extra 5 percent of the costs of the program, in addition to the 90 percent it covers for newly eligible individuals under Obamacare.

The Kaiser Family Foundation estimates those incentives will send $110 million to South Dakota.

Opponents of Medicaid expansion, including Republican Gov. Kristi Noem, argued the measure would cost the state in the long run, force lawmakers to raise taxes, and discourage able-bodied adults from getting jobs. Proponents, meanwhile, pointed to the program’s success in the 38 other states that have implemented it over the last decade.

More than 17 million low-income Americans have gained coverage as a result of Medicaid expansion, a portion of the Affordable Care Act that was made optional as a result of a 2012 Supreme Court decision.

The South Dakota vote signals the end of an era for expanding Medicaid ballot box. Of the 11 states that still have yet to expand Medicaid, only three — Florida, Mississippi and Wyoming — have a voter-initiated ballot measure process, and none appear likely to take up the proposal in the short term.

In Florida, a 60 percent voter approval threshold makes passing ballot measures challenging. In Mississippi, the state Supreme Court effectively threw out the state’s ballot initiative process. And in Wyoming, proponents are pushing to expand Medicaid through the legislative process rather than at the ballot box.

Supporters of the measure included the South Dakota State Medical Association, the Greater Sioux Falls Chamber of Commerce and the South Dakota Farmers Union.
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Right now the yeses have it at 62%. Just in time for the PHE wind-down.

 
 

 
 

Medicaid expansion(WITN)

RAPID CITY, S.D. (KEVN) – As the November midterm elections approach, voters are focused on a wide variety of candidates and issues.

However, as one recent poll shows voters could also be looking to expand healthcare access in South Dakota.

A state-wide poll conducted in late August confirmed what officials from the American Cancer Society say they’ve known for a while.

“South Dakotans want to see Medicaid expanded and the majority of voters, 62%, plan to support Amendment D in November,” stated David Benson, Senior State and Local Campaigns Manager for the American Cancer Society.

Amendment D would amend the South Dakota state constitution and provide Medicaid benefits to people ages 18-65 with an income at or below 133% of the federal poverty level.

This would expand access to health care for thousands of South Dakotans.

“Those that may not afford health insurance on their own or they’re not provided health insurance through their provider. So, that is going to help those that are caught in the middle. They either make too much to qualify for Medicaid, traditional Medicaid, and they don’t make enough to get those subsidies to go on the marketplace,” explained Benson.

Benson added there are also financial incentives for states that haven’t expanded their Medicaid yet.

“To keep the tax dollars from going to Washington, to help for healthcare access in states like New York and California. We want to keep those tax dollars here in South Dakota to invest in our healthcare and local economy and Amendment D would do just that,” said Benson.

So why is the American Cancer Society advocating for the expansion of Medicaid?

According to Benson, thousands of South Dakotans are diagnosed with cancer every year, “and having access to healthcare and routine screenings can make the difference between a stage 1 diagnosis or a stage 4 cancer diagnosis. So, what we know from studies, the American Cancer Society has a study that shows newly diagnosed cancer patients have a better survival rate if they live in a state that has expanded Medicaid,” explained Benson.

South Dakota voters have the opportunity to vote on Amendment D this November.

 
 

Clipped from: https://www.blackhillsfox.com/2022/09/14/new-poll-shows-south-dakota-voters-are-leaning-toward-expanding-medicaid/

MM Curator summary

[MM Curator Summary]: Ya don’t say?

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

As North Carolina’s legislative session came to a close, a deal that included expanding Medicaid fell through, Axios Raleigh reported Aug. 15. 

North Carolina’s House of Representatives and Senate had each passed one version of the legislation. 

Both the state’s Democrats and Republicans told Axios Raleigh that the failure of negotiations was mainly due to the North Carolina Healthcare Association, which aimed to block the Senate’s Medicaid plan because it would have loosened the state’s certificate-of-need laws, which the association contended would hurt hospitals’ revenues, according to the publication. 

“The House of Representatives has no intention of moving [the Senate’s bill] nor an appetite for changes to the [Certificate of Need] law,” Steve Lawler, president and CEO of the North Carolina Healthcare Association, said in a June letter to its members, according to Axios Raleigh. “Attempts to negotiate CON changes with the Senate are not only counterproductive to our messaging on our Medicaid priorities but undermine our support in the House.”

State leaders and the association are still discussing Medicaid proposals and policies. 

North Carolina is one of 12 states that has not expanded its Medicaid program since 2014. 

 
 

Clipped from: https://www.beckershospitalreview.com/finance/north-carolina-medicaid-expansion-legislation-falls-through.html

MM Curator summary

[MM Curator Summary]: Its good for you to hear from people you disagree with from time to time.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Are we really doing this again?

Another election year, another opportunity to pretend Medicaid expansion is a cure for Georgians. Both the working poor and rural hospitals are pitched as beneficiaries of enrolling more people in America’s safety-net program.

If it were actually that simple, Georgia might already have capitulated to the Affordable Care Act’s enticements for expanding Medicaid. As proponents are quick to point out, that offer includes federal taxpayers picking up the entire tab for the expansion’s earliest years.

But rather than starting with the financial aspects of Medicaid expansion, let’s look first at the people affected.

It’s increasingly hard for Medicaid patients to find a doctor. The State Health Access Data Assistance Center (Shadac) reports that, from 2011-2013, only 71.6% of Georgia doctors accepted new Medicaid patients. From 2014-2017, that number fell to 69.4%. The Georgia Board of Health Care Workforce, using a different survey, reports that in 2019-2020 the number was 60%.

In each case, more doctors accepted new privately insured patients — over 90% in both periods of time Shadac studied.

There are financial reasons for this. But before we get into those, let’s think through what this means.

For those who would gain coverage, it means the promise of receiving care is somewhat illusory. If it’s hard to find a doctor, many patients will go without care until they wind up in the emergency room. In other words, they’ll behave the same as when they were uninsured.

For those already on Medicaid — in Georgia, that means the truly vulnerable: children, pregnant women, the aged, blind and disabled, and the truly destitute — things will get worse. Suddenly, they would be competing with hundreds of thousands of additional people for a relatively small number of doctors appointments.

That’s a grim outlook for both groups.

Why is this so? Bureaucratic hassle is a major reason: Although proponents of single-payer (read: taxpayer-financed) healthcare love to bash insurance companies, and not wholly without reason, Medicaid isn’t so easy to work with, either.

And — finally we come to money — Medicaid’s payments can be not only slow, but skimpy. The latest data from the Georgia Hospital Association indicate Medicaid reimburses providers at 88% of cost. While that’s markedly better than for uninsured patients (22%), it’s still a loss.

We’ve already seen how hard it is for Medicaid patients to find doctors. But let’s forget that for a moment, and entertain expansion proponents’ arguments that new enrollees will receive more services. If that’s true, then might not a larger volume of loss-making patients offset the higher reimbursements?

This is the dilemma rural hospitals face. Yes, they would benefit from more cash flow. But those who understand the industry — including some hospital executives, in their unguarded moments — acknowledge this is a short-term fix. Losing less money per patient, especially if this spurs more volume, is a poor business strategy.

Rural hospitals struggle for two basic reasons. One is having too few people nearby: A rule of thumb is that you need a population of at least 40,000 to sustain a local hospital, and 110 of Georgia’s 159 counties don’t meet that threshold. That includes more than 50 counties with hospitals.

The other is their “payer mix.” Having uninsured patients who could be on Medicaid is less of a problem than having too few privately insured patients. Private insurance pays more than the cost of services, offsetting losses from other patients. If a hospital has too few privately insured patients, Medicaid expansion isn’t going to save it.

That’s one reason Gov. Brian Kemp’s Medicaid “waiver” plan held promise.

Although fewer Georgians would be subsidized than under the ACA expansion, many of them would have joined their employer’s insurance plan. That would afford them greater access to care, while offering more reimbursement for providers and limiting taxpayer exposure.

It’s easy to simply say “expand Medicaid.” Maybe that soothes some people’s consciences. Unfortunately, it doesn’t solve the problems many patients and providers in Georgia face.

Clipped from: https://www.dailycitizen.news/opinion/columns/kyle-wingfield-expanding-medicaid-isnt-the-silver-bullet/article_6edde968-1a94-11ed-9906-4bcb20a34bae.html

MM Curator summary

[MM Curator Summary]: The 2 ballot initiatives have been consolidated, but a pesky $456M annual state funds additional costs estimate still hangs out there.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Facade of South Dakota Capitol building in Pierre.

Paul Brady Photography / Shutterstock

(The Center Square) – Zach Marcus of South Dakotans Decide Healthcare is confident South Dakota voters will approve Medicaid expansion in November. 

Ask him why and he will quote numbers he says were given to him by the state’s Legislative Research Council. 

“Forty-two thousand, five hundred South Dakotans are currently stuck in the coverage gap, right?” Marcus, the campaign manager for the organization, told The Center Square. “They’re working hard but still they’re stuck making too much money to qualify for Medicaid, not enough money to actually afford health care.”

And there’s another number. Medicaid expansion would bring back $1.3 billion in federal funding to the state, Marcus said. 

Until earlier this week. South Dakotans Decide Healthcare and Dakotans for Health both had Medicaid expansion measures on the ballot. The groups have joined forces in a grassroots effort to get the measure passed. 

“We are grateful to the 24,000 South Dakotans who signed our petition, and the hundreds of South Dakotans who worked tirelessly to get Initiated Measure 28 on the ballot,” Rick Weiland, co-founder of Dakotans for Health, said in a news release. “After conversations with South Dakotans Decide Healthcare members, we have agreed that the best path forward to accomplishing this goal is to join efforts behind one campaign.”

The groups have an adversary in Gov. Kristi Noem, who has staunchly opposed Medicaid expansion. Noem’s administration did not immediately return a message seeking comment. But when lawmakers discussed passing Medicaid in February, a member of Noem’s administration said it would be costly. 

The Department of Social Services would need an additional $456 million a year in ongoing taxpayer funding, said Laurie Gill, the department’s secretary. The department would need an additional 64 full-time employees, she said.

“This growth of the program is out of line with our charge to be fiscally responsible,” Gill told the South Dakota Senate Health and Human Services committee

The Medicaid expansion effort has broad support from South Dakota’s health care community. Among the groups backing the amendment are the American Cancer Society Cancer Action Network, AARP South Dakota, South Dakota State Medical Association, Avera Health, Monument Health, Sanford Heal and the American Heart Association

South Dakota is one of 12 states that has not expanded Medicare. 

 
 

Clipped from: https://www.thecentersquare.com/south_dakota/medicaid-expansion-faces-hurdles-in-south-dakota/article_4f1772ea-03a4-11ed-b7fc-27de89e00e7c.html

MM Curator summary

[MM Curator Summary]: They were able to convince the other guy to fold his initiative in with theirs. They being Big Hospital who needs to ensure the win.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

(WSAZ)

SIOUX FALLS, S.D. (AP) – A pair of South Dakota campaigns trying to expand access to Medicaid through the November ballot will join efforts to focus on passing an amendment to the state constitution.

The announcement from the two organizations – South Dakotans Decide Healthcare and Dakotans for Health – puts to rest a potential rivalry between the two campaigns.

Both brought separate ballot proposals to require the state to make Medicaid government health insurance available to people who live below 133% of the federal poverty level.

South Dakotans Decide Healthcare is sponsoring Constitutional Amendment D and is backed by the state’s health care industry. It says that Dakotans for Health will join its coalition rather than push its own proposal for a voter-initiated measure.

 
 

Clipped from: https://www.dakotanewsnow.com/2022/07/11/south-dakota-medicaid-expansion-groups-join-constitutional-amendment/

MM Curator summary

[MM Curator Summary]: Those pesky politicians want to tie work requirements to expansion for able-bodied adults who can work and don’t meet the normal low-income requirements.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Derek Schmidt, a Republican gubernatorial candidate for governor, would not support Medicaid expansion in its current proposed form, said Katie Sawyer, his running mate, during a candidate forum in June.

TIM CARPENTER/KANSAS REFLECTOR

TOPEKA – Katie Sawyer, Republican gubernatorial candidate Derek Schmidt’s running mate, said neither she nor the attorney general would support Medicaid expansion in its current proposed form.

Sawyer made the remarks at a candidate forum in Salina the last weekend of June in response to a question from an audience member who asked if Schmidt would support a plan to expand KanCare, the state-run Medicaid program. The audience member also questioned former Gov. Sam Brownback’s stance against expansion, arguing the state lost billions of dollars by not expanding.

“I can’t speak to what Gov. Brownback did,” Sawyer said. “What I will say pretty clearly is, as it stands right now in its current proposed form, Derek Schmidt would not be supportive of expanding Medicaid.”

 
 

CJ Grover, campaign manager for Schmidt, said the attorney general could not support current proposals because they would assist able-bodied Kansans without children without a work requirement. No matter who is governor, Grover said he did not believe the Legislature was likely to pass Medicaid expansion.

Overall, he said Schmidt considers himself an “open-minded skeptic” on the issue.

“Should the Legislature one day reconsider and decide to advance a proposal, there are requirements AG Schmidt believes must be met,” Grover said. “First, the state share of the expansion cost must be honestly paid for, second there must be a work or job training requirement to ensure expansion is not a welfare program but instead a way to help able-bodied Kansans who are working to support themselves, and third there must be a clear and enforceable prohibition of any taxpayer funding for abortion coverage.”

According to the most recent Kansas Health Institute estimates, expansion in January 2023 would lead to 148,000 newly enrolled Kansans. Nearly 88,000 adults who currently fall in the “Medicaid coverage gap” would gain coverage if Medicaid were to expand.

The April estimates indicate an increase of 36% from the pre-pandemic monthly average KanCare enrollment, but only a 1.4% increase in spending. In addition, KHI estimated that the American Rescue Plan Act would create $418 million in savings for Kansas over two years if KanCare were expanded to low-income adults.

“None of the non-expansion states have adopted expansion since ARPA was enacted,” the brief notes in conclusion. “In the meantime, Kansans who remain in the coverage gap have few alternatives for comprehensive affordable health insurance.”

KHI estimates include indirect effects of expansion enrollment for children and currently eligible adults.

Alliance for a Healthy Kansas estimates the state has lost out on over $5.6 billion without expansion and 150,000 Kansans fall in the Medicaid gap.

Proponents of expansion also highlight concerns with rural hospital closures. Since 2005, nine rural hospitals in the state have closed, and of the 105 rural hospitals in Kansas 75 are currently running at a loss and are vulnerable to closure, according to a Center for Health Care Quality and Payment Reform study.

Madison Andrus, a campaign spokeswoman for Gov. Laura Kelly, said the governor would continue to strongly support expansion.

“It will expand quality health care for 150,000 hardworking Kansans and create 23,000 jobs,” Andrus said. “That’s good for rural Kansas, good for the Kansas economy, and good for Kansas health care workers – and it will remain a top priority in her second term.”

 
 

Clipped from: https://www.derbyinformer.com/news/area_news/gubernatorial-candidates-at-odds-on-approach-to-medicaid-expansion-in-kansas/article_2dccaac4-fc9c-11ec-8d17-ffe35c5ca232.html

 
 

MM Curator summary

[MM Curator Summary]: The Good Guvn’r has to decide whether his year’s long fight for Medicaid expansion is worth throwing the whole state in disarray.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Gov. Roy Cooper will now have to decide whether to veto the budget, which does not include Medicaid expansion. Cory Vaillancourt photo

Both chambers of the North Carolina General Assembly approved the state’s $28 billion fiscal year 2022-23 budget last week, but as Gov. Roy Cooper nears the halfway point of his final term, he’ll now have to decide whether or not to veto the proposal, which does not include what’s become his signature issue — Medicaid expansion.

“North Carolina is emerging from the pandemic stronger than before, and we will sustain that only if we invest in a strong foundation for our people: A quality education, good jobs and infrastructure, and access to affordable healthcare,” Cooper said  in a May 11 press release attached to his own budget proposal, which included Medicaid expansion. 

The House and the Senate each passed their own proposals for expansion, but ultimately could not agree on which to advance. 

Expansion aside, the proposed budget  represents a 7.2% increase from the previous biennium, increasing the rainy-day fund’s balance to nearly $5 billion and setting aside an additional $1 billion in anticipation of a recession. 

State employees will see a 3.5% pay increase, teachers 4.2% and non-certified public school employees either 4% or a raise to $15 an hour, whichever is greater. Entry-level teachers will also see an increase in starting salary. Overall, education spending is up nearly 7%. 

In the wake of the mass shooting at Robb Elementary School in Uvalde, Texas, North Carolina legislators pushed for a dramatic increase in school safety spending, including an additional $32 million in grants to support safety equipment and training as well as students in crisis. School resource officer spending will increase by more than $40 million, and an additional $15 million has been earmarked for elementary and middle school SROs. 

A series of threats to the state’s Historically Black Colleges and Universities this past February, including Fayetteville State University and Winston-Salem State University, prompted an additional $5 million in funding for cybersecurity and bomb threat prep at the state’s HCBUs. 

More than $880 million has been set aside for water and wastewater infrastructure projects, alongside $250 million to cover possible project cost overruns due to inflation. There’s also a small $5 million increase in the GREAT grants program for rural broadband. 

One element of Cooper’s proposed budget did make it into the General Assembly’s proposal, a $1 million appropriation to the Economic Development Partnership of North Carolina to identify megasites that could host advanced manufacturing facilities. 

Public safety spending is also on the rise, increasing nearly 4% over the last budget. An additional 13 magistrates, 11 assistant district attorneys and more than 130 judicial support and clerk positions will be funded if the budget’s approved. 

On the local level, there was much anticipation over how much state funding Haywood County and the Town of Canton would receive to aid in the recovery from historic flooding  that took place in August, 2021. 

The scale of the damage was initially estimated at more than $300 million, including private property. The Town of Canton suffered catastrophic losses to major infrastructure including police, fire and town hall. 

Given the town’s relatively small annual budget, replacing the multi-million-dollar facilities would have resulted in substantial property tax increases, however Haywood County’s Rep. Mark Pless said in a release that he’d worked to secure more than $23 million. 

At least $8 million will go toward repairing damaged buildings and the town’s playground. The appropriation is separate from a $9 million previous allotment intended for repair of water infrastructure damaged un the flood. 

Another $5 million is set for use on debris removal, mostly outside the town’s municipal boundaries. 

Yet another $5 million has been lined up to help farmers affected by the flood, which came just as many summer crops were ripening in the fields; famously, thousands upon thousands of green peppers littered streets and riverbanks from just south of Canton through Clyde. The money will be administered through the state’s Agricultural Crop Loss Program. 

There’s also another $5 million for bridges and roads destroyed in the flooding. The funding is earmarked for private roads and bridges not covered by previous reimbursements from the Federal Emergency Management Agency. 

Unrelated to the flood, an additional $5 million was appropriated to a separate crop loss program for a freeze that affected crops last April, and $150,000 has been allotted for baseball and softball facilities in Bethel. 

As part of the state’s overall public safety spending, Pless said that some of the funding would result in an additional assistant district attorney for the 43rd prosecutorial district as well as another assistant clerk for the Superior Court in Haywood. Since 2020, the judicial system has been hobbled by a backlog of cases due to COVID-19 shutdowns in the court system. 

Pless also secured $3 million for a wastewater treatment plant in Yancey County. 

“Our office is pleased with the appropriations for these important projects and positions,” said Pless. “We have been working hard this session to listen to the needs of the district and secure funding based on those needs and suggestions. While we did not secure all of our requests, we will continue to advocate for them in future budgets.” 

 
 

Clipped from: https://www.smokymountainnews.com/news/item/33909-state-budget-goes-to-gov-cooper