A race is on to court legislators in the “maybe” column on Medicaid expansion.
Gov. Dennis Daugaard’s office needs to convince 54 legislators — 36 in the House and 18 in the Senate — to back his plan to expand the health insurance program to cover an additional 50,000 needy South Dakotans.
It won’t be easy.
A faction of conservative Republicans in each chamber is poised to sink the deal and the prospect of a special session unless Daugaard can unite Democrats, moderate Republicans and a handful of conservatives who want to leverage Medicaid expansion to improve Native American health care.
The Republican governor has done it before, pushing through the first permanent sales tax hike in decades last session to boost teacher pay. But swaying fellow GOP lawmakers on the expansion of a federal health care program associated with the Obama administration will be a tougher fight.
The clock is ticking, too, with the federal program potentially set to elapse or be overhauled next year under a new president.
MORE MEDICAID DEBATE: Skeptics questions Daugaard’s timing on Medicaid expansion talk
Daugaard has a stronghold among Democrats, a block of 12 in the House and eight in the Senate, as well as a corps of moderate Republicans. They include Senate Majority Leader Corey Brown, R-Gettysburg, who helped tailor the agreement with a pair of federal agencies to help usher in improvements at the state’s Indian Health Service hospitals.
State health groups eager to expand Medicaid have started calling legislators still on the fence, but conservative lobbying groups, including Americans for Prosperity, have launched counter efforts, including mailing campaigns and online petitions to try to nix a potential special session for expansion.
House Majority Leader Brian Gosch, R-Rapid City, was one of Daugaard’s fiercest adversaries in passing the sales tax hike and also opposes a special session for Medicaid. The House likely will pose the greatest challenge for the governor in getting the simple majority he needs to move forward.
“I’m confident that it doesn’t have the support of the House,” Gosch said Friday. “It would not be money well-spent to call a special session because there’s no support for it.”
Rep. Tona Rozum, R-Mitchell, said she’s skeptical of the federal government’s ability to uphold its side of the bargain with expansion but said she’d welcome a special session to learn more about the possible improvements to the Indian Health Service (IHS). Rozum said at this point she’s a ‘maybe’ vote who has been targeted by lobbying groups for and against expansion.
As part of the deal to consider Medicaid expansion, IHS agents agreed to contract for additional services like teleheath and dialysis at South Dakota hospitals and to change a policy, potentially saving the state money on Native American health care. The agency has come under fire in the state after a series of failings at hospitals in Pine Ridge, Rapid City and Rosebud.
“We’re talking about real people’s lives and health care,” she said. “We need to get this situation figured out. And if that means a special session, I’m open to that discussion.”
Rep. Nancy Rasmussen, R-Hurley, said her vote is still up in the air, at least until she’s heard the governor make his case again for expansion. She said two pro-expansion groups have called to fill her in on the new details.
“Until the governor calls a session, why make a decision until I’ve heard all the facts?” she said.
For other lawmakers, the new information for and against the proposal hasn’t spurred a change in opinion.
Rep. Mary Duvall, R-Pierre, said she’s heard from a number of lobbyists on both sides of the issue, as well as the governor’s office, as the opposing parties attempt to gauge support for a special session.
“I haven’t heard any new information that answers any of my concerns,” Duvall said.
Duvall said she’s inclined to oppose the proposal as she has seen similar expansion plans fail in other states and doesn’t want to approve a program that allows for “government handouts” without employment requirements.
Rep. Wayne Steinhauer, R-Hartford, said he likely couldn’t support a special session because IHS hasn’t upheld its side of the bargain in improving health care to the state’s Native Americans.
“I don’t see the rush, candidly,” he said. “Expansion is predicated on a promise the federal government hasn’t been able to keep to the Native Americans. I’d like to them really demonstrate that they can keep that promise.”
Rep. Al Novstrup, R-Aberdeen, a self-proclaimed “maybe” vote, said he’s avoided the lobbying from the governor’s office and various groups so far.
“I’m not hearing anything,” Novstrup said. “I heard the arguments from the governor six months or a year ago, but nothing since then.”
Novstrup and Reps. Dick Werner, R-Herreid, and Burt Tulson, R-Lake Norden, said they’re leaning toward ‘no’ votes on expansion, but would prefer to bring up the prospect after the presidential election, if at all.
“I suspect that the program would look really different under President Trump or President Clinton. After November there might not be an option of expansion,” Novstrup said.
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