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• The money
• For some states, choosing to expand Medicaid was a no-brainer: They would pay significantly less for their Medicaid program if they did so.
• By expanding Medicaid, Vermont and Delaware would both end up paying about 12 percent less between 2013 and 2022, according to projections by the Kaiser Commission on Medicaid and the Uninsured.
• Both Dakotas would end up paying slightly more over those 10 years than they would if they didn't expand Medicaid, but not significantly more: When savings from uncompensated care is figured in, North Dakota will end up paying 2.8 percent ($159 million) more than without Medicaid expansion, and South Dakota would pay 1.7 percent ($95 million) more.
• Some states will end up paying less because they invest more in Medicaid currently; the federal government will end up picking up the tab for Medicaid coverage that those states had been paying for already. The Dakotas, on the other hand, have significantly lower income limits for Medicaid coverage than many other states, and so have more ground to cover to get from where they are to the 133 percent level.
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• Arguments against expansion
• A number of people spoke against expansion to the S.D. Medicaid task force in June. One physician said Medicaid doesn't cover the cost of preventative care measures that would make a difference in the lives of patients and expansion would keep the state enmeshed in a broken system. Another said it wasn't constitutional for the state to provide health coverage at all.
• One recurring question was how a new entitlement would be paid for in an era of debt and deficits. President Obama campaigned for the PPACA by saying it would be completely paid for, but many speaking against the program clearly distrust that promise.
• Another argument against expansion was the worry that it would exacerbate South Dakota's physician shortage. Watch for a future Dakotafire story on that topic.
• The basic question remains: Is it worth it to spend 1.7 percent more to give 46,000 South Dakotans health coverage? Thanks to the Supreme Court, it's an offer the state can refuse. If it should is up to the Legislature.
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