http://www.yankton.net/articles/2013/02/20/community/doc512452a699368214609745.txt

Forum Tackles Medicaid Expansion

Joy Smolnisky, director of the South Dakota Budget and Policy Project, discusses the pros and cons of South Dakota joining the Medicaid expansion plan, during a forum held Tuesday at Mount Marty College. (Kelly Hertz/P&D)

By Andrew Atwal
andrew.atwal@yankton.net

The pros and cons of Medicaid expansion were discussed during a forum held at Mount Marty Tuesday.

Joy Smolnisky, director of the South Dakota Budget and Policy Project, reviewed the potential positives and negatives of Medicaid expansion and also took time to answer audience members’ questions.

Smolnisky said the Affordable Care Act has five components to it that will not change regardless of potential Medicaid expansion in South Dakota. Those components include coverage guarantees, insurance exchanges, federal tax credits to help pay for insurance, an individual mandate and funding provisions.

“The main concept of health care remains the same: If someone is sick, we will treat them,” she said. “However, with provisions in the Affordable Care Act, no one can be turned down for insurance because of preexisting conditions. Insurance also has to be affordable, given someone’s income level.”

Smolnisky added that 20 percent of non-elderly South Dakota adults do not currently have insurance, and that number could come down if Medicaid expands in the state.

One of the provisions of the Affordable Care Act — federal tax credits to help individuals pay for insurance — works under the premise that if a household or individual has a lower income, they are entitled to lower premiums. However, as their income increases, they take more responsibility for their costs of insurance, making their premiums rise with income level.

Smolnisky said that the 2014 insurance exchange subsidies will only be in place for those that are within 100-400 percent of the federal poverty level. Thus, those under 100 percent of the poverty level and above 400 percent are not eligible for the subsidies.
Without Medicaid expansion in 2014, there will be approximately 30,000 South Dakota residents left uninsured.

“Some of the lowest income residents across the state will not be eligible for certain aspects of the health care reform,” Smolnisky said. “In some cases, if someone has an income that is too low, they will not qualify for federal subsidies to buy insurance and their income would also be too high to qualify for South Dakota Medicaid, if the state chooses not to expand the program.”

She added that the expansion decision might be purely political for legislators.

“If South Dakota does decide to expand, and then they don’t like the results, they can choose to change back to the old Medicaid program,” Smolnisky said. “There is also a broad array of folks out there, both providers and consumers of health care, that are in support of the expansion. However, regardless of the decision, health care reform and Medicaid must continue to be monitored by officials.”

She said the Medicaid expansion decision would primarily impact the poor, adults without children, non-elderly and parents who are between 50 and 100 percent of the federal poverty level.

“It makes economic sense for the state to expand the Medicaid program from the perspective that they would get a 10 to 1 match from the federal government for the program,” Smolnisky said. “It brings money into the state to provide care that is needed for poor people. If, down the line, the government can no longer afford to give funding to states for the Medicaid program, South Dakota can switch back to the old program.”

There will be a public hearing on Medicaid expansion today (Wednesday) in Pierre at 10 a.m. The hearing will also contain a period of public testimony where South Dakota citizens can voice their opinions on the Medicaid expansion decision to legislators.

You can follow Andrew Atwal on Twitter at twitter.com/andrewatwal