PIERRE, S.D. (AP) — Health care officials and some low-income earners urged South Dakota lawmakers Wednesday to expand Medicaid so thousands of people would be covered by the government-run system, but opponents said an expansion would be too expensive and would interfere with the free market.
Katherine Ruggles, 53, of Pierre, said she can get treatment at a community clinic that bases fees on ability to pay, but she and many others live in fear they will get seriously ill and face a hospital bill they cannot pay. She said she now works only a few hours a week because of chronic health problems.
"We are one medical crisis away from economic disaster that may take us years — or never — to recover from," Ruggles told a special legislative hearing held to consider the advantages and drawbacks of expanding Medicaid as part of the federal health care overhaul.
Ruggles was one of about 20 people who encouraged lawmakers to expand Medicaid. Only two people testified against the expansion.
"We have to be realistic. The problem with socialism is that sooner or later you run out of other people's money," said Florence Thompson, of Caputa, who described herself as a taxpayer.
Republican Gov. Dennis Daugaard has recommended that South Dakota delay a decision on whether to expand Medicaid because he is uncertain the federal government can afford to pay most of the cost. Rather than expanding Medicaid in 2014, the state could wait until 2015 or 2016, he has said.
Sen. Jean Hunoff, R-Yankton, chairman of the Senate Health and Human Services Committee, said she doesn't know whether this year's Legislature will decide to expand Medicaid. The decision will likely be made when the state budget is put together in a couple of weeks, she said.
"I think everybody believes it's the right thing to do in principle. The question that is looming out there is, will there be federal dollars?" Hunhoff said after the hearing.
South Dakota's Medicaid program now covers about 116,000 children, adults and disabled people. The expanded eligibility would add an estimated 48,000 people, mostly adults without children.
People earning up to 138 percent of the federal poverty level would be covered by the expansion, which the federal government would fully cover through 2016. The state's contribution would rise in stages to 10 percent of the medical costs, but it would face substantial extra costs in administrating the larger program.
Health care executives said all patients will continue to pay higher bills if more low-income people are not allowed into Medicaid. They said people without coverage often delay getting medical care until they are very sick and then show up at hospital emergency rooms. Since they cannot afford to pay for expensive emergency care, hospitals have to charge insured patients more to offset losses in charity care, they said.
Hospitals have reported that they are unable to collect about $90 million a year.
Tim Tracy, chief executive officer of Sanford Health in Vermillion, said the federal health care overhaul required South Dakota hospitals to give up $470 million in Medicare reimbursements in the next decade to help pay for the expansion of Medicaid. He said Medicaid needs to be expanded not to help hospitals, but instead to help working people who cannot afford health insurance.
Linda Sandvik, a Rapid City nurse, said the Medicaid expansion would help those with diabetes and other problems get care before their conditions get serious.
"It's going to impact our most vulnerable residents, the sick and the poor. These people are not deadbeats. They are not lazy. They are not milking the system. They are the working poor," Sandvik said.
At the end of the hearing, committee members were split on the issue.
Rep. Manny Steele, R-Sioux Falls, said expanding Medicaid would help people in the short term, but he does not believe Medicaid expansion and other parts of President Obama's health care law will make health care affordable in the long term because the federal government is in financial trouble.
"We're already broke as a nation," Steele said.
Rep. Steve Hickey, R-Sioux Falls, said he also thinks government will have a hard time paying for the health care overhaul, but he is keeping an open mind on expanding Medicaid.
"If there's a way to do this and make the dollars fit, I do think we ought to try to take care of as many people we can," Hickey said.
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