Medicaid question surrounds gubernatorial debate

MITCHELL – Gov. Dennis Daugaard shrugged off punches from his two opponents and stayed on message Wednesday during their first debate.

Democrat Susan Wismer accused Daugaard and the Republicans who have controlled state government the past 40 years for caring more about wielding power in Pierre than serving the people of South Dakota. Independent candidate Mike Myers accused state government of being corrupt, and he touted his age — 78 — as a reason voters should trust him.

"Look at me," he told the audience of more than 200. "I can't be a career politician."

Daugaard, meanwhile, talked about guiding the state through economic crisis and natural disasters, only to see it emerge stronger. He said he wanted four more years to ensure the state remains on an even better financial footing.

"I promise if re-elected, we won't spend money we don't have," he said.

Rounds under fire at Dakotafest debate

Wismer, a Democratic lawmaker from Britton, repeatedly talked about how one-party rule in state government had been bad for South Dakota. Under Republican rule, the state's roads have deteriorated and nursing homes are struggling, she said. But her main complaint centered on Daugaard's refusal to expand Medicaid, the federal/state medical program for the poor.

Under the 2010 Affordable Care Act, states can expand Medicaid to cover adults who are considered among the working poor. In South Dakota, an expansion would cover an estimated 48,000 adults.

That population, she said, ends up costing the state's hospitals $88 million in debt, some of which is passed on to county indigent-care budgets.

"That's bad debt that is being financed by our counties and by you and me in our insurance premiums," said Wismer, a state lawmaker from Britton.

Daugaard said he remains open to the idea, but he said people should know that expanding the program isn't free. Taxpayers pay for it at the federal level, and he indicated that two other entitlement programs, Social Security and Medicare, have financial problems.

The federal government would pay most of the costs in the first two years to expand the program, but then the state would have to pay 10 percent later. Between 2017 and 2020, that would translate to more than $95 million in state money. Daugaard said taxpayers should be aware that expanding the program means taking resources from other programs.

"What kind of tradeoffs are we making when we are obligating ourselves to those kind of expenses?" he said.

But Wismer argued the state's hospitals are losing more than $250 million a year from federal money that would flow into the health care system if the program were expanded. Daugaard countered that half the people eligible for expansion could buy private insurance on the federal exchanges, with some spending less than 2 percent of their incomes for coverage.

Myers took aim at the state's nonprofit hospitals, arguing they need to be reformed. The hospitals spend millions on advertising, pay doctors and administrators millions while gouging patients and taxpayers, he said.

Myers said the Legislature should enact a law that requires health providers to disclose to patients what it costs for procedures. That type of transparency would allow consumers to make better choices with their health care dollars.

"Let's turn this around, because we need to put some kind of consumer-based behavior into our health system," said Myers, a former law professor and hospital executive.

Following the debate, Larry Stroschein and Aaron Vilhauer, two friends who had come to the debate from the Aberdeen area, debated the Medicaid issue.

Stroschein, a Democrat, favored expanding the program, while Vilhauer said he agreed with Daugaard that government should be careful about expanding entitlement programs to able-bodied adults.

Stroschein argued that the state should take the money because it would help nursing homes and hospitals. He said the low wages in South Dakota make it difficult for the working poor to afford insurance.

But Vilhauer said he didn't think expanding Medicaid would translate to lower health care costs for himself. And he said that many lower-income adults are where they are in life because they've made bad decisions.

Besides Medicaid, Wismer and Myers tried to put Daugaard on the defensive about the EB-5 Immigrant Investor program. Myers hinted that Richard Benda, the former economic development secretary, had not committed suicide amid an investigation into the program, but had instead been murdered. Wismer accused Daugaard of narrowing the focus of the audits and investigation into the program, and she said the scandal was "emblematic" of the problems that come from one-party rule.

Daugaard defended his actions after learning about a federal investigation into the program. He asked Attorney General Marty Jackley to investigate, and he asked three different entities to audit the program and economic development. The audits and other investigative materials were made public by the governor's office.

"I'm not hiding anything," he said. "I'm trying to be as transparent as possible."