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Wednesday, October 28, 2009

Munsterman to Medicaid Patients: Drop Dead

Where is George W. Bush's compassionate conservatism when we need it?

Governor Rounds says increased enrollment in Medicaid may set the state back another $40 million. Candidate Scott Munsterman's solution: kick people off Medicaid.

Munsterman said the state should scale back Medicaid eligibility and provide vouchers to purchase health insurance for catastrophic events.

He also called for more personal responsibility on the part of Medicaid recipients.

“We have a higher rate of medical care within our Medicaid system than other people do who have their own insurance,” he said. “We need to look at deductibles, we need to look at co-pays. We need to have a program that they can engage in, and become responsible, too” [David Montgomery, "Munsterman Says Medicaid Eligibility Must be Scaled Back in SD," Pierre Capitol Journal, 2009.10.27].

More personal responsibility—that's conservative code for not my problem.

Sure, we can probably find folks who take advantage of Medicaid (just like we can find insurance execs who take advantage of their clients... but I don't hear Munsterman calling for dropping the hammer on that system). But the problem the state faces in funding Medicaid is not a sudden surge of goldbrickers. The problem is thousands of responsible South Dakotans who have lost their jobs or/and their health insurance and have nowhere else to turn to get their families decent medical care. They don't want charity; they don't want to face the stigma of irresponsibility that conservatives like Munsterman keep piling onto folks who need help through no fault of their own. But the recession is hammering them, the flu is coming, and they just want to be healthy and not bankrupt.

The proper response from society is to say to these neighbors, "All right, we'll get you through." Candidate Munsterman's response is plain old class warfare—if folks need help, it must be their fault, and they should pay for their irresponsibility.

Practically, his proposal makes about as much sense as cutting unemployment benefits during a recession. It continues the long, sad history of Republican "leaders" unwilling to take the lead on getting South Dakota as a community to recognize our common obligations to each other in tough times. Blame the poor, demand nothing of the well-off: typical GOP.

Update 2009.10.29 07:10 CDT: A reader forwards this breakdown of South Dakota's Medicaid enrollment and spending. The data come from 2006 through 2008, so they don't capture the recession-related surge in Medicaid enrollment. But in FY2006, here's who was on Medicaid in South Dakota:

Medicaid EnrollmentSD

Total Enrollment, FY2006118,50058,714,800--% of total residents
Children70,10029,182,40059.249.7% of Medicaid enrollees
Adults20,10014,879,70017.025.3% of Medicaid enrollees
Elderly12,4006,116,20010.510.4% of Medicaid enrollees
Disabled15,9008,536,50013.414.5% of Medicaid enrollees
source: State Medicaid Fact Sheet, StateHealthFacts.org, Kaiser Family Foundation, downloaded 2009.10.29

83% of the people Dr. Munsterman thinks need to take more personal responsibility for their health care are children, disabled, or elderly. Evidently the Republican philosophy is to balance the state budget on the backs of those who can't fight back.


  1. Such a high percent of children compared to the national average tells me that there are many South Dakota parents stuck in low wage jobs. If there were higher paying jobs with better benefits the parents would take them. This has been a chronic problem in SD. I'd like to see someone address that.

  2. Joseph Bryant

    I question the legitimacy of The Kaiser Commission on Medicaid and the Uninsured who does all thier on calculations and bases them off of an analysis of the Current Population Surveys. I believe that must colleges would question this source.

  3. Well, Mr. Bryant, do you have any mroe reliable numbers to replace them? You can't just wish away stats you don't like without offering solid numbers of your own to guide policy decisions.

  4. Mr. Bryant: a commenter whose identity I can't verify offers a reasonable defense of the Kaiser Foundation's numbers: "The Current Population Survey is a legitimate data source that statisticians and scholars often use in their research. The Annual Social and Economic Supplement (a.k.a. the March supplement) is where the Kaiser foundation derives their information - it's full of useful information. The CPS is run by the Bureau of Labor Statistics, who, in my opinion, have some of the best statisticians in the world."

    In the policy debate world, I hear Munsterman advocating the change to the status quo. He has the affirmative burden of proof. On the negative, I offer the above as evidence that Munsterman's plan won't work (not enough potential waste to achieve financial goals). Mr. Bryant attempts to indict my numbers but offers no counternumbers supporting the affirmative case. My anonymous interlocutor is able to provide a reasonable defense of the source of the negative numbers. The ball lies back in Munsterman's/Bryant's court.

  5. Gee, I wonder why poverty stricken children, elderly, and disabled people might need more medical care than those on private insurance ... well, whatever it is, I'm sure it can be fixed by helping them LESS.

  6. I was the commenter who discuss the CPS. I guess I didn't have my blogger profile set up at the time. Can my identify be verified now?

  7. Mr. Van Riper! Thanks -- it works! Welcome to the show, and thank you for the helpful information. :-)


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